Palliative interventions for metastatic breast cancer are ‘durable
MedWire News: Palliative interventions for symptoms of metastatic breast cancer (MBC) provide symptom control for the duration of life in the majority of patients, particularly those with neurologic or musculoskeletal symptoms, say researchers.
To better define the need for palliation in the natural progression of MBC and to evaluate the durability of commonly performed palliative interventions, Tari King (Memorial Sloan-Kettering Cancer Center, New York, USA) and team prospectively identified MBC patients undergoing palliative procedures, and followed-up the patients until death.
Over a 1-year period, 91 patients with MBC underwent 109 primary palliative procedures to control the symptoms of their disease. At study entry, patients had received a mean of six prior systemic therapies for metastatic disease.
The most common system-specific symptoms reported were neurologic (33%), cardiothoracic (23%), musculoskeletal (22%), and gastrointestinal (14%). The most common palliative procedures were thoracostomy, with or without pleurodesis (27%), craniotomy with resection (19%), and orthopedic open reduction/internal fixation (19%).
The researchers found that symptom improvement was reported by 91% of patients at 30 days and by 81% of patients at 100 days. In addition, 70% reported continued benefit for duration of their life.
At a median interval of 75 days from intervention, 23 (25%) patients underwent 61 additional procedures for recurrent symptoms.
King and co-authors report that the durability of palliation varied with system-specific symptoms. Definitive surgical treatment of neurologic or musculoskeletal symptoms provided the most durable palliation, whereas interventions for gastrointestinal or cardiothoracic symptoms had a high requirement for additional maintenance procedures.
Of note, the 30-day complication rate was 18% and there were no procedure-related deaths. Median survival after palliative intervention was 8.4 months.
"Here we report that for patients with MBC, both surgical and nonsurgical palliative interventions are safe and provide durable control of symptoms," write King et al in the journal Cancer.
"While we await prospective trials that focus on quality of life using patient-reported outcomes, for now, open discussion among the multidisciplinary team members, patients, and their families must be encouraged to optimize patient care and quality of life," the authors conclude.
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By Laura Dean