LAUSR

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 fi ndings 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 (n 5 59) that received routine care and an intervention group (n 5 61) that participated in 5 palliative 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 signi fi cant bene