Early and Integrated Palliative Care as Valuable Support in Patients With Metastatic Breast Cancer Camelia Rohani, PhD M etastatic breast cancer (MBC) is the most advanced stage of breast cancer, and refers to cancer that has spread from the breast to other parts of the body. 1 There were an estimated 2.3 million new cases of female breast cancer and 684,996 death worldwide in 2020, 2 with MBC causing the majority of those deaths. 3 The number of deaths is higher in developing countries compared with developed countries. 4 The 5-year survival rate for women with MBC is reported to be 28%. 3 Around 5% to 10% of patients are diagnosed with an advanced stage of disease. 5 However, early breast cancer can relapse or recur as MBC after a long time following treatments. 6 There are not enough data, but some studies report that 20% to 30% of patients with early breast cancer will develop MBC and will die. 6,7 Therefore, implementing early integration of outpatient palliative care (OPC) programs is very important. These programs can support patients with advanced cancer, their families, and the healthcare system by reducing unnecessary rehospi- talizations and improving the quality of life (QoL) of patients and their families. 8,9 The 2016 ASCO palliative care clinical practice guideline recommends integrating palliative care early in the cancer trajectory, together with treatment. 10 In this issue of JNCCN, Greer et al 11 present their findings from a valuable clinical trial evaluat- ing the effects of a palliative care intervention on the documentation of end-of-life (EoL) care discussions in the electronic health record; patient-reported discussions about EoL care preferences, QoL, and symptoms of anxiety and depression; and hospice utilization in 2 groups of patients with MBC: a control group (n559) that received routine care and an intervention group (n561) that participated in 5 pallia- tive care intervention visits in coordination with their oncologic care. Data collection was done prospectively, at baseline and at 6, 12, 18, and 24 months after baseline and hospice utilization. This type of data collection is very important and provides rich data. The study by Greer et al 11 resulted in significant benefits for patients with MBC. The rates of discussion and documentation regarding EoL care and hospice services improved within the intervention group compared with the control group. However, study groups did not differ in patient-reported QoL and symptoms of depression and anxiety. The medical literature highlights positive outcomes for OPC programs around the world, but few details of such programs have been published. 8,12 Thus, Greer et al 11 should be praised for moving forward from designing a palliative care model in their prior studies to applying this specific in patients with MBC. They used an adapted intervention program from their prior research based on evaluation of an integrated palliative and oncology care model. 13,14 OPC clinics deliver palliative care services on a specific level, such as a short, concise consultation, and coordi- nate care in alliance with the patient’s primary care physician. They also have a referral process. These clinics are also responsible for postdischarge follow-ups, transition of patient care from hospital to home or home healthcare centers, super- vision of patient care and medications, and answering questions for patients and their families after hospital discharge. 8,9 CAMELIA ROHANI, PhD Camelia Rohani, PhD, is an affiliated researcher at the Department of Health Care Sciences, Palliative Care Center in Ersta Sk€ ondal Br€ acke University College, Campus Ersta, Stockholm, Sweden. She is also an Associate Professor in the Department of Community Health Nursing in the School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. She is currently working on a project involving integrated home-based palliative care services for patients with cancer in the healthcare system of Iran. doi: 10.6004/jnccn.2022.7005 The ideas and viewpoints expressed in this commentary are those of the author and do not necessarily represent any policy, position, or program of NCCN. See page 136 for related article. JNCCN.org | Volume 20 Issue 2 | February 2022 215 THE LAST WORD