Live Well With Metastatic Triple-Negative Breast Cancer: Tools for Wellness and Coping

Living with metastatic triple-negative breast cancer (mTNBC) means facing uncertainty and emotional ups and downs. “Treatment can not only take a physical toll, but also a mental and emotional toll,” says Monique C. James, MD, an assistant attending psychiatrist at Memorial Sloan Kettering Cancer Center in New York City.

On top of that, people with mTNBC are living with a constant undercurrent of doubt. “There are all these new therapies, and people are now living longer, but there is no certainty that these new or future medicines will be effective for you and your particular tumor type,” says Dr. James.

While you may not be able to control the illness, there are meaningful ways to care for your body, mind, and spirit. These strategies can help you take control of your experience, improve your quality of life, and focus on what matters most to you.

Receiving a diagnosis of metastatic mTNBC can unleash a flood of emotions, and you may have emotional highs and lows throughout your journey. It’s common to feel:

• Hope fatigue (exhaustion from staying positive during ongoing treatment)
• Isolation and loneliness
• Sadness and grief over the loss of a “normal” life
• Scanxiety (anxiety around upcoming scans or test results)
• Survivor’s guilt, particularly if you’ve connected with others in the breast cancer community who are no longer here
• Uncertainty regarding your future and what it means for your loved ones and your plans

These feelings are valid, and you’re not alone in them. But there are things you can do to manage your emotional health:

Find a Therapist

Therapists, oncology social workers, psychologists, and psychiatrists with experience in metastatic breast cancer counseling can offer coping strategies and a space to process complex feelings. In addition to one-on-one therapy, you might also consider group therapy. “This can be particularly helpful, because metastatic breast cancer can be such a lonely and isolating disease,” says James.

If you’re a person of color, consider seeking a therapist who understands the added layers that can bring to navigating cancer care.

Join a Support Group

Talking to others who understand, whether online or in person, can be incredibly grounding. The cancer center you go to may host support groups specifically for mTNBC. If not, you may be able to find a group through a national organization such as TNBC Thrivers or Living Beyond Breast Cancer.

Practice Mindfulness

Mindfulness techniques, such as deep breathing, guided imagery, and meditation, can help ease anxiety and keep you feeling centered. Many apps and websites offer free guided meditations, and some cancer centers provide mindfulness workshops. “Once you’re comfortable using these tools, you can do them yourself whenever you’re feeling anxious, no matter where you are — whether it’s in a waiting room, in an Uber, or on the subway,” says James.

Plan for Scans

Think about previous scans and how they have affected you. “Maybe you need to take the morning or whole day off from work. Maybe you want to go alone, or you might want someone to go with you. Maybe you need a treat that night, or maybe you’ll need one the next day,” says James. “There’s no right or wrong way, but be honest with yourself about what you need. And once you figure it out, plan for it.”

Reframe Your Goals

You don’t necessarily have to give up on your goals, but you may need to adjust them. One way to do this is to home in on the intent behind a goal. “For example, maybe you had a goal to write a book, and now you feel like you can’t. Think about what the book was going to do for you,” says James. “If the crux of the goal was to tell your story, maybe there are other ways to do that, such as going to groups, sharing on social media, or writing poems. Goals may have to shift, but that doesn’t mean they’re better or worse. It’s about accepting that some things will be different.”

Ask for and Accept Help

“People often want to help, but they don’t know how. So it’s okay to steer them,” says James. You might assign jobs based on people’s skills and interests. Maybe one friend has great musical taste and can make you a playlist, while another can help with transportation. A tech-savvy friend may be more than happy to solve a problem you’re having with your phone or laptop. It’s okay to lean on your loved ones and ask for what you need.

• Pain Pain can be related to the treatment or to the cancer itself. Even mild pain can interfere with daily life and make other side effects, such as fatigue, worse. Fortunately, pain can almost always be addressed.

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   Speak to your care team about pain management options, which may include medications, physical therapy, and complementary therapies, such as acupuncture or hypnosis.
• Fatigue Both cancer and its treatments can make you extremely tired. Strategies that may help include drinking plenty of water, delegating responsibilities, eating a healthy diet, getting some light physical activity in, maintaining a regular sleep routine, and reducing stress (such as through journaling, meditation, or yoga).
• Nausea This is a common side effect of some mTNBC treatments. Anti-nausea medications can help, as can eating dry foods (such as cereal and crackers) in small portions, frequently throughout the day, sipping ginger ale or ginger tea, and rinsing your mouth with water before and after eating.
• Constipation Some medications used in mTNBC treatment, including anti-nausea drugs, can cause constipation. Combat it by increasing your fluid intake, eating high-fiber foods (such as beans, fruits and vegetables, and whole-grain breads and cereals), and trying to get some exercise (which can help stimulate digestion).
• Diarrhea Some chemotherapy drugs can cause diarrhea. Try drinking plenty of liquids (such as water, sports drinks, and broth) and eating small, frequent meals (such as applesauce, bananas, and yogurt). Avoid acidic foods and drinks, alcohol, caffeine, and foods that are very greasy or spicy.
• Skin Problems Dryness, rashes, and sun sensitivity can result from some mTNBC therapies. To prevent and manage these issues, moisturize regularly, use gentle, fragrance-free skin-care products, and wear sunscreen daily. If problems persist, look for a dermatologist familiar with oncology care.

Self-care is a vital part of supporting your emotional, mental, and physical well-being. Even small acts of self-care can improve your quality of life. Here are some ways to nurture yourself:

• Stay socially connected. Whether it’s family members, old friends, or others who have mTNBC, connecting with people can help combat isolation and lift your spirits. “Sometimes, you may want to connect with people in the cancer world. And sometimes you may want to put breast cancer to the back of your mind and simply enjoy this lovely, gorgeous walk or this lovely, gorgeous movie. We need both at different times,” says James.
• Engage in hobbies. Creative outlets, such as crafting, gardening, painting, photography, or writing, can help you express your emotions and find joy. Doing something you love for even just a few minutes a day can provide enjoyment and a sense of purpose and normalcy during challenging times.
• Move more. Even if it’s the last thing you feel like doing, try to get some physical activity in every day. Walking, light stretching, or gentle yoga can help improve your energy, mood, and sleep.
• Nourish your body. Do your best to focus on nutrient-rich foods and minimize your intake of ultraprocessed foods to help your body feel strong. If possible, work with an oncology dietitian to personalize a plan for your nutrition needs, especially if you’re managing treatment side effects.
• Set boundaries and protect your energy. Don’t feel obligated to say yes to every request or invitation. Conserve your energy for the people, experiences, and activities that matter most to you. Politely declining when you don’t feel up for something is an important part of self-care.
• Prioritize sleep. Practicing good sleep hygiene and getting restful sleep can also help you feel more energized each day.

• Supporting your emotional needs through therapy, mindfulness, and community can help you manage the ups and downs of life with mTNBC.
• Proactively addressing mTNBC symptoms and treatment side effects can dramatically improve your comfort and quality of life.
• Whether it’s boundaries, food, movement, or rest, honoring your self-care needs is a vital part of living well with mTNBC.