Metastatic breast cancer patients: the forgotten heroes!

Metastatic breast cancer (MBC) patients have long been treated as ‘‘forgotten heroes’’: forgotten by the research community, by the media, and even by the advocacy world and their fellow breast cancer patients with early disease. Everyone prefers a story with a happy ending, and the fatality burden associated with MBC is often too hard to deal with. It touches the profound human fears of suffering and mortality. The research community, both pharma-sponsored and academic, are too eager to move any new advances, particularly new drugs, to the larger adjuvant setting, and important management questions specific to the advanced setting are frequently left unanswered. In addition, many new agents are either abandoned or moved to the adjuvant setting without having their full potential and optimal usage explored in the advanced setting. For early breast cancer, cooperative groups and pharma-sponsored networks exist or are rapidly created to run very large prospective trials in a record period of time. The same rarely happens for MBC, for which these collaborative efforts are even more crucial in view of the lower number of available patients (approximately one third of the breast cancer population has advanced disease, whereas two thirds have early disease). The great majority of advocacy groups have so far chosen to focus their efforts on issues of prevention, early diagnosis and treatment of early breast cancer. This is, of course, totally understandable and even correct since these are the measures that can impact on the lives of much larger numbers of women. However, it should not be at the expenses of much reduced efforts for MBC patients. Even for early breast cancer patients, who have gone through the ordeal of dealing with the diagnosis and harsh path of treatment, MBC patients can be a reminder which is too hard to bear of what might happen in their own future, and one that they do not wish to be confronted with. Fortunately, two recent initiatives have brightened this dark scenario, and a third one is being prepared. Published in this issue of The Breast, the consensus report of the first meeting of the recently created MBC Advocacy Working Group highlights the unmet needs of MBC patients and issues important recommendations in three major areas: a) Improved access to information, resources and support services; b) Heightened attention to the MBC community; and c) Increased understanding of and access to clinical trials. The second initiative is the first global survey of 950 women living with MBC in nine countries (BRIDGE survey).2,3 The BRIDGE survey has identified the major needs of these women in areas of information and support resources, psychosocial support and access to clinical trials.