Why patient recorded outcomes should be mandatory in and outside clinical trials to guide management of patients with metastatic breast cancer

Although metastatic breast cancer (MBC) may be responsive to further treatment, it is incurable, and so improving the quality of life (QoL), not merely the length of life, is an important parameter of benefit. Patients need appropriate formal psychosocial assessment to enable identification of those who may require different forms of support in order to minimize the social and emotional impact of the diagnosis and effects of treatment. Between 31% and 57% of women with MBC will have a mood disorder that merits intervention, but oncologists are not very skilled at recognizing psychological distress and then referring patients for specialist help. This means that patients' psychological needs may go unrecognized, underestimated and under-treated. Some countries may well have resource constraints that limit access to specialist supportive care provided by breast care nurses, trained counsellors, clinical psychologists, liaison psychiatrists and others, but a clear evidence base exists from at least five meta-analyses that demonstrates the efficacy of psychosocial interventions in adult cancer patients. In MBC specifically, the benefits of interventions such as group support and cognitive behaviour therapy have been demonstrated. The UK and Australia have both produced national guidelines and guidance about the provision of supportive services.