Answer: B. Fulvestrant and palbociclib
Although all of the options are appropriate, hormonally-targeted treatment is less toxic than chemotherapy, and combination therapy with an estrogen blocker would further improve survival in this patient. Fulvestrant/palbociclib has been shown to improve PFS in hormone-receptor –positive, HER2-negative metastatic breast cancer that progressed on previous endocrine therapy.
Image identifying a palliative approach in the literature from Sawatzky R, Porterfield P, Lee J, et al. BMC Palliat Care. 2016;15:5. [Open access.] PMID: 26772180, PMCID: PMC471527Palliative Care Treatment of metastatic disease is palliative, with"the goal to anticipate, prevent, and reduce suffering," as well as to improve quality of life.A study in patients with metastatic non–small-cell lung cancer found that those who received early palliative care not only experienced significant improvements in quality of life and mood but also had longer survival, with less aggressive care at the end of life.
Inpatients and outpatients with advanced cancer should receive dedicated palliative care services early in the disease course concurrent with active treatment.Building rapport and relationships with patients and family caregivers Exploration of understanding and education about the illness and prognosisAssistance with medical decision making1