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How to Choose a Treatment Center for Metastatic Breast Cancer

  • A cancer diagnosis is a life-altering experience for most people, and living with metastatic cancer presents additional concerns. Women with metastatic breast cancer can undergo treatment for many years and can face different challenges than women with early-stage breast cancer. These may include managing more medical appointments, reassessing and making new treatment decisions, dealing with fear about the future, and managing the reactions of friends and loved ones.

    You may choose to receive treatment at a cancer center with a program designed to help women with metastatic breast cancer understand and manage these and other concerns.

    Here is a list of questions you might ask an oncologist when you are choosing a cancer center to help determine which center is right for you.

    Diagnosis

    Can I improve my outcome?
    Treatment options for metastatic breast cancer continue to advance and improve the outcomes of many people with the disease, but everyone responds differently.

    You may consider participating in a clinical trial as one of your treatment options. Participating in a clinical trial is a very personal decision, and a choice that is completely yours to make. If it feels right to you, there are several good reasons to participate:

    • Clinical trials are how we make progress against cancer.
    • Over the past decade, thanks to participating patients, a number of new drugs have been approved for treatment of metastatic breast cancer.
    • Taking part in a clinical trial can offer you new treatment options that are not available as part of standard care.

    By participating in a clinical trial, you contribute to knowledge that can help future patients.

    Should I seek a second opinion?
    When you're facing a breast cancer diagnosis, it's normal to feel a sense of urgency about starting treatment immediately. However, in most cases, there's time to do some research to make sure your treatment plan is the best one available for you at the time. This may include getting a second opinion.

    A second opinion may confirm your original doctor's diagnosis and treatment plan, provide more details about your type of breast cancer, or provide the opportunity for treatment options you hadn't considered. Decisions about your care should only be made after you have learned all you can about your diagnosis, potential outcomes, and available treatment options. If you are interested in a second opinion from Dana-Farber Cancer Institute, your local doctor can refer you or you may refer yourself.

    At your second-opinion consultation, experts in the care and treatment of metastatic breast cancer will meet with you to review your medical record and discuss the treatments that are available for you and your individual situation.

    If you don't live near Boston and are unable to travel, Dana-Farber's Online Second Opinion program lets patients from around the country – and around the world – get a second opinion from a Dana-Farber medical oncologist without traveling to Boston.

    If you choose to receive treatment at Dana-Farber, your Dana-Farber physician can collaborate with you and your local oncologist during the course of your treatment. You can receive the majority of your care from your local oncologist and travel to Dana-Farber for consultations, specialty care, or to participate in a clinical trial. We are here to provide active, continuous care to help you achieve the highest possible quality of life and make informed decisions about your care.

    If you are concerned about paying for a second opinion consultation, Dana-Farber offers a Patient Financial Assistance program that is available to provide resources and support.

    Expertise

    Do you have a program dedicated to caring for women with metastatic breast cancer?
    Treating patients with metastatic breast cancer is a significant part of our practice at Dana-Farber's Susan F. Smith Center for Women's Cancers. Our doctors, nurses, research staff, social workers, and others provide continuous care, support, and assistance to approximately 1,500 patients per year. We are committed to providing each patient with the best and most personalized treatment options available, taking advantage of the full range of services of a top-ranked cancer hospital and research center.

    All metastatic breast cancer patients at Dana-Farber are invited to join the Ending Metastatic Breast Cancer for Everyone (EMBRACE) program, which provides resources and information to help guide patients through many situations and decisions. Throughout their journey, metastatic breast cancer patients in the EMBRACE program receive education and support from expert clinicians, other professionals, and one another.

    Are the physicians in your program actively involved in metastatic breast cancer research?
    Clinicians and scientists at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) conduct research to understand the basic biology of how and why breast cancer can spread, and clinical trials to test potential therapies in patients with metastatic disease.

    Much of the research performed at DF/BWCC has resulted in treatment breakthroughs for patients with metastatic disease. Some of these breakthroughs include:

    • Adding a PI3K inhibitor to a hormone blocker may delay the advance of ER-positive metastatic breast cancer.
    • A CDK4/6-inhibiting drug called abemaciclib caused tumors to shrink or stop growing in one-third of participants with ER-positive metastatic breast cancer.
    • The combination of two oral medications – neratinib (Nerlynx) and capecitabine (Xeloda) can be effective in patients with HER2-positive breast cancer that has spread to the brain. This is the first systemic treatment to gain recognition by the National Comprehensive Cancer Network (NCCN) guidelines for treatment of patients with brain metastases.

    Will I have access to clinical trials?
    DF/BWCC offers a greater number of metastatic breast cancer clinical trials than any other cancer center in New England, many of which are changing the standard of care worldwide. Our clinical trials focus on the types and phases of your disease so therapy can be targeted to your type of breast cancer.
    DF/BWCC partners with organizations across the country to provide access to clinical trials. See our full list of clinical trials for metastatic breast cancer.

    Care and Treatment

    Who will be part of my health care team?
    The program staff includes world-renowned breast cancer experts who partner with patients to help them make informed decisions about their care. This team includes specialists in metastatic breast cancer from medical oncology, surgical oncology, and radiation oncology, as well as social workers, nutritionistspsychologists and psychiatrists, exercise physiologists, sexual health counselors, integrative therapists, and others.

    An EMBRACE coordinator meets patients on their first day, outlines supportive care and educational resources and services available to them, and works closely with the medical oncologist to coordinate their care and identify possible clinical trials.

    Will my care team be accessible between appointments?
    We encourage you to contact your care team in between their appointments if you have questions or concerns. Your EMBRACE coordinator can help answer questions about your care and help connect you with resources at Dana-Farber and in your community.

    How do you develop treatment plans for your patients?
    Our care team works closely with each patient, providing the expertise and collaboration of many specialists. Experts from medical oncology, surgical oncology, and radiation oncology coordinate your care to ensure that you will receive the combination of treatments that is best for you.

    Will you work with my local oncologist and other doctors during my treatment?
    As partners in your treatment, our care team will collaborate with you and your local oncologist during your treatment. Near or far, we are here to provide active, continuous care to help you achieve the highest possible quality of life and make informed decisions about your care.

    Support

    Does your program offer support for women with metastatic cancer, who may be living with the disease a long period of time?
    Dana-Farber Cancer Institute offers a range of supportive services. Just as we create a personalized treatment approach for your specific type of cancer, we also design an individual plan of care and support for you and your loved ones based on your goals and values.

    In addition to medical, surgical, and radiation oncologists and nurses, your care team may include social workers, nutritionists, psychologists and psychiatrists, exercise physiologists, sexual health counselors, integrative therapists (acupuncturists, massage therapists), pain and symptom-management specialists, and others who can help you achieve the best possible quality of life.

    If financing cancer care concerns me, who can help me understand what aspects of my care are covered by my insurance and help me manage the other costs of cancer care?
    Dana-Farber's Patient Financial Assistance program helps patients who have concerns about financing their cancer care. For more information about the program, please visit www.dana-farber.org/financial-assistance or call our financial counselors at 617-632-3455.

    Does your program provide nutritional support and support for maintaining a healthy lifestyle?
    The Leonard P. Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber can help you enhance your quality of life through integrative therapies and healthy living programs.
    The clinical services, education, and group programs include individual treatments such as acupuncture, massage, and Reiki; group programs such as movement, meditation, and creative arts; and exercise and nutritional consultations. All Dana-Farber patients are eligible to take advantage of the Zakim Center's one-on-one offerings and free group classes.

    The Zakim Center offers lectures and educational seminars on topics related to integrative therapies and cancer treatment, which you and your loved ones and caregivers are invited to attend. We also conduct research on the value of integrative therapies and healthy living for cancer patients and survivors.

    How does your program support caregivers and loved ones?
    Patients and their loved ones often face many new concerns following a cancer diagnosis. Dana-Farber's licensed social workers, working as part of our Department of Psychosocial Oncology and Palliative Care, can help you and your loved ones with concerns such as depression and anxiety, the impact of cancer on your family and caregivers, discussing your illness and treatment with your children, the impact of cancer on work, school, and finances, conflict resolution, and finding supportive resources in your local community.

    We offer a variety of support groups, some of which are specific to metastatic breast cancer, younger women with breast cancer, and caregivers, as well as individual and family counseling.

    If you're a parent living with cancer, social workers in our Family Connections Program can help you deal with the difficult task of managing a family during treatment.

    What patient education materials, classes, and/or programs does your program offer?
    We provide resources and information to help guide patients through many situations and decisions. Throughout their journey, metastatic breast cancer patients receive education and support from expert clinicians, other professionals, and one another.

    An EMBRACE coordinator meets patients on their first day and outlines supportive care and educational resources and services available to them, including integrative therapies, support groups, and peer mentorship.

    We offer patient- and family-centered care, which means that you and your family are the focus of our attention. Your health care team will take the time to listen, understand your needs and preferences, and help give you a better sense of control over your life.

    Every year, metastatic breast cancer patients and their loved ones gather at Dana-Farber for a day-long forum that includes updates on research and treatment advances; sessions on integrative therapies, nutrition, and other ways to improve quality of life; and discussion groups with other attendees.

    Throughout the year, patients in the program receive additional updates on research and care in the form of webcasts, web chats, podcasts, email and print newsletters, and other channels.