Best practice in metastatic breast cancer care

In October 2019, Cancer Australia launched its Influencing best practice in metastatic breast cancer Statement.

The Statement, which BCNA was involved in the crafting of, aims to deliver better care and ensure people living with metastatic breast cancer know what their treatment options are and are involved in the decisions around that treatment.

We know Australians living with metastatic breast cancer need support, information and access to treatment and supportive care. Many BCNA members report frustration and disappointment about the gaps and disparity of care that exist in meeting those needs.

The Statement hones in on the critical importance of helping and empowering people with metastatic breast cancer to live as well and fully as possible.

What does best practice look like?

As someone living with metastatic breast cancer, you should feel supported to make evidence-informed and shared decisions about the treatment and care that is right for you and empowered to participate actively in conversations around the key practices outlined in the Statement.

The goal of the of the practices outlined in the Statement is to drive practical change so that all Australians receive the information and support they need to work through complex and sensitive decisions about treatment and care.

The Statement highlighted 10 key appropriate and inappropriate metastatic breast cancer practices to ensure that patients receive consistent care.

Appropriate practices include:

  • Enabling access to effective pain and symptom management and psychosocial support, including multidisciplinary supportive and palliative care services.
  • Offering participation in suitable and relevant clinical trials from the time of diagnosis and throughout treatment.
  • Offering biopsy of accessible metastases to assess biological markers (such as oestrogen and progesterone receptors, and HER2 status), and to offer germline genetic testing for BRCA1/2, if the result is likely to lead to a change in the management of patients.
  • Involving a multidisciplinary team to consider evidence-based anti-cancer and supportive therapies.
  • Communicating effectively and sensitively in a culturally safe environment with metastatic breast cancer patients and their families, and provide timely, comprehensive, patient-centred information.
  • Considering single fraction radiotherapy initially for uncomplicated painful bone metastases in patients with metastatic breast cancer, rather than routinely using radiotherapy with extended fractionation schemes (>10 fractions)

Inappropriate practices include:

  • Using chemotherapy in patients with metastatic breast cancer who are unlikely to benefit.
  • Using chemotherapy in preference to endocrine therapy as initial treatment for patients with metastatic breast cancer that is hormone receptor-positive and HER2 negative, unless there is a visceral crisis.
  • Routinely using extensive locoregional therapy in those with minimal symptoms attributable to the primary tumour.
  • Using whole brain radiotherapy for those with brain metastases without considering initial surgery or stereotactic radiosurgery.

To read more about the Statement, visit Cancer Australia’s website.

Issue 86
Autumn 2020