It’s important for women with metastatic breast cancer to tell their doctor about any symptoms they are experiencing, or if symptoms get worse.

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Managing pain

Metastatic breast cancer affects different women in different ways. Some women have no pain, others find that pain affects them at certain times of the day or night or while doing different activities. The type and level of pain experienced by two women who have cancer in the same parts of the body may not be the same. Not everyone with metastatic breast cancer finds it painful.  Pain caused by metastatic breast cancer doesn’t always get worse with time.

Describing pain

Many people don’t like to complain about pain. However, it’s important to report any new or worsening pain so that doctors can find the most likely cause and recommend the best way of managing it.

Tips for describing pain

When describing pain, try to give the healthcare team as much information as possible.

Some people find it helpful to keep a diary, noting the times of the day when pain gets better or worse.

What to consider when describing cancer pain

Treatments for pain

Cancer pain can usually be controlled. It’s rare to have cancer pain that can’t be lessened or changed.

Drug treatments for cancer pain

There are lots of drugs available to manage different types of pain. Everyone is different in how they respond to pain relief. It may take a while to find the treatment or combination of treatments that’s right for an individual woman.

Some people have pain that comes and goes, and only need to take painkillers from time to time. Others have pain all the time. It’s better to prevent pain rather than waiting until it comes back. For women experiencing constant pain, it’s important to start pain relief when discomfort starts and continue taking it at regular intervals.

There are different ways of taking or giving drugs to manage cancer pain. The method used will vary according to the drug, the level of pain and other symptoms, such as nausea or vomiting.

Importantly, taking pain medication in tablet or liquid form is as effective as other forms and can make it easier for women with metastatic breast cancer to manage their medication at home.

Addiction to painkillers is very unlikely in women with metastatic breast cancer. The dose of the drugs can be increased or decreased according to individual needs. If one painkiller stops controlling pain, there are others that can be tried.

Other medical treatments for cancer pain

Other medical methods of pain relief used in metastatic breast cancer may include radiotherapy or surgery.

Non-medical forms of pain relief

There are a number of other ways to control pain that don’t involve using drugs. These can be helpful on their own or in combination with medical treatments.

• Relaxation methods including abdominal breathing, progressive muscle relaxation and yoga, can ease cancer pain.
• Acupuncture involves placing small needles in key areas of the body and can ease pain.
• Some women find that massage and aromatherapy can help with relaxation and coping with pain. Massage should not be used on swollen or inflamed parts of the body. Massage should not be used during radiotherapy. Vigorous massage should not be used on parts of the body where there is known to be a cancer.
• Some women and health professionals suggest that cold packs can be helpful to relieve pain where there is swelling or inflammation, and that hot packs can help relieve back or joint pain.
• Support from friends, family, trained counsellors, other health professionals or other sources may help women cope with their pain.
• Transcutaneous electrical nerve stimulation (TENS) is a way of stimulating the body’s own natural painkillers and can be helpful for relieving pain in particular parts of the body.

Questions to ask about managing pain

Listed below are some questions that may be helpful when talking about managing pain caused by metastatic breast cancer:

• What pain relief drugs do you recommend for me and why?
• How often should I take the drugs you are recommending?
• What are the side effects of the drugs you are recommending?
• Who should I contact if I develop side effects?
• Are there ways I can manage the side effects?
• Are there other ways I can help to relieve my pain?
• Can the pain relief drugs interact with other medicines I am taking?
• If I am taking pain relief drugs, can I drink alcohol?
• Can I still drive while I am taking pain relief drugs?
• Who should I contact if my pain changes/gets worse?

Managing symptoms and side effects of treatment

The symptoms of metastatic breast cancer and side effects of treatment will depend on where the cancer is and what treatments a woman is having. Symptoms might change with time. Not all symptoms are due to metastatic breast cancer. Some may be the result of treatment and others may be caused by other illnesses or medical conditions. It’s important for women with metastatic   breast cancer to report any new symptoms or if a symptom gets worse.

Tips for reporting symptoms of metastatic breast cancer

When describing a symptom, it’s important to provide as much information as possible. Some women find it helpful to keep a diary of how frequent or severe their symptoms are and how well symptoms are controlled so they can discuss this with their doctor.

Treatments are available to control and relieve symptoms of metastatic breast cancer and side effects of treatment. With some symptoms and side effects, the treatment recommended may depend on the underlying cause of the symptom.

Hypercalcaemia

Tiredness (fatigue)

What causes it? 

• The cancer itself
• Low levels of red blood cells in the blood (anaemia)
• Changes in the body’s metabolism
• Side effects of treatment
• Travelling for treatment
• Coping with pain or other symptoms
• Being worried or anxious about living with cancer
• Depression
• Sleeping difficulties

How to manage

• Finding out what’s causing the tiredness can help you find ways to manage it
• Gentle exercise
• Red blood cell transfusion (for women with significant anaemia)

Tips for conserving energy

• The following tips are based on the experience of health professionals and women themselves:
• make sure symptoms such as pain are controlled properly
• save your energy for things you enjoy doing
• take things easy and break tasks down into manageable steps
• try to get enough sleep
• build in rest periods during your day
• work out the best time of day for you to do things
• organise some practical help before you start chemotherapy – help with childcare or making meals can give you more time to recover
• encourage friends and family to have short, frequent visits rather than longer ones
• eat a well-balanced diet
• pace yourself and think about using aids or devices that will help you conserve your energy and help you get around more easily.

Fatigue and exercise

A normal reaction to feeling tired is to rest. However, research shows that exercise can help to reduce fatigue caused by chemotherapy and other treatments. Although it may not be what you would expect, exercise during and after treatment can help women feel less tired.

Exercise can also reduce the chance of weight gain and has been shown to help improve sleep, body image and mood. Gentle exercise like walking is ideal. Some women find that more strenuous exercise is also helpful. A physiotherapist or another member of the healthcare team can advise on suitable exercise programs.

Nausea and vomiting

Tips to help prevent nausea and vomiting

The following tips are based on the experience of health professionals and women themselves:

• have frequent small meals instead of bigger main meals
• avoid fatty or fried foods
• rest before and after eating
• don’t lie down during or after eating
• make sure you drink enough fluids
• see a dietitian for advice about what you should eat
• do some relaxation training – this can be particularly helpful if nausea is caused by nervousness.

Loss of appetite

Tips to help with appetite loss

The following tips are based on the experience of health professionals and women themselves:

• eat small meals and snacks as often as you can during the day
• eat a variety of foods and try to include foods that are high in fibre
• choose foods you think you will enjoy and treat yourself when you feel like it
• use ready-made foods if you are too tired to cook
• drink protein and carbohydrate drinks if you find it difficult to eat solid food
• don’t force yourself to eat if you can’t face it but take advantage of those times when you do feel able to eat.

Sleeping difficulties

Tips to help you sleep better

The following tips are based on the experience of health professionals and women themselves:

• tell your healthcare team about any pain or other symptoms you have
• do some gentle exercise each day – ask your doctor, nurse or physiotherapist about exercises you can do even if you are in bed or sitting down for much of the day
• try and get into a routine during the day with visits from friends to keep you busy and stop you from dozing during the day
• avoid coffee, tea and other drinks with caffeine in them in the afternoon and evening
• have a warm drink such as herbal tea or warm milk before you go to bed
• try deep breathing and relaxation
• have a massage from a qualified massage therapist or a friend or partner
• have a warm bath before you go to bed
• try putting essential oils, such as lavender oil, on your pillow
• if you have problems sleeping, use the time to read or listen to music.

Constipation

Tips to help prevent and relieve constipation

The following tips are based on the experience of health professionals and women themselves:

• do gentle exercise – ask your doctor, nurse or physiotherapist about exercises you can do even if you are in bed or sitting down for much of the day
• eat fresh fruits, vegetables, cereals and grains
• abdominal massage can be helpful
• drink more water or other fluids.

Mouth ulcers

Tips to help relieve mouth ulcers

The following tips are based on the experience of health professionals and women themselves:

• brush your teeth and gums with a very soft brush after every meal to prevent infection
• use an analgesic gel from the chemist or sodium bicarbonate (baking soda) mouthwash to help relieve discomfort
• you might need to take pain relief such as paracetamol.

Some mouthwashes can make ulcers worse – advice should be sought from a health professional before using a mouth wash.

Skin changes

Tips to prevent and relieve symptoms of skin changes

The following tips are based on the experience of health professionals and women themselves:

• wear sun protective clothes or use sun screen when you are in the sun
• avoid irritants – protect the skin from chemicals (for example, perfumes, deodorants, hair dyes or hair spray)
• keep skin folds dry
• keep hydrated – drink plenty of fluids to keep hydrated as dehydration is a common cause of skin dryness
• avoid extreme weather conditions like severe cold and hot weather – these conditions can aggravate dry skin
• wash clothes in a mild detergent – look for detergents labelled ‘allergen free’ or ‘unscented’.

Movement problems

Headaches

Tips to help prevent headaches

The following tips are based on the experience of health professionals and women themselves:

• avoid bright lights and loud noises
• lying with the head of the bed slightly elevated can help when the problem is due to cancer in the brain.

Pressure sores

Questions to ask

Listed below are some questions that may be helpful when talking about managing symptoms of metastatic breast cancer:

• What’s causing my symptoms?
• What can be done to manage my symptoms?
• Are there things I can do to help relieve/prevent symptoms?
• Who should I contact if my symptoms get worse?
• How will these symptoms affect the quality of my life?

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