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Surveys indicate that MBC patients strongly desire better communication with their HCPs.
They would like to feel cared for and respected as persons, not just patients, and to have their
concerns heard and the challenges they face understood. Areas much in need of improvement
are continuity and coordination of care; patient-friendly office procedures and hours, including
less waiting time, timely test results, and better access to staff when the office is closed. Also
needed are higher-quality patient education and disclosure to facilitate treatment decision
making, more time with providers to address patient concerns, and referrals to second
opinions and specialists [57, 79] .

An overwhelming majority of surveyed patients with MBC are either currently undergoing an
anticancer treatment or are in the process of changing treatments after disease progression. People diagnosed
When asked, very few survey participants say they prefer to “live out the time they have with MBC would like
peacefully, without treatment” [3, 57] . to feel cared for and
respected as persons,
When asked, MBC patients have many concerns about the treatment they receive, some of not just patients,
and to have their
which could be addressed through better communication with HCPs. They express frustration concerns heard and
at the trial-and-error nature of treatment, seek less toxicity, and are eager for biomarkers the challenges they
predictive of treatment benefit. When asked about the risk-to-benefit “trade-off” of treatment, face understood.
MBC patients show a willingness to tolerate significant toxicity in exchange for possible benefit,
such as longer survival or even a modest delay in progression of their disease [79-81] . However,
symptom severity is also of concern to them, and treatment choices may vary by stage of
life—for example, whether or not children are still at home [80] .

We did not review the extensive literature on communication issues with physicians, patients,
and families surrounding end-of-life choices, as the focus of our analysis is living with MBC. But
it is never too soon for MBC patients to establish lines of frank and open communication with
their treating physicians, as a full discussion of the goals of treatment is central to quality of
cancer care as well as quality of life.

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