National Institute for Health and Clinical Excellence (NICE)
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New NICE guidelines on the treatment and care of people with advanced breast cancer

The National Institute for Health and Clinical Excellence (NICE) has today (25 February) issued a new guideline on best practice for the diagnosis and treatment of advanced breast cancer.

There are approximately 40,500 women diagnosed with breast cancer and 10,900
deaths recorded in England and Wales each year, making it the most common
cancer affecting women. Although rare, breast cancer can also affect men, with
about 260 cases diagnosed and 68 deaths each year. Advanced breast cancer is
breast cancer that can no longer be cured. Those diagnosed in the advanced stages
represent only a small proportion of these new cases.

The guideline, produced for NICE by the National Collaborating Centre for Cancer,
will help clinicians to provide coherent and consistent care for patients with advanced
breast cancer, providing a systematic framework to support patients with the disease
and ensuring equal access to services across England and Wales.

Key recommendations include:
• Offer endocrine therapy as first-line treatment for the majority of patients with oestrogen receptor (ER)-positive advanced breast cancer.
• For patients who are receiving treatment with trastuzumab for advanced breast cancer, discontinue treatment with trastuzumab at the time of disease progression outside the central nervous system. Do not discontinue trastuzumab if disease progression is within the central nervous system alone.
• Healthcare professionals involved in the care of patients with advanced breast cancer should ensure that the organisation and provision of supportive care services comply with the recommendations made in ‘Improving outcomes in breast cancer: manual update’ (NICE cancer service guidance 2002) and ‘Improving supportive and palliative care for adults with cancer’ (NICE cancer service guidance 2004).
• A breast cancer multidisciplinary team should assess all patients presenting with uncontrolled local disease and discuss the therapeutic options for controlling the disease and relieving symptoms.
• Consider offering bisphosphonates to patients newly diagnosed with bone metastases, to prevent skeletal-related events and reduce pain.
• Offer surgery followed by whole brain radiotherapy to patients who have a single or small number of brain metastases that could potentially be removed by surgery, a good performance status and who have no or well-controlled other metastatic disease.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE said:
“The guideline focuses on the whole patient, not just medical treatment. This guidance will ensure that patients have the right information to allow a full discussion on what options are available. These are the first guidelines looking at how best to diagnose and manage advanced breast cancer and set a standard of care across the country.”

Mr John Winstanley, Consultant Surgeon at Royal Bolton Hospital and Guideline Development Group (GDG) Chair said: “It is important that being diagnosed with advanced breast cancer is not seen as an immediate death sentence; it can be managed effectively, allowing patients to have a reasonable quality of life. This guideline pulls together the best ways to treat the cancer medically, helping relieve the symptoms and to support patients psychologically, emotionally and practically.”

Dr Nick Murray, Senior Lecturer and Honorary Consultant Medical Oncologist,
Cancer Research UK Clinical Centre, University of Southampton and GDG
Clinical Lead said:
“As we improve treatments for early breast cancer, fewer people go on to develop advanced breast cancer and there is clear evidence that most patients are getting good care already. The recommendations we have made aim to ensure that all patients receive the best possible care enabling them to maintain a good quality of life.”

Mrs Netta Wooles, GDG Patient Representative said: “Care for people with breast
cancer has dramatically changed since I was treated 20years ago. This guideline,
specifically for the advanced stage of breast cancer, is really good news for patients
especially as advanced breast cancer is often seen as the Cinderella of breast
cancer. Being diagnosed with advanced breast cancer is devastating. It is so
important that information and support is available and easily accessible to ensure
patients can make the most appropriate decision for them in terms of treatment. This
guideline acknowledges that, and makes clear recommendations about supportive

Kathleen Jenkins, Marie Curie Community Nurse and member of the GDG said:
“Caring for people who have been told “there is no further active treatment for you”
can be daunting and for me as a palliative care Clinical Nurse Specialist a not
infrequent occurrence in recent years. Today, advanced breast cancer can be
controlled and managed and many people can enjoy good quality of life and remain
active and productive for years. Good supportive care, palliative care and attention to
managing complications are key recommendations and of particular interest to
nurses is the recommendation for the nomination of a key worker for individual
patients. I consider nurses to be in an ideal position for this role.”

Notes to Editors

About the guideline

1. The advanced breast cancer guideline is available at: 

About NICE

2. The National Institute for Health and Clinical Excellence (NICE) is the independent
organisation responsible for providing national guidance on the promotion of good health
and the prevention and treatment of ill health.

3. NICE produces guidance in three areas of health:

public health – guidance on the promotion of good health and the prevention of ill
health for those working in the NHS, local authorities and the wider public and
voluntary sector
health technologies – guidance on the use of new and existing medicines,
treatments and procedures within the NHS
clinical practice – guidance on the appropriate treatment and care of people with
specific diseases and conditions within the NHS.

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