A prospective evaluation of the durability of palliative interventions for patients with metastatic breast cancer Journal Article


Authors: Morrogh, M.; Miner, T. J.; Park, A.; Jenckes, A.; Gonen, M.; Seidman, A.; Morrow, M.; Jaques, D. P.; King, T. A.
Article Title: A prospective evaluation of the durability of palliative interventions for patients with metastatic breast cancer
Abstract: BACKGROUND: Although systemic therapy for metastatic breast cancer (MBC) continues to evolve, there are scant data to guide physicians and patients when symptoms develop. In this article, the authors report the frequency and durability of palliative procedures performed in the setting of MBC. METHODS: From July 2002 to June 2003, 91 patients with MBC underwent 109 palliative procedures (operative, n = 76; IR n = 39, endoscopic n = 3). At study entry, patients had received a mean of 6 prior systemic therapies for metastatic disease. System-specific symptoms included neurologic (33%), thoracic (23%), musculoskeletal (22%) and GI (14%). The most common procedures were thoracostomy with or without pleurodesis (27%), craniotomy with resection (19%) and orthopedic open reduction/internal fixation (19%). RESULTS: Symptom improvement at 30 days and 100 days was reported by 91% and 81% of patients, respectively, and 70% reported continued benefit for duration of life. At a median interval of 75 days from intervention (range, 8-918 days), 23 patients (25%) underwent 61 additional procedures for recurrent symptoms. The durability of palliation varied with system-specific symptoms. Patients with neurologic or musculoskeletal symptoms were least likely to require additional maintenance procedures (P < .0002). The 30-day complication rate was 18% and there were no procedure-related deaths. At a median survival of 37.4 mos from MBC diagnosis (range, 1.6-164 months) and 8.4 months after intervention (range, 0.2-73 months), 7 of 91 patients remained alive. CONCLUSIONS: Palliative interventions for symptoms of MBC are safe and provide symptom control for the duration of life in 70% of patients. Definitive surgical treatment of neurologic or musculoskeletal symptoms provided the most durable palliation; interventions for other symptoms frequently require subsequent procedures. The longer median survival for patients with MBC highlights the need to optimize symptom control to maintain quality of life. © 2010 American Cancer Society.
Keywords: adult; treatment outcome; aged; aged, 80 and over; middle aged; osteosynthesis; survival rate; major clinical study; cancer radiotherapy; prospective study; cancer palliative therapy; palliative care; metastasis; quality of life; breast cancer; maintenance therapy; practice guideline; breast neoplasms; time factors; cancer hormone therapy; longitudinal studies; evaluation; disease progression; endoscopic surgery; neoplasm metastasis; surgery; craniotomy; symptomatology; disease control; trastuzumab; metastatic breast cancer; neurologic disease; gastrointestinal disease; thorax drainage; thorax disease; musculoskeletal disease; palliative; open reduction; interventions; pleurodesis
Journal Title: Cancer
Volume: 116
Issue: 14
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2010-07-15
Start Page: 3338
End Page: 3347
Language: English
DOI: 10.1002/cncr.25034
PUBMED: 20564060
PROVIDER: scopus
PMCID: PMC4465203
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Monica Morrow
    450 Morrow
  2. Andrew D Seidman
    254 Seidman
  3. Mithat Gonen
    716 Gonen
  4. Tari King
    167 King
  5. Mary Morrogh
    33 Morrogh
  6. Anna Yong Park
    22 Park