Page 70 - MBCA_FULL REPORT_FINAL_FOR_WEB

5. Relief of Physical Symptoms

Since the goal of MBC treatment is to control the disease for as long as possible while
preserving functional status and quality of life, a major task for the health care team is palliating
For most MBC symptoms that may interfere with daily life, causing emotional distress, and the fatigue,
patients, symptoms sleeping difficulties, pain, and many other symptoms typically experienced. As mentioned
and side effects of previously, physical symptoms are intertwined with psychosocial distress. As the disease
treatment disrupt progresses, symptoms tend to become more debilitating and interfere more with normal
daily life and interfere functioning, resulting in greater distress. One consecutively sampled community-based
with normal activities. study [82] found significant physical impairments in almost all 163 MBC patients, yet only one
third were receiving appropriate remediation with occupational or physical therapy. Racial and
socioeconomic disparities in provision of care were clearly present.

Physical symptoms of MBC may be generalized, such as fatigue or insomnia, or organ-
specific, according to the site of tumor-cell spread. Organ-specific examples include dyspnea
(breathlessness), which may be associated with lung metastases or pleural effusion, and
anemia, which may be related to bone marrow metastases or to low red blood cell counts from
chemotherapy.

The prevalence of chronic pain in patients with metastatic cancers is estimated at 70–90%
and is among the most distressing physical symptoms [83] . Pain may be associated with tumors
exerting pressure on or displacing nerves. A common source of pain is bone metastases,
although bone-modifying agents have significantly decreased bone pain and fractures in recent
years. Some drugs used to control the cancer cause worrisome and in some cases permanent
side effects, such as taxane-related peripheral neuropathy.

Nausea and vomiting may be related to involvement of the gastrointestinal tract, such as liver
or peritoneal metastases or ascites, or to brain or other central nervous system metastasis
or side effects from chemotherapy or other anticancer agents. Significant progress has been
made in developing supportive medications that can decrease the frequency and severity of
nausea and vomiting.

Fatigue is by far the most common physical symptom reported by MBC patients, occurring in
80% or more of those undergoing treatment [84] , as confirmed in patient surveys [57] . Fatigue is
frequently associated with depression or anxiety as well as with treatment toxicities and MBC
[4]
itself . Other contributing factors may include tumor burden, pain, difficulty sleeping, anemia,
poor diet, inactivity, and other coexisting conditions [51, 85-88] . Fatigue is also one of the most
difficult symptoms to treat [89] .
70