A woman confronting metastatic breast cancer faces challenges that, at the outset, seem overwhelming.
Research tells us these patients are especially vulnerable to anxiety, depression, hopelessness and other sources of distress. At the same time, they are asked to make complicated choices about their medical care — such as whether to participate in a clinical trial, choosing between available therapies and weighing a treatment's effectiveness against quality-of-life issues.
James Waisman, MD, a highly respected and well known expert on breast cancer, is here to discuss Metastatic Breast Cancer and the hope that lies here at City of Hope for women diagnosed with Metastatic Breast Cancer.
Selected Podcast
Living with Metastatic Breast Cancer
Featured Speaker:
Learn more about James Waisman, MD
James Waisman, MD
James Waisman, M.D., a highly respected and well known expert on breast cancer, is a clinical professor in the Department of Medical Oncology & Therapeutics Research. He joined City of Hope from the Breastlink Medical Group, Inc., a network of breast centers in Southern California, where he served as Medical Director of the Research Group. He was an Associate Clinical Professor of Medicine at Keck School of Medicine, USC, prior to joining Breastlink, and served as Vice President of the Medical Staff at USC/Norris, as well as the Chair of the Practice Operations and Development Committee. Prior to his time at USC, Dr. Waisman was an Assistant Professor of Medicine at UCLA and the Medical Director of Cedars-Sinai’s hospice program.Learn more about James Waisman, MD
Transcription:
Living with Metastatic Breast Cancer
Melanie Cole (Host): A woman confronting metastatic breast cancer faces challenges that, at the outset, seem really overwhelming. These patients are especially vulnerable to anxiety and depression while at the same time they are facing very complicated choices about their medical care. My guest today is Dr. James Weisman. He’s a highly respected and well-known expert on breast cancer and clinical professor in the department of medical oncology and therapeutic research at City of Hope. Welcome to the show, Dr. Waisman. So, tell us what does that mean when we hear the term “metastatic” breast cancer?
Dr. James Waisman (Guest): First of all, good morning. It means that the cancer has spread from the breast to another organ in the body. Early breast cancer is defined as cancer in the breast and the lymph node under the armpit but metastatic disease can be anywhere in the body. There are certain areas, like the brain, liver, lung and bone that are more likely to be areas where it spreads, but it can literally spread anywhere.
Melanie: Okay. So, you hear the word “spread” and right away a woman freaks out. When you hear that it’s contained, then there are lumpectomies and treatments and things that you can do but when you hear that it spreads, right away that would cause a woman to sort of lose hope. People are living with metastatic breast cancer, yes?
Dr. Waisman: Absolutely. I’ve been practicing for a couple of decades and the changes we are seeing really make us say that this is now considered a chronic disease. Something like diabetes or heart disease, where people live and live productive lives and we have to keep treating them, but the drugs we have and the treatment we have are not only extending life but making people have lives that are completely livable.
Melanie: So, what kinds of treatments are available? Right away people think of losing their hair and getting very sick from chemotherapy. All of that, that’s involved, especially if the cancer is systemic. What are the treatments that are involved and how are you getting women to live longer with this?
Dr. Waisman: Well, the thing that has to be understood is that it’s not one disease. Actually breast cancer and other cancers are newly defined by molecular characteristics, by the biology of the tumor and it can be different. Really, we look at three main different kinds of metastatic breast cancer; one, whether it’s hormone sensitive and is responsive to things that block estrogen, for example. That’s usually pills or very low side effect related medications. Patients live without hair loss, without the side effects of chemotherapy and do very well for a long time. Then, there’s a second kind of breast cancer where a protein called the HER2/neu is on the cancer cell. We have incredible new therapies for that based on antibodies and, again, avoid a lot of the side effects of chemotherapy. The third kind of breast cancer metastatic disease is what we call “triple negative” meaning it doesn’t have any protein receptors that can be used to target the cancer cell and for that we do use chemotherapy but often low side effect related. We use the term “toxicity chemotherapy.” So, the old image of women sick and ill and vomiting is much less the common experience.
Melanie: If a woman has metastatic breast cancer is there any way she knows? Would that be something that because her breast cancer initially was undetected? Is that why it becomes metastatic? Or, is it something that, that’s where it was going to go anyway?
Dr. Waisman: That’s a great question and we don’t exactly know the reasons that women who have breast cancer develop metastatic disease. We know it is related to how large the cancer is; how far it has spread initially into lymph nodes; how aggressive it is as we see it under the microscope. What I tell women because they have breast cancer and they ask me, “Well, how do I know if I have metastatic disease?” The answer is, it’s not an experience that you will have ever had in your life, as a general rule. So, people who have mild headaches and coughs and backaches and skin rashes; that is very rarely metastatic disease. I do a lot of reassuring of women with breast cancer, that they are adults and they go through life like the rest of us and only if they have something really unexpected, like shortness of breath or not able to get up and take a shower. Then, that’s something they have to be concerned about.
Melanie: So, then what kinds of things do they look to deal with? This has got to be a very multi-disciplinary approach, correct, Dr. Waisman? Because it’s a chronic disease, because it affects other organs and such, what is that multidisciplinary approach to help these women go through something so scary?
Dr. Waisman: It’s a great question and, frankly, it’s the main reason that I left private practice to come to the City of Hope. The team, now, really is been expanded to include immune-directed scientists and doctors with expertise in removing tumors with robotic equipment using fine surgical approaches. We do use surgery now for resecting areas of metastatic disease. There are scientists who are interested in these concepts of targets, so you have to examine the tissue with a molecular analysis, which can be very complex. So, yes, we need the multidisciplinary teams and that includes nutritionists, physical therapists, and psychologists because, really, it’s a situation where we want women to feel a sense of well-being as they are living with--and I like that term, “living with”--metastatic disease.
Melanie: You use that term “living with.” Are there certain factors that will determine that? Women say, or anybody with cancer says, “How long do I have?” That’s been around for so many years, so is there a certain factor that determines that you can say, “Yes. We’re going to get you to live a nice long life.”
Dr. Waisman: Well, I mean, we are concerned about if a vital organ is involved. Obviously, things like the liver or brain or lung, that’s different than the skin or lymph node or bone. So, yes, we are more concerned when the metastasis is in those organs. Having said that, I have, and my colleagues have, many patients with disease in the liver or lung that years ago would have been a fatal illness. It no longer is the case. We can treat them with medications and not only extend their life but extend the quality of their life. I actually keep a list of all my patients with metastatic disease, so I know exactly how they are doing and for how long they have been dealing with this. Many of those patients are living more than a decade. So, things like using the average length of life, is just simply not a real concept anymore.
Melanie: In just the last few minutes, Dr. Waisman, give us your best advice for women that might be newly diagnosed with metastatic breast cancer. What’s going on in the horizon and what’s exciting in the research and why they should come to see you at City of Hope for their care? You sound to me like a caring and amazing doctor, so give women kind of that little encouragement that I can hear from you, so that they know that there is hope out there.
Dr. Waisman: First of all, it’s a new day. So, what women heard from their relatives and their friends from even three years ago, is changed. All those different cancers have new targets. The concept of target means, you can identify something in the cancer cell that makes that cell vulnerable to treatment. We just have more treatment, less side effects from that treatment and what happens at a place like the City of Hope is that the technology and the science is moving together so rapidly that you really have to stay current with what is going on. By reading, by listening to programs like yours, by being a participant in educational settings. So, to me, the most important thing is to be involved and engaged in the future of your life and to see yourself with a future. I think that is probably the major change that we’ve seen over the last several years: that women can see a future. That means working; that means traveling; that means being with their family and the old model of this is an end of life conversation is no longer operative and no longer the norm. Yes, bad things can happen, but we don’t look at patients like that--not when we have the options that we now have.
Melanie: Thank you, so much, Dr. Waisman, for such great information. You are listening to City of Hope Radio. For more information you can go to cityof hope.org. That’s cityofhope.org. This is Melanie Cole. Thank you so much for listening.
Living with Metastatic Breast Cancer
Melanie Cole (Host): A woman confronting metastatic breast cancer faces challenges that, at the outset, seem really overwhelming. These patients are especially vulnerable to anxiety and depression while at the same time they are facing very complicated choices about their medical care. My guest today is Dr. James Weisman. He’s a highly respected and well-known expert on breast cancer and clinical professor in the department of medical oncology and therapeutic research at City of Hope. Welcome to the show, Dr. Waisman. So, tell us what does that mean when we hear the term “metastatic” breast cancer?
Dr. James Waisman (Guest): First of all, good morning. It means that the cancer has spread from the breast to another organ in the body. Early breast cancer is defined as cancer in the breast and the lymph node under the armpit but metastatic disease can be anywhere in the body. There are certain areas, like the brain, liver, lung and bone that are more likely to be areas where it spreads, but it can literally spread anywhere.
Melanie: Okay. So, you hear the word “spread” and right away a woman freaks out. When you hear that it’s contained, then there are lumpectomies and treatments and things that you can do but when you hear that it spreads, right away that would cause a woman to sort of lose hope. People are living with metastatic breast cancer, yes?
Dr. Waisman: Absolutely. I’ve been practicing for a couple of decades and the changes we are seeing really make us say that this is now considered a chronic disease. Something like diabetes or heart disease, where people live and live productive lives and we have to keep treating them, but the drugs we have and the treatment we have are not only extending life but making people have lives that are completely livable.
Melanie: So, what kinds of treatments are available? Right away people think of losing their hair and getting very sick from chemotherapy. All of that, that’s involved, especially if the cancer is systemic. What are the treatments that are involved and how are you getting women to live longer with this?
Dr. Waisman: Well, the thing that has to be understood is that it’s not one disease. Actually breast cancer and other cancers are newly defined by molecular characteristics, by the biology of the tumor and it can be different. Really, we look at three main different kinds of metastatic breast cancer; one, whether it’s hormone sensitive and is responsive to things that block estrogen, for example. That’s usually pills or very low side effect related medications. Patients live without hair loss, without the side effects of chemotherapy and do very well for a long time. Then, there’s a second kind of breast cancer where a protein called the HER2/neu is on the cancer cell. We have incredible new therapies for that based on antibodies and, again, avoid a lot of the side effects of chemotherapy. The third kind of breast cancer metastatic disease is what we call “triple negative” meaning it doesn’t have any protein receptors that can be used to target the cancer cell and for that we do use chemotherapy but often low side effect related. We use the term “toxicity chemotherapy.” So, the old image of women sick and ill and vomiting is much less the common experience.
Melanie: If a woman has metastatic breast cancer is there any way she knows? Would that be something that because her breast cancer initially was undetected? Is that why it becomes metastatic? Or, is it something that, that’s where it was going to go anyway?
Dr. Waisman: That’s a great question and we don’t exactly know the reasons that women who have breast cancer develop metastatic disease. We know it is related to how large the cancer is; how far it has spread initially into lymph nodes; how aggressive it is as we see it under the microscope. What I tell women because they have breast cancer and they ask me, “Well, how do I know if I have metastatic disease?” The answer is, it’s not an experience that you will have ever had in your life, as a general rule. So, people who have mild headaches and coughs and backaches and skin rashes; that is very rarely metastatic disease. I do a lot of reassuring of women with breast cancer, that they are adults and they go through life like the rest of us and only if they have something really unexpected, like shortness of breath or not able to get up and take a shower. Then, that’s something they have to be concerned about.
Melanie: So, then what kinds of things do they look to deal with? This has got to be a very multi-disciplinary approach, correct, Dr. Waisman? Because it’s a chronic disease, because it affects other organs and such, what is that multidisciplinary approach to help these women go through something so scary?
Dr. Waisman: It’s a great question and, frankly, it’s the main reason that I left private practice to come to the City of Hope. The team, now, really is been expanded to include immune-directed scientists and doctors with expertise in removing tumors with robotic equipment using fine surgical approaches. We do use surgery now for resecting areas of metastatic disease. There are scientists who are interested in these concepts of targets, so you have to examine the tissue with a molecular analysis, which can be very complex. So, yes, we need the multidisciplinary teams and that includes nutritionists, physical therapists, and psychologists because, really, it’s a situation where we want women to feel a sense of well-being as they are living with--and I like that term, “living with”--metastatic disease.
Melanie: You use that term “living with.” Are there certain factors that will determine that? Women say, or anybody with cancer says, “How long do I have?” That’s been around for so many years, so is there a certain factor that determines that you can say, “Yes. We’re going to get you to live a nice long life.”
Dr. Waisman: Well, I mean, we are concerned about if a vital organ is involved. Obviously, things like the liver or brain or lung, that’s different than the skin or lymph node or bone. So, yes, we are more concerned when the metastasis is in those organs. Having said that, I have, and my colleagues have, many patients with disease in the liver or lung that years ago would have been a fatal illness. It no longer is the case. We can treat them with medications and not only extend their life but extend the quality of their life. I actually keep a list of all my patients with metastatic disease, so I know exactly how they are doing and for how long they have been dealing with this. Many of those patients are living more than a decade. So, things like using the average length of life, is just simply not a real concept anymore.
Melanie: In just the last few minutes, Dr. Waisman, give us your best advice for women that might be newly diagnosed with metastatic breast cancer. What’s going on in the horizon and what’s exciting in the research and why they should come to see you at City of Hope for their care? You sound to me like a caring and amazing doctor, so give women kind of that little encouragement that I can hear from you, so that they know that there is hope out there.
Dr. Waisman: First of all, it’s a new day. So, what women heard from their relatives and their friends from even three years ago, is changed. All those different cancers have new targets. The concept of target means, you can identify something in the cancer cell that makes that cell vulnerable to treatment. We just have more treatment, less side effects from that treatment and what happens at a place like the City of Hope is that the technology and the science is moving together so rapidly that you really have to stay current with what is going on. By reading, by listening to programs like yours, by being a participant in educational settings. So, to me, the most important thing is to be involved and engaged in the future of your life and to see yourself with a future. I think that is probably the major change that we’ve seen over the last several years: that women can see a future. That means working; that means traveling; that means being with their family and the old model of this is an end of life conversation is no longer operative and no longer the norm. Yes, bad things can happen, but we don’t look at patients like that--not when we have the options that we now have.
Melanie: Thank you, so much, Dr. Waisman, for such great information. You are listening to City of Hope Radio. For more information you can go to cityof hope.org. That’s cityofhope.org. This is Melanie Cole. Thank you so much for listening.