Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
JCO Oncol Pract. 2021 Apr;17(4):177-183. doi: 10.1200/OP.20.00622. Epub 2021 Jan 22.
The clinical progression patterns of metastatic breast cancer (MBC) are heterogeneous; patients experience acute and stable phases at different time points. The acute phase consists of rapid progressive symptomatic changes, whereas in the stable phase, patients have relatively low symptom burden. Therefore, personalized interdisciplinary care is essential. The optimal palliative or supportive care in MBC is to provide comprehensive care that is individually prioritized to the patient's disease status. The purpose of this review is to provide a practical guide for oncologists to understand the priorities for supportive care for patients with MBC in the two phases. We note that for better decision making in patient care, performance status should be broadened to consider not only physical status but also psychosocial needs and cognitive condition. We summarize the clinical importance of physical symptom control, psychosocial support, physical activity, nutrition support, and advance care planning. For optimal care, we present palliative or supportive care checklists according to the disease progression phase, combining the limited evidence with expert input. In the acute phase, close monitoring of the patient's status and symptom management take priority. In the stable phase, the focus can shift to maintenance or improvement of physical strength and emotional condition. Finally, we discuss future directions and unmet needs in providing the best supportive care for patients with MBC.
转移性乳腺癌（MBC）的临床进展模式具有异质性；患者在不同时间点经历急性和稳定期。急性期包括症状迅速进展的变化，而在稳定期，患者的症状负担相对较低。因此，个性化的多学科护理至关重要。MBC 中最佳的姑息或支持性护理是提供根据患者疾病状况个体化优先考虑的全面护理。本综述的目的是为肿瘤学家提供实用指南，以了解 MBC 患者在这两个阶段支持性护理的重点。我们注意到，为了更好地做出患者护理决策，应扩大表现状态的范围，不仅要考虑身体状况，还要考虑心理社会需求和认知状况。我们总结了控制身体症状、提供心理支持、进行身体活动、营养支持和预先护理计划的临床重要性。为了获得最佳护理，我们根据疾病进展阶段提出姑息或支持性护理检查表，将有限的证据与专家意见相结合。在急性期，优先密切监测患者的病情和症状管理。在稳定期，可以将重点转移到维持或改善身体力量和情绪状况。最后，我们讨论了为 MBC 患者提供最佳支持性护理的未来方向和未满足的需求。
