abdominal pain with liver mets

my friend was diagnosed with stage II breast cancer in the fall of '03. she had the mastectomy, TRAM procedure & CMF chemo. all seemed to be ok, then in the fall of '05 presented with difficulty breathing. a dianosis of stage IV breast ca was made-C-T scans revealed mets to the liver, bones,lungs & brain. she had chest tubes & a pericardial window to drain the malignant fluid. she underwent a month of brain radiation followed by xeloda p.o. off & on for about 2 months-she could not tolerate it, and was started on Taxol& Zometa in Feb.  She has had 3 doses.late Feb. she was diagnosed with a pleural effusion & had that addressed with talcum powder added for sclerosis. she now complains of right upper quadrant pain-she thinks it's her liver & has not been able to eat or drink much. she has dropped 30 pounds, has become increasingly weak, is on oxygen constantly...........she refuses to start Zoloft, takes Atavan & Dilaudid. she needed IV hydration on Mon. of this week. Her hgb. dropped & she probably won't be able to receive the Taxol this Mon. (this is her "off" week). she has all but given up. as a friend, should I encourage her to stay with the plan, or try to get her to accept hospice-care, or take that one last trip with her husband? should the pain be followed up, or is it just part of the disease process? thanks,,,,,,,,,,,

[CCF-RN,MSN-JS]

Dear friendofk,  It is difficult to advise about what is the best route to take without knowing the whole situation.  The most immediate need based on the above information would be management of symptoms particularly the pain.  Encourage her to make sure her oncologist is aware of her pain so they can evaluate, she may need adjustment of her pain medications.  As her friend supporting her in whatever decision she is making, based on discussions with her family and health care team.

[OnTheCouch]

I wouldn't presume to answer your very serious questions, but I did want to tell you this:

Many hospices are experimenting with a new program and accepting patients who are still undergoing curative treatment.  They believe that the pain control and psychosocial issues are the same and that they can be of benefit under circumstances other than those which are terminal.  You might check with your local hospice and see if they offer this option.  It is possible that your friend can have the best of both worlds.