Metastatic cancer: Treat with chemo or manage symptoms?

Hi--I'm glad you found Mayo Connect. I hope you get some useful comments here. I'm just a bit younger than your mom, with breast cancer that is predicted to spread. Can you talk to your mom about what she wants? The basic decision is hers--although I'm making all my decisions in conjunction with my daughter, husband, and best friend. Your mom is so lucky to have you! I think that you need to let her talk openly about her feelings and decision making process. What does her oncologist suggest? You have clearly noted the two main options. But she could consider chemo, and then eventually go on to just management. Is she generally healthy, or have other conditions? Anyway, ask her what she wants--and find out how much input she needs from you...I'm guessing she'd like your opinions too. Wishing you both peace and strength--and just saying again it is great how you care about your mom.

@louryne Welcome to Mayo Clinic Connect. It must be heartbreaking for your mom, and her family and friends, to hear this kind of news.

Metastatic cancer can be present in many different levels of occurrence. As @mir123 Miriam said, what does your mom want to do? Is she gathering thoughts from people? Has she sat with a cup of tea and considered what she wants to do? Has she been able to have that difficult conversation with her medical team, and gotten their input on a course of treatment? She is lucky to have you there with you. If possible, and if she is okay with it, tag along with her to her appointments, to listen, as a second set of ears if nothing else, to what her medical team has to say. As her family member and non-patient, you might hear things she will skip over as she is processing the sentence before.

We always want the best for our family member/friend as they navigate through this. It doesn't mean to set aside your own emotions. Perhaps there is a social worker at the oncology practice who will have words of wisdom, and resources you can turn to. And of course, here on Connect!
Ginger

I'm so sorry. Your mom has what they call "high load" stage 4 metastatic cancer, vs "oligometastatic" stage 4 like my prostate cancer (just one known metastasis, though it did a lot of damage to my spine).

I don't know much about modern breast cancer treatments, but for prostate cancer there are many new treatment options now, even after it spreads like that. None of the treatments is a picnic, though, and many increase the risk of other conditions like heart disease or diabetes.

I was 56 at the time of my diagnosis and mostly healthy (except that the cancer had left me temporarily paraplegic), so we decided to "throw the kitchen sink" at my stage 4 cancer. So far, it's doing the job and I feel I still have a good quality of life as well as quantity. Treating her cancer with "curative intent" could buy her more years as well, but it could also make her sicker, especially if her health already isn't great.

As others have mentioned, there's nothing wrong with choosing palliative (focus on managing symptoms) over curative (focus on fighting the cancer), or vice-versa. This is a decision she'll have to reach after talking with her care team and family.

Best wishes.

Thank you so much for your reply and advise.

I’m 65 and was diagnosed with bowel cancer 3 years ago. I had part of my colon removed and chemo. Now I’ve mets to the liver but as I have always had 3 month checkups, it’s been caught and I’m having it removed in a few weeks. As I get older the more determined I am never to stop having any treatment that gives me another day. Like someone said, I’ll throw the kitchen sink at it to stay here. Your mum may feel the same as me. Or she may not. Discuss it with her.

Thank you. I appreciate your feedback.

I also want to add that "palliative" isn't the same as hospice. Palliative just means that the treatment prioritises reducing pain (even though it might also fight cancer); curative treatment prioritises fighting cancer (even though it might also reduce pain). Hospice is end-of-life care, but even then, many people are discharged alive from hospice because their palliative treatment at the hospice is enough to push the cancer into remission. It's all pretty confusing at first.

It freaked me out when I came home from hospital after 3½ months and homecare made a visit and told me that I was getting palliative care. I called the hospital, and they apologised and explained that the classification is automatic with any kind stage 4 cancer, even though I've been getting curative doses of treatments. My oncologist now tells me that I'm in full remission (with the support of the "forever meds"), though "remission" is another tricky term ...

@louryne My mother is also 73 yrs old with metastatic cancer that originated in her breast but they didn’t recommend chemo for her. They don’t feel it would be beneficial because it is incurable and would actually make her feel worse. She is on medication instead and is going through different pain relief alternatives.

I’m so sorry for your mom and your family and friends having to deal with this hand life has dealt your mom. In 2016 my mom was diagnosed with stage 4 small cell lung cancer. We thought she had the flu before she was diagnosed, and she deteriorated very quickly after diagnosis'.

For our sakes she tried radiation immediately on diagnosis with a view to moving on to chemo. At least the radiation of her brain gave her back all her cognitive abilities and ability to move normally - she was able to function as she had before. Mom was extremely sick and very tired. Her team had stopped the radiation as it was no longer helping and she wouldn’t be doing chemo. She passed at home in the early hours of the morning before going into hospital to be rehydrated. She and we only got a month from diagnosis. Luckily we had made every day count as much as we could.

It was a huge blow to lose mom so suddenly and so quickly, but such a relief for mom.

I am still deeply conflicted and bear guilt because in a way through ignorance we pushed mom to try longer than I think she wanted to do so. I am also grateful to her medical team for calling a halt.

It is a very very hard situation you face. Knowledge of options, prospects of success, quality of life etc are vital tools to help your mom and you all decide what to do.

I am now facing stage 4 appendix cancer myself but treatments (like immunotherapy and targeted therapies) have improved out of sight since my mom’s illness. With that knowledge and trusting my medical team to carefully monitor my organs/quality of life I did throw the kitchen sink at it. I am very fortunate to be in 2 years remission with very few side effects other than managing digestive issues (constipation and problems drawing in water) due to a colon resection after part was removed.

Prayers up 🙏❣️

Thanks so much for sharing your experience and dealing with your illness. It can't and could not have been easy. Much love.