How to deal with metastatic breast cancer with bone pain?

Question

Hello doctor,

My 34-year-old daughter was diagnosed with metastatic breast cancer last month, and she has been having a very difficult time coping with it. The cancer has spread to her bones and liver, according to the PET scan results.

She has been receiving Fulvestrant injections for the past three weeks. However, the bone pain in her spine has been getting worse each day. Her recent blood tests showed a CA 15-3 level of 89 U/mL (normal is usually below 30 U/mL) and an alkaline phosphatase level of 156 U/L, which her oncologist mentioned could indicate bone involvement.

The pain has become so severe that she can no longer lift her 2-year-old child. We tried Fentanyl patches for pain relief, but she is very hesitant to use them because her father struggled with opioid addiction in the past.

Since chemotherapy, her periods have stopped completely. She is also experiencing frequent hot flashes that wake her up six to seven times a night. The weakness has become so pronounced that sometimes she can barely walk to the bathroom without assistance.

We are very worried about her quality of life right now. Could you please advise if there are other options for managing her pain? We are also wondering whether the hormone therapy is working, since she currently feels worse rather than better.

Her next scan is scheduled in two months, but we are concerned that the cancer might be progressing more quickly than expected. Any guidance on what we should discuss with her oncologist in the meantime would be greatly appreciated.

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

I truly understand how frightening and painful this time must be for your family. Seeing a young loved one go through metastatic breast cancer can shake anyone deeply, and your concern for your sister shows how much you care about her.

Please remember that many families face this situation with the same fears, and there are now several treatments that can help control the disease and improve quality of life.

Since she has already started hormonal therapy with Fulvestrant, this is an important step in treating hormone-receptor–positive metastatic breast cancer. Hormonal and targeted therapies can often control the disease effectively for long periods.

However, it may take several weeks to a few months before the full benefit of the treatment becomes noticeable, so feeling unwell right now does not necessarily mean the treatment is not working.

Regarding her bone pain, there are additional supportive treatments that can help significantly:

Palliative radiotherapy (radiation treatment given to relieve symptoms like pain or pressure caused by cancer, rather than to cure the disease) to painful bone areas can reduce pain and improve mobility.
Bone-strengthening medications such as Denosumab or Bisphosphonates may be given once a month to strengthen bones and reduce complications from bone metastases.
Pain management with medications, including opioids when necessary, can be very effective and is carefully supervised by doctors.

Many patients worry about addiction to opioids. When these medicines are prescribed and monitored by a pain specialist or oncologist for cancer-related pain, they are used safely and appropriately. The medical team will regularly assess her pain and adjust the treatment to keep her comfortable.

At this stage, the most important goals are pain control, maintaining strength, and emotional support. Once her pain is better managed, she may gradually regain the ability to perform more daily activities.

It is also helpful to focus on maintaining good nutrition to support her strength and recovery, ensuring she gets adequate rest and quality sleep, and providing strong emotional support from family members.

Being present, offering reassurance, and helping her feel supported can play a very important role in helping her cope with the illness and its treatment. Your presence and encouragement can make a huge difference to her during this difficult time.

I truly hope that her next PET scan (positron emission tomography, a scan that helps detect cancer activity in the body) shows a good response to treatment and improvement in her condition.

Please stay hopeful, and do not hesitate to discuss all these supportive care options with her oncologist.

I hope this helps.

Please revert in case of further queries.

Thank you.