Symptomatic Nursing Management of Advanced Breast Cancer with Multiple Metastases During DS-8201 Treatment: A Case Report and Literature Review

Abstract

To summarise the therapeutic effects of symptomatic nursing during DS-8201 (Enhertu) treatment in a patient with advanced breast cancer with metastases to the ribs, lungs and liver. The patient, diagnosed with breast cancer with multiple metastases, was admitted to the hospital on 4 January 2021, 2 months after the discovery of a right breast mass. DS-8201 was administered during this period, and nursing care was tailored to address the patient's symptoms while on the medication. Before treatment, the Hamilton Anxiety Scale score was 22, the Pittsburgh Sleep Quality Index score was 19 and the Insomnia Severity Index score was 24. After treatment, the SAS score decreased to 15, the PSQI score to 12 and the ISI score to 11, indicating improvements in sleep quality and anxiety. Re-examination showed minimal change in left breast nodules compared with previous results, with no additional metastases detected. By the follow-up in September 2023, the patient showed no signs of obvious recurrence and had not returned to the hospital for further consultation. During a telephone follow-up in October 2023, the patient reported no significant discomfort, her condition remained stable and her health indicators were well controlled while on the medication. This study details the symptoms and corresponding nursing interventions for patients with advanced breast cancer undergoing DS-8201 treatment, providing a nursing reference for future patient care.

Keywords: Enhertu; breast cancer; multiple metastases; nursing.

Figure 1

Pathological Section of Breast Cancer Tissue. (A) Postoperative pathology of the right breast, showing invasive ductal carcinoma (Hematoxylin and Eosin stain, ×100), grade 2, with malignant cell clusters. (B) Puncture smear of the right breast lymph node (Hematoxylin and Eosin stain, ×200), revealing metastatic involvement. These images confirm the initial diagnosis, which informed the subsequent treatment approach and nursing care strategies.

Figure 2

Abdominal Ultrasound of Liver Metastasis. (A) A 2D ultrasound image showing a hypoechoic liver lesion approximately 77 mm × 25 mm under the hepatic capsule in segment S4. (B) Color Doppler Flow Imaging (CDFI) highlighting blood flow around the lesion. This figure demonstrates the metastatic progression of the cancer, which was crucial in determining the need for Trastuzumab Deruxtecan (DS8201) treatment and symptom-focused nursing care.

Figure 3

CT Imaging of Rib Metastasis. (A) Chest CT cross-section showing destruction of the fourth rib with a soft tissue shadow, indicating metastatic malignancy. (B) Pathological section confirming rib invasion by cancer cells. These images underscore the extent of metastasis, necessitating vigilant symptom management through personalized nursing interventions.

Figure 4

Lung CT of Metastatic Nodules. (A) Lung CT displaying multiple small nodules in both lungs, with enlargement in the lingual segment of the upper left lobe. The red arrow indicates the primary metastatic nodule in the upper lobe of the left lung, which was found to be slightly enlarged compared to previous imaging, suggesting disease progression. (B) Pathological section showing cancer cell invasion in lung tissue. This figure relates to the nursing care plan by highlighting the patient’s respiratory health needs, a consideration during symptom management with DS8201 treatment.