There is a need for better research dedicated to the issues of advanced breast cancer, according to an expert who presented the 3rd ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 3) at the recently concluded European Society of Medical Oncology (ESMO) Asia 2016 Congress.

Dr Fatima Cardoso, Director of the Breast Unit at the Champalimaud Clinical Center in Lisbon argued that a lot of the existing guidelines for advanced breast cancer are based on expert opinion ? the lowest level of evidence. Indeed, while 32 guidelines are based on level 1A and 1B evidence ? the two highest levels of evidence ? 43 guidelines are based only on expert opinion.

Such a lack of strong evidence as bases for medical decisions serves only to underscore how important guidelines are, Dr Cardoso said. This is especially true because patients in a clinical trial population may not reflect those that are actually encountered.

In her presentation, Dr Cardoso emphasized the poor survival of breast cancer patients, especially those with advanced and metastatic cancers. “There will be an estimated 561,334 deaths worldwide in 2015 and an estimated 805,116 by 2030,” she said.

Similarly, the quality of life of metastatic breast cancer patients has not seen improvements over the past decade. In fact, according to the Global Status of Advanced/Metastatic Breast Cancer Report, the quality of life has even slightly decreased over the past decade.

If anything, these statistics only serve to further emphasize the importance of guidelines. “If all cancer patients would be treated according to the current knowledge, mortality would substantially decrease,” Dr Cardoso said.

The ABC 3, published in The Breast and Annals of Oncology, recommends that the management of advanced breast cancer should involve a multidisciplinary team. This includes professionals with various specialties like surgical oncology, radiation, pathology, imaging, palliative care, social work, nursing, psycho-oncology and gynaecology.

While experts and professionals across the board agree on this, in reality, it isn’t completely followed. Indeed, according to the Here & Now research, while 96 percent of healthcare professionals agree that better care can be achieved by a multidisciplinary team, 26 percent of healthcare professionals concede that they do not work in such a team.

Because advanced breast cancer patients now benefit from better survival rates, the ABC 3 also recommends that healthcare professionals should be aware of various survivorship issues.

For instance, they should be prepared to adapt their treatment strategies to fit the needs of the patient especially in terms of adverse effects, quality of life and disease status.

Moreover, the ABC emphasizes that patients who decide to return to their jobs, either out of financial need or desire, should have the opportunity to do so. In line with this, they should also be afforded reasonable and appropriate flexibility in their schedules to make room for occasional hospital visits and continuous treatment.

Unfortunately, this isn’t what happens in reality as well. According to the Here & Now research, about 50 percent of those with previous employment needed to change their work situation as a result of advanced breast cancer. Worse, 37 percent had to stop working either temporarily or permanently.

Additionally, those that do return to their original work left within a year. This is because a big number of employers and healthcare providers are inadequately educated about metastatic breast cancer and its effects on a person’s work, according to Dr Cardoso

Another general recommendation of the ABC 3 focuses on clinical trials. Specifically, it calls for clinical trials to address important clinical concerns, and not just be accomplished for regulatory purposes. In fact, the document recommends that clinical trials should be continuously performed, even after a treatment is approved, to provide accurate and real-world data about the said treatment.

Aside from general recommendations, the ABC 3 also makes recommendations for specific types of advanced breast cancer.

For HER-2 positive advanced breast cancers, the document notes that the optimal length of anti-HER2 maintenance therapy is still unknown, especially for those who achieved a complete remission. Such maintenance therapy should be balanced with cost, toxicity and logistical burden.

For patients with ER-positive or HER-2 negative metastatic breast cancer, the document notes that the best sequence of endocrine agents is still unknown.

Furthermore, according to the ABC 3, triple negative advanced breast cancers currently do not have data that support specific chemotherapy recommendations. Thus, chemotherapeutic recommendations that work for HER-2 negative breast cancers apply to these cases.

Finally, for patients with a triple negative breast cancer found to be associated with BRCA mutations, if the cancer was previously treated with anthracycline with or without taxane, the best option to use is a platinum regimen if no other clinical trials are available.

The recommendations presented by Dr Cordoso are only select messages from the ABC document. As such, there are much more recommendations in the document which tackle deeper issues related to advanced breast cancer care.