70 5. Relief of Physical Symptoms Since the goal of MBC treatment is to control the disease for as long as possible while preserving functional status and quality of life, a major task for the health care team is palliating symptoms that may interfere with daily life, causing emotional distress, and the fatigue, sleeping difficulties, pain, and many other symptoms typically experienced. As mentioned previously, physical symptoms are intertwined with psychosocial distress. As the disease progresses, symptoms tend to become more debilitating and interfere more with normal functioning, resulting in greater distress. One consecutively sampled community-based study[82] found significant physical impairments in almost all 163 MBC patients, yet only one third were receiving appropriate remediation with occupational or physical therapy. Racial and socioeconomic disparities in provision of care were clearly present. Physical symptoms of MBC may be generalized, such as fatigue or insomnia, or organ- specific, according to the site of tumor-cell spread. Organ-specific examples include dyspnea (breathlessness), which may be associated with lung metastases or pleural effusion, and anemia, which may be related to bone marrow metastases or to low red blood cell counts from chemotherapy. The prevalence of chronic pain in patients with metastatic cancers is estimated at 70–90% and is among the most distressing physical symptoms[83] . Pain may be associated with tumors exerting pressure on or displacing nerves. A common source of pain is bone metastases, although bone-modifying agents have significantly decreased bone pain and fractures in recent years. Some drugs used to control the cancer cause worrisome and in some cases permanent side effects, such as taxane-related peripheral neuropathy. Nausea and vomiting may be related to involvement of the gastrointestinal tract, such as liver or peritoneal metastases or ascites, or to brain or other central nervous system metastasis or side effects from chemotherapy or other anticancer agents. Significant progress has been made in developing supportive medications that can decrease the frequency and severity of nausea and vomiting. Fatigue is by far the most common physical symptom reported by MBC patients, occurring in 80% or more of those undergoing treatment[84] , as confirmed in patient surveys[57] . Fatigue is frequently associated with depression or anxiety as well as with treatment toxicities and MBC itself[4] . Other contributing factors may include tumor burden, pain, difficulty sleeping, anemia, poor diet, inactivity, and other coexisting conditions[51, 85-88] . Fatigue is also one of the most difficult symptoms to treat[89] . For most MBC patients, symptoms and side effects of treatment disrupt daily life and interfere with normal activities.