A case of recurrent breast cancer with severe hepatic dysfunction: Integrating narrative-based medicine and clinical decision-making

BACKGROUND: Patients with recurrent breast cancer and liver metastases complicated by hepatic failure have limited treatment options and poor prognoses. Narrative-based medicine (NBM) and shared decision-making (SDM) may support patient-centered decisions even in critical clinical situations. OBJECTIVES: To describe the role of NBM and SDM in guiding treatment decisions for a patient with recurrent breast cancer and diffuse hepatic metastases associated with severe liver dysfunction. METHODS: We present the case of a woman with recurrent breast cancer who developed hepatic failure caused by diffuse liver metastases. Repeated SDM discussions were conducted among the patient, her family, and a board-certified breast oncologist with certification in palliative care. Chemotherapy with eribulin was initiated together with intensive supportive care despite life-threatening organ failure. CONCLUSION: Following the initial onset of adverse effects, the patient's liver function improved, allowing continuation of outpatient chemotherapy and fulfillment of her goal of spending meaningful time with family. The patient survived for approximately 5 months after treatment initiation. SIGNIFICANCE OF RESULTS: This case suggests that individualized care guided by NBM and SDM may support safe and goal-concordant treatment decisions, even near the end of life. Integration of oncologic and palliative expertise may help align medical interventions with patient values and preferences in complex clinical situations.