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To examine the role and value of specialist metastatic breast care nurses in Australia from the perspective of metastatic breast care nurses, patients, and family members. Metastatic breast cancer (mBC) is treatable yet incurable, with distinct supportive care needs, yet many of these needs are unmet. Diverse sampling methods were used to recruit 10 people with mBC, 5 family members and 10 metastatic breast care nurses. Semi-structured interviews were conducted online or by telephone during August–December 2020, and analysed thematically. The role of the specialist nurse was strongly valued within and across participant groups, with close alignment regarding what was highly valued. Three themes were identified. First, nurses played a vital role in giving voice and visibility to patients with mBC in a healthcare system in which they often felt invisible. Second, nurses combined their clinical and psychosocial skills with a sense of authentic engagement to create a safe space for those with mBC to discuss their feelings, experiences, and topics, especially those that were unlikely to be discussed in their other social and clinical interactions. Finally, nurses supported patients in living as well as possible while managing symptoms, ongoing treatment, and attendant psychosocial impacts of an incurable and life-limiting condition. This study underscores the central importance of metastatic breast care nurses in enhancing patient well-being, bridging gaps in care, and offering much-needed support. By addressing patients' emotional, clinical, and social needs, these specialist nurses contribute to a more holistic and compassionate approach to managing mBC. • Treatment advances are extending the length of time some people are living with mBC. • Supportive care for people with mBC has not always kept pace with treatment advances. • Supportive care for people with mBC is complex and distinct from early breast cancer care. • Specialist mBC nurses are redefining models of breast cancer care. • Specialist mBC nurses reduce the burden of living with mBC. [ABSTRACT FROM AUTHOR]

To assess population-level characteristics and post-metastasis survival of people with recurrent metastatic breast cancer (rMBC) during a period when new publicly-subsidised adjuvant and metastatic systemic therapies became available. Record linkage study of females in NSW Cancer Registry (NSWCR) diagnosed with non-metastatic breast cancer (BC) in 2001–2002 (C1) and 2006–2007 (C2). We identified first rMBC from NSWCR, administrative hospital records, dispensed medicines and radiotherapy services (2001–2016). We used death registrations to estimate cumulative incidence of BC death. The analysis included 2267 women with rMBC (C1:1210, C2:1057). Compared to C1, C2 had access to adjuvant HER2-targeted therapy and were more likely to have received adjuvant chemotherapy (C1:38%, C2:47%) and aromatase inhibitors (C1:52%, C2:73%, of those dispensed endocrine therapy). Five-year probability of BC death was 65% (95%CI:62–68%) in C1 and 63% (95%CI:60–66%) in C2. Regional disease (T4 or N +) at initial BC diagnosis (C1:62%, C2:68%), and age ≥ 70 years at first metastasis (C1:27%, C2:31%) were more common in C2 and had poorer prognosis. Five-year probability of BC death was lower in C2 than C1 for treatment-defined HER2-positive BC (C1:72% 95%CI:63–79%; C2:52% 95%CI 45–60%) and those dispensed chemotherapy alone (C1:76% 95%CI:69–82, C2:67% 95%CI:59–74%, p = 0.01), but not treatment-defined hormone receptor-positive HER2-negative BC (C1:60% 95%CI 56–63%, C2:64% 95%CI 60–68%). Despite less favourable prognostic characteristics in C2, BC-related survival following rMBC was similar between the two cohorts; and improved for women with HER2-positive tumours. These findings support the real-world benefits of newer treatments for rMBC. • Population-based study of distant metastasis following Stage I-III breast cancer. • Proportion of people using more effective adjuvant therapies increased over time. • First metastasis at older age and after regional disease increased over time. • Despite these differences, post-metastasis survival was maintained over time. • Post-metastasis survival improved for HER2-positive breast cancer. [ABSTRACT FROM AUTHOR]