Cancer Australia is placing metastatic breast cancer front and centre with a new national statement aimed at promoting best practice for patients.

Launched last Thursday, the statement addresses 10 practices for better metastatic breast cancer care.

The 10 priority areas address four key themes:

  • Reducing unwarranted variation
  • Encouraging clinical reflection
  • Conversations with patients
  • Leading change through collaboration.

Cancer Australia CEO, Professor Dorothy Keefe said metastatic breast cancer is also referred to as secondary breast cancer.

“[Cancer] can spread outside of the breast to other parts of the body …that’s when we call it metastatic … it tends to spread particularly to the bones, the lungs, the liver and the brain,” Professor Keefe said.

“Once the cancer has spread outside of the organ of origin, in this case the breast, it’s much harder to cure.”

This is because it’s harder to remove cancer cells that have spread to more than one place.

Professor Keefe said while breast cancer affects near 20,000 people a year –approximately only five percent of that number will develop metastatic breast cancer.

While Indigenous Australians are slightly less likely to be diagnosed with early stages of breast cancer than non-Indigenous Australians, they are more likely to develop metastatic breast cancer and less likely to survive it.

Those living in rural and remote areas are also more likely to develop metastatic breast cancer

The CEO said this is due to diagnoses often being received at the cancer’s more advanced stages.

“[For Indigenous Australians] there are fewer breast cancers that are curable at diagnosis, even though the overall number diagnosed might be slightly lower, because they’re a slightly higher stage they are more difficult to treat and the outcomes are not so good,” Professor Keefe said.

The CEO said late diagnosis is a complex issue but is thought to be related to the social determinants of health such as disadvantage and distance from treatment centres.

“That probably doesn’t explain all of it, it’s an area that we need to do more work [on],” Professor Keefe said.

“This is an area that Cancer Australia is very interested in trying to help fix.”

 

Holistic and multidisciplinary

As part of the national statement, Cancer Australia has looked at a wealth of evidence on treating metastatic breast cancer, seeking advice from doctors, nurses, clinicians and consumers, too.

“We looked at not just physical treatments … but we also looked at the communication, culturally appropriate care and the psychological support,” Professor Keefe said.

“It is a holistic issue – we have to look after the whole person.”

Professor Keefe said it’s about empowering people to partner in their own care.

The resources provided online with the statement have two separate streams – clinician-focused instructions and consumer information for people with breast cancer or metastatic breast cancer.

“The idea is that it brings the clinicians and the consumers together so that they … come to a joint decision about what the best treatment is for the individual,” Professor Keefe said.

To enable best practice, the CEO said multidisciplinary teams should be mandatory for patients and should include people such as psychologists, radiologists, surgeons, oncologists, cultural and linguistic workers and Indigenous health workers (if the person is Indigenous).

“It’s not something that a single clinician should manage on their own because there are always multiple perspectives that need to be taken into account,” Professor Keefe said.

 

Seeking advice

The CEO also said Cancer Australia is continuing its fight to raise awareness of breast cancer, particularly during this Breast Cancer Awareness Month.

The organisation has been working with several groups, including Breast Cancer Network Australia, Australasian Society for Breast Disease and Cancer Australia’s Intercollegiate Advisory Group which hosts the presidents of large medical and nursing colleges.

“We use our Indigenous leadership group for advice and then we look at whether we’ve actually communicated with everyone that needs communicating with,” Professor Keefe.

“We don’t know necessarily what Indigenous people think or feel or want unless we actually ask them directly.”

Cancer Australia’s Leadership Group on Aboriginal and Torres Strait Islander Cancer Control is made up of nine members representing organisations including the Menzies School of Health Research, National Aboriginal Community Controlled Health Organisation (NACCHO) and the National Aboriginal and Torres Strait Islander Health Standing Committee (NATSIHSC).

“We work with this group to seek the insights we need to provide the best care that we can.”

 

Researching the gap

With the gap in outcomes for cancer in Indigenous and non-Indigenous Australians not improving, Cancer Australia has great interest in researching and trying to narrow this gap.

“Cancer Australia established two or three years ago a National Aboriginal Leadership Group with whom we work closely to look at areas for investigation and improvement in Indigenous cancer outcomes,” Professor Keefe said.

Professor Keefe said the organisation is interested in exploring whether there is something biologically different in cancers in the Indigenous population.

Last year, Cancer Australia also published an Optimal Care Pathway for Indigenous Australians with cancer and earlier this year, launched Yarn for Life, an initiative aimed at creating community conversation to break the stigma around cancer.

To access the national statement from Cancer Australia and other useful resources, visit: https://thestatement.canceraustralia.gov.au/metastatic.

By Hannah Cross