Editor’s Note: MBCN’s 6th Annual National Conference (“Moving Forward With Metastatic Breast Cancer,” took place Oct. 13, 2012 at Northwestern’s Lurie Cancer Center in Chicago. In a few weeks, videos and presentation handouts will be posted at MBCN.org. In the interim, here are some highlights from selected breakout sessions, from attendee Pam Breakey.
BREAKOUT SESSION 1:
Hormone Positive Metastatic Breast Cancer
Ruta Rao, M.D., Assistant Professor in Hematology/Oncology, Rush University Medical Center
Dr.Rao highly recommended having biopsies of the metastatic site:
• to verify metastases
• to determine if receptors have changed from the primary to metastatic site.
She quoted a Swedish study that found changes of 34% in hormone receptor positive mbc and 14% with her2neu positive mbc.
In monitoring treatment, physical exam, labs, CBC, Chem. Panel, tumor markers, scans are used. When a drug is effective, it is generally continued until progression or toxicity. Tumor markers not used alone but with scans, history and physical exam.
She discussed “visceral crisis”—rapid progression or large disease burden with significant symptoms, often beginning in the chest.
Endocrine treatment is often stopped when a patient has had no response to 3 consecutive hormonal treatments or is in visceral crisis. Chemo is used then.
She talked some about specific hormonals—my note taking could not keep up!
Dr. Rao spoke softly but audibly and was understandable. This was a large break out session.
Pam Says: I have a pro Rush University Medical Center bias— I did my Clinical Pastoral Education (Chaplaincy Internship) and then worked part time in that system for over 2 years, enabling me to incur no more student loan debt during seminary. I appreciated that the physicians that I encountered were very open with patients when any mistakes, including errors leading to death, were made. I had very positive experiences with the ethics committee within the Rush system and liked that chaplains were always involved in end of life care.
BREAKOUT SESSION 2
Treating Bone Metastases
William Gradishar, M.D., Professor of Medicine in Hematology/Oncology Division, Northwestern University, Director of Maggie Daley Center for Women’s Cancer Care
>As treatment extends lives, there are more long term issues with bone mets, largely QOL issues.
>In the US, 400,000 new patients a year develop bone mets.
>Of those with mbc, 68% have bone mets.
>Of those with multiple myeloma, 51% have bone mets,
>Of those with metastatic prostate cancer, 49% have bone mets
>Of those with metastatic lung mets, 48% have bone mets.
(These stats may be of SRE(skeletal related event) rather than bone mets…..hope somebody else who attended can help me here!)
SRE-skeletal related event—from bone mets, these have symptoms and consequences such as pain, fractures, need for surgery or radiation.
- Pathologic fracture 52%
- Radiation Therapy 43%
- Surgical intervention 11%
- Spinal cord compression 3%
>12 months median time to SRE
>26.7 months median survival
>As we live longer, more SRE…
>Bisphosphonates have been available for 15-20 years and delay SRE and need for opiate pain meds.
>The ideal dosing schedule is not known…..every 1, 2, 3 months are often used.
>“Mab” at the end of a drug name means it is an anti body.
Q & A
A question was asked about spread to other organs when one has only bone mets—he came down in the camp that believes that cancer cells are already present but not detectible
>Osteo blastic—build up bone
>Osteo lytic—break down bone in healthy bone there is a cycle that includes both
Pam Says: Dr. Gradishar was also easy to listen to. I wish this session had been longer and included hand outs! I found him likable, too.
BREAKOUT SESSION 3
Living With MBC for those over 40
moderator Roz Kleban, LCSW, Clinical Social Worker, Memorial Sloan-Kettering Cancer Center
Pam Says: I was on the panel for this presentation and cannot be objective.
Panelists did little but introduce themselves and the discussion was lead by the moderator who invited and encouraged audience participation. Most questions were about family relationships, especially problematic ones.
(I had thought a lot about what I might want to say and am writing up some notes, which I can post here…with a disclaimer that what has been useful for me and what I think I have learned are not universal!)
About Pam Breakey: Pam is a retired psychotherapist and Episcopal priest who has been living with de novo metastatic breast cancer since March, 2004. She and her husband of eleven years, Mike, a retired police officer, live on ten acres in the SW Michigan woods where they compost, grow flowering plants and feed the birds and a feral cat. Pam is active member of bcmets.org.
Pam says her two- year-old granddaughter and her pets teach her a lot about living in the moment. She values questions over answers and views life as a journey.