Description
On 3rd March 2009 NICE released the latest guideline CG81 Advanced breast cancer: full guideline on their website. This is a comprehensive review of the management of metastatic breast cancer and some aspects have already proved controversial particularly for the recommendations for individual drug therapies which some see as too restrictive and based on poor evidence. One key area which is highlighted however has general agreement; that the co-ordination of care for patients with advanced breast cancer is much poorer than in the primary curative setting. This same theme would I suspect be replicated across the other cancer sites.
The management of patients with advanced disease is very complex. A diagnosis of advanced breast cancer is devastating for the patient and their family and carers, and may lead to anxiety, depression
and complex and changing psychosocial, physical, spiritual and financial needs. Patients often report that they were unaware of what support services were available, and in many centers there is a lack of the availability of a key worker to co-ordinate care – since many (surgical) breast care nurses’ roles end after primary diagnosis. It is clear that patients with advanced cancer and their families need a seamless service throughout all stages of their journey and the provision of a key worker or specialist oncology nurse would be crucial to this. As patients move towards the later stages of their disease and treatment, choices about end of life preferences need to be available and it is vital that palliative care liaison and services are available.
In the current issue we look at amongst others, important issues in patients with advanced cancer such as depression (approximately 80% of psychiatric morbidity is unrecognized) and its management,
and unusual methods of symptom relief in severe intractable pain. It is clear from the above that multidisciplinary management for advanced cancer patients is essential, and that all members of the team need to be aware of the wide range of clinical and social scenarios which affect our patients.
