What Palliative Care Means for Patients with Metastatic Breast Cancer

Despite its vital function in many patients’ cancer journeys, palliative care is still the subject of several persistent myths and misconceptions, as an expert recently explained.
Dr. Dinaz Irani — a palliative care physician at Columbia University’s Irving Medical Center, part of the NewYork-Presbyterian Hospital System — discussed the role of palliative care for patients with metastatic disease during a December 2025 Educated Patient® Breast Cancer Summit.

“I think there’s a lot of myths and misconceptions about palliative care,” she said during her presentation at the summit. “We’re basically an extra layer of support, and we can help with the relief of suffering anytime someone has a serious illness. We provide specialized medical care that’s focused on comfort and symptom management as well as coping strategies, and we really try to take a holistic approach toward our patients and their families.

"We support not just physical symptoms, but also emotional, social, and spiritual well-being.”

In particular, palliative care is not synonymous with hospice care: The former can be provided at any stage of an illness and administered alongside treatment in a variety of inpatient and outpatient settings, although the latter is one aspect of palliative care and is concerned with end-of-life symptom management.

“The palliative care team is really an interdisciplinary team,” said Irani. “It may be made up of physicians or nurse practitioners and physician assistants. There are usually social workers. There may be therapists on the team, chaplains, and spiritual advisors. We work very closely with your other health care providers, so that you really have one large health care team all working together to try and manage things as holistically as possible and in very close collaboration.”

These multidisciplinary teams, as explained, can address many types of pain via holistic support, including physical pain, emotional pain, social pain, or spiritual and existential pain.

Common symptoms that palliative care teams see in patients with metastatic breast cancer include pain, menopausal symptoms, fatigue, shortness of breath, nausea and appetite loss, constipation or diarrhea, emotional distress, sleep problems, and lymphedema.

“When is the right time to ask for a palliative care referral? Really, there’s no wrong time,” Irani said. “Palliative care may be recommended at the time of diagnosis by your oncologist, or you and your oncologist may decide later on that palliative care referral is appropriate when symptoms are difficult to control, if the treatments are starting to feel overwhelming, if you want help understanding your options, if you or your family are experiencing distress, or if you just want to plan ahead. We can really be helpful at any point during the illness.”

Palliative care teams, Irani noted, can also be involved in advance care planning for patients.

“One of the roles of palliative care is really to help patients think about their wishes for future medical care, so that your values and preferences are honored, even if you’re unable to speak for yourself later in the course of the disease,” Irani said. “We try to help clarify your values and priorities.

Everybody is different, and there are no right or wrong answers when it comes to your decisions about future medical care, but we want to get to know you, and we want to understand what they are so we can honor them. Part of that is also helping you communicate with your loved ones and with the person you designate as your health care decision maker.”

Palliative care teams can help patients fill out health care proxy forms and advance directive forms, with the caveat that, as Irani said, nothing is ever written in stone.

“As the illness changes, and as time goes on, your priorities might change and your decisions might change,” she said. “Things that you thought you wanted before may be different, and we’ll walk you through that. We’ll have these discussions as often as you need them. We can always change your decisions and change your paperwork. We don’t have any agenda here. Our goal really is to just help support you and to advocate for you, and to make sure that whatever decisions you’ve made or whatever preferences you have are followed.”

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