Policy briefing

Secondary breast cancer: charity’s study reveals inadequate levels of care and support

Breast Cancer Care urges Health Education England to fund continuing professional development programmes to equip staff with the knowledge and skills to help people with secondary breast cancer

Breast Cancer Care urges Health Education England to fund continuing professional development programmes to equip staff with the knowledge and skills to help people with secondary breast cancer

Secondary breast cancer occurs in the bones, brain, lungs or liver
Picture: Science Photo Library

Essential facts

Inadequacies have been revealed in the care and support offered to people living with secondary breast cancer.

A study by the charity Breast Cancer Care (BCC) says people who have secondary breast cancer regularly report feeling ‘isolated and forgotten’.

Secondary breast cancer commonly occurs in the bones, brain, lungs or liver. It can be treated, but not cured.

Main arguments

  • Research by BCC for its campaign, Secondary. Not Second Rate, suggests that many people living with secondary breast cancer experience delays in diagnosis.
  • People who are experiencing secondary cancer do not always receive the care they need and have limited access to specialist nursing care – despite their complex emotional and supportive care requirements.

UK data

Estimates suggest there are about 36,000 people in the UK living with secondary breast cancer. But BCC says that incomplete data collection at trusts in England means the figures are unreliable.

Ways to support patients

The charity’s report makes recommendations grouped around three areas: diagnosis, data collection, and support and nursing care.

It says, for example, that NHS organisations should consider open access to follow-up that allows immediate self-referral back to the breast care team for anyone with concerning signs or symptoms.

The charity also recommends that Health Education England should urgently fund continuing professional development programmes that equip staff with the necessary skills and knowledge to support patients with secondary breast cancer.


A number of good practice examples in secondary breast cancer care are contained in the report, including training initiatives developed at Edinburgh Breast Unit.

Among these are rotation opportunities for clinical nurse specialists in the early breast and adjuvant cancer service. The clinical nurse specialists work alongside the secondary team, either for a fixed period or for one or two days a week, with the aim of developing skills and competencies in caring for patients with secondary breast cancer.

Implications for nurses

Many hospitals are looking to improve services for patients with secondary breast cancer but best practice needs to spread wider, says Breast Cancer Care (BCC). 

The best breast care teams take a proactive approach to providing patients with important information, support and care. Nurse-led approaches can help to maximise resources when teams work collaboratively to ensure a wider, holistic level of support.

Specialist nurses providing secondary breast cancer care must develop appropriate expertise, including assessment and management of common symptoms such as bone pain, and supportive communications skills. They must also acquire understanding of secondary breast cancer biology and pathophysiology, and knowledge of local and national support services.

BCC says the key characteristics of an excellent clinical nurse specialist in secondary breast cancer include the ability to build relationships with patients based on trust; and a ‘kind but firm’ approach that allows bad news to be relayed in an honest, open manner.

Examples of other key qualities are being accessible and available, and a willingness to attend clinic appointments, with a debrief afterwards to explain results and answer any questions.

Patients spoken to by BCC said repeatedly that ‘little things matter’.

‘Patient feedback has stressed that an approachable, positive point of contact can make a huge difference,’ the charity says.

Expert comment

Catherine Priestley, clinical nurse specialist in secondary breast cancer at Breast Cancer Care

‘Far too many people living with incurable secondary breast cancer are still not getting the support they need. Close to half of trusts and health boards we surveyed were not providing specialist nursing care for these patients.

‘We also found that more than 40% of people with the disease felt their overall care was poorly managed.

‘But many hospitals are now striving to improve their services – and innovative strategies and sharing good practice are crucial.

‘Meeting the needs of individual patients is central to delivering better care. This could be through offering information, a holistic needs assessment and appropriate signposting to care and support.

‘Most importantly, healthcare providers must listen to patients. We must all identify opportunities to maximise limited resources to provide the greatest amount of care and support.’


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