Appropriate to involve a multidisciplinary team to consider effective evidence-based anti-cancer and supportive therapies in the management of patients with metastatic breast cancer. A key contact person should be agreed to support communication and coordination of patient-centred care.
Appropriate to communicate effectively and sensitively in a culturally safe environment with metastatic breast cancer patients and their families, and provide timely, comprehensive, patient-centred information on matters including:
prognosis and the intent of treatment
potential benefits and harms of treatment (including complementary and alternative therapies)
Appropriate for patients with metastatic breast cancer to have access to effective pain and symptom management and psychosocial support, including multidisciplinary supportive and palliative care services when required.
Appropriate to offer 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 with metastatic breast cancer.
Not appropriate to use chemotherapy in patients with metastatic breast cancer who are unlikely to benefit, such as those who have received multiple lines of prior therapy for advanced disease, and with low performance status (3 or 4) or at high risk of toxicity.
Not appropriate to use chemotherapy in preference to endocrine therapy (with or without a CDK inhibitor) as initial treatment for patients with metastatic breast cancer that is hormone receptor-positive and HER2 negative, unless there is visceral crisis.
Appropriate to consider 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).