Metastatic Breast Cancer Treatment: How to Talk to Your Doctor About Your Options

People with a metastatic breast cancer diagnosis are living longer than they ever have before. “Today, we have so many new treatments and options available for our patients,” says Natalie Berger, MD, hematologist and oncologist at The Mount Sinai Hospital. “The most important thing that I want my patients to know is that there is hope.” 

If you’re feeling overwhelmed with your options, preparing for your healthcare visits can help. You’re the most important voice in the room when meeting with your breast cancer treatment team. So here are some tips to help you get the information you need to develop the best treatment plan for you.

1. Ask about your treatment options

Many people expect their treatment course will be chosen by their healthcare provider. But with so many options available, your individual treatment goals play a big part in these decisions. 

The best treatments for you are not just the ones that fight the cancer cells. They’re also the ones that best align with your lifestyle and preferences. This is because treatment for metastatic breast cancer is life long. So it's important to develop a plan that treats your cancer, while also allowing you to live your life the way you want.

The first step is to ask your healthcare provider which treatment options are available to you. Not every person will be a candidate for every treatment option. But there may be more than one option that’s right for you.

The mainstay of metastatic breast cancer treatment is something called ‘systemic treatment’. These are medications that are delivered to the whole body, so they can kill cancer cells wherever they have spread. There are four main categories of systemic treatment options:

• Chemotherapy: This refers to medicines that kill rapidly dividing cancer cells in the body. Chemotherapy is typically administered through an IV (intravenous) infusion.

• Hormone therapy: This is an option for people who have breast cancer that grows in response to estrogen or progesterone (called hormone receptor-positive breast cancer). These medicines block the hormone receptors, making it harder for the cancer cells to grow. They come in pill and injectable forms.

• Targeted therapy: This is used specifically for HER2-positive breast cancer. Similar to hormone therapy, these medicines target certain receptors that play a role in cancer growth. They come in pill, injectable, and IV forms. 

• Immunotherapy: This is a newer treatment that helps the body’s immune system target and destroy cancer cells. Immunotherapy is only an option for certain kinds of breast cancer. Like chemotherapy, it’s usually given through an IV infusion. 

Other common cancer treatments — like surgery or radiation — are used less often in metastatic breast cancer. That is because they only target a specific area of cancer cells, and are less effective when the cancer has spread to distant areas. They still may be an option depending on where your cancer has spread, and what kind of symptoms you’re experiencing. 

2. Ask about side effects

When you’re choosing your treatment plan, it will help to weigh the risks and benefits of each option. This includes understanding the side effects of each treatment.

“Side effects are always a very, very scary part of cancer treatment, probably one of the most scary parts. So it’s so important to sit down with your doctor and ask them questions to better understand what side effects are,” Dr. Berger says.

Chemotherapy and immunotherapy tend to have more side effects than hormone or targeted therapy. But keep in mind that there are many medications that can help alleviate unwanted side effects. And in metastatic breast cancer, chemotherapy is often given in lower doses to make it more tolerable over a longer period of time.

It can feel overwhelming to hear a list of all the possible side effects from each treatment. But as Dr. Berger explains, “Most of the side effects are not going to happen to everybody. So it's really important to know that even though we tell you about all these different side effects, chances are, you won't experience most of these, but we just want to let you know so that you're aware and prepared.” 

3. Ask how the treatment is given

In addition to side effects, the details about how and when a treatment is given can help you decide if it’s right for you. The scheduling and planning for treatment can have a big effect on your life. Some things to consider include:

• If the treatment can be taken at home, or if you have to go to an office or clinic

• If the treatment is a pill, injection, or infusion, which requires an IV that allows the medicine to flow directly into the bloodstream

• If you need something called a PICC or a port for infusion treatments — these are special devices inserted under the skin that make it easier to access the vein 

• How often the treatment is given

• How long it takes to receive the treatment, like a chemo infusion

• If the treatment requires any monitoring, like blood tests or imaging scans

4. Write down your questions

There are inevitably going to be many questions that pop up during your talk with your doctor. But it helps to write down your core questions before the visit. You can refer to this throughout the visit to keep your mind on track, and make sure you get all the information you need.

“The most important thing to prepare for an appointment with your doctor when discussing treatments is writing down your questions, because as soon as you walk into the office and your doctor starts talking to you, you may forget a lot about what you wanted to ask,” Dr. Berger says.

No question is too simple or basic. And don’t be afraid to ask your healthcare provider to clarify a term, or take a step back and explain something to you more clearly. The more you understand your treatment plan, the more confident you’re likely to feel throughout the process. This can help alleviate any stress and anxiety about your treatment.

5. Bring someone with you

It may help to bring a trusted friend or family member with you. 

• They can help you feel emotionally supported during the appointment, and empowered to advocate for yourself and your needs.

• A loved one can help you stay calm and keep you company in the waiting room or consultation room. 

• They can make sure you remember all of your questions. They may also think of their own questions that may be helpful for you.

• Loved ones can help you remember what your healthcare provider said. It can be easy to forget all the details, or even absorb all the information. You can also ask them to take notes during the appointment.

• They can get you to and from your appointment safely. You’ll likely have a lot on your mind before and after your appointment. So it helps to have someone drive and help you find your way to the appointment.

• Loved ones can help you process your thoughts and feelings after the appointment.

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Written by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Reviewed by:

Nicholas McAndrew, MD, MSCE

Dr. Nicholas McAndrew is a hematologist oncologist at the UCLA David Geffen School of Medicine in Los Angeles. Dr. McAndrew received his medical degree from the Perelman School of Medicine at the University of Pennsylvania, and completed both his internal medicine residency and his hematology/oncology fellowship at the Hospital of the University of Pennsylvania.

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