Giving hope to those affected
by secondary breast cancer
22nd November 2025 by Sarah Thomas
There are few conversations harder - or more necessary - than those about end-of-life. For people living with secondary (metastatic) breast cancer, these discussions sit at the intersection of hope, honesty, and humanity. Yet too often, they come too late or happen without the right people in the room.
A recent global workshop led by the Advanced Breast Cancer (ABC) Global Alliance, published in the European Journal of Cancer Care, explored what “best practice” looks like when communicating prognosis and end-of-life care. 71 participants: including patients, caregivers, oncologists, nurses, psycho-oncologists and palliative care specialists, came together from 27 countries to share experience and insight.
Their message was clear: these conversations matter deeply. And when they happen at the right time, in the right way, with the right people and language, they can help people live fully and die on their own terms.
Many people say that end-of-life conversations happen too late - often when symptoms are overwhelming, or when energy and time to process information are limited. The workshop participants agreed that these conversations should begin early enough that the end still feels far away.
That doesn’t mean delivering everything in one heavy meeting. It means having a series of small, open conversations that evolve as treatment and life circumstances change. These talks might begin around the time of diagnosis, after a scan, or when treatment goals shift - but only when the person feels ready.
As one nurse in the workshop put it, “It’s about planting a seed, not forcing it to grow.” Sometimes the best first step is simply to say, “This is something we can talk about together when you feel ready.”
No one should face these conversations alone. The report recommends that people with secondary breast cancer are encouraged to bring someone they trust - a family member, friend or carer - for support. Their presence can help remember information and provide comfort.
But the choice should always belong to the person with cancer. Cultural and personal preferences differ widely. Some people want their whole family involved; others prefer to talk privately. What matters most is asking what feels right.
For nurses and clinicians, the research underlines the value of continuity and trust. The conversation should ideally be led by someone the patient knows - often their oncologist or specialist nurse - and supported by the wider multidisciplinary team. Good communication within that team ensures everyone is giving consistent, compassionate messages.
The words we use can shape how people experience their illness and their future. Honesty is vital, but so is sensitivity. Participants in the ABC workshop agreed that it helps to talk about best and worst-case scenarios rather than exact timelines. This allows people to plan without feeling that their future has been reduced to a number.
Before sharing information, nurses and clinicians can start by asking what the person already understands and what they want to know. Simple, open questions like “What’s most important to you right now?” or “Would you like to talk about what might happen next?” can help guide the discussion.
People should also be told about the full range of support available - not only medical or palliative care, but also psychological, spiritual, social and financial support. These are part of living well, right to the end.
More than anything, people need time, privacy and presence. The research highlights how important it is that these discussions are unhurried and held in a calm, private space. Nurses, who often spend the most time with patients, play a vital role here - noticing when someone is ready to talk, holding the space for emotion, and translating medical language into compassion.
End-of-life discussions are not only about medical decisions; they are about identity, meaning, and control. A quiet room, an open chair, a clinician who listens more than they speak - these small acts can transform the experience from one of fear to one of shared humanity.
Providing a written or audio summary of what’s been discussed can also help patients and families process information and ensure consistency if care teams change.
What the ABC Global Alliance workshop reminds us is that end-of-life care is everyone’s responsibility - not just doctors and not just patients. It’s a shared journey that begins with trust and grows through understanding.
For nurses and doctors, it means having the confidence, training and support to lead or join these conversations early. For patients, it means knowing that asking questions - or asking not to talk about certain things yet - is absolutely okay.
And for all, it means recognising that the right time and the right way will look different for each individual.
There may never be a perfect script for talking about dying. But there can be better beginnings. When handled with care, end-of-life conversations become not about loss, but about choice, connection and living well to the very end.
The right time is when someone is ready.
The right way is with kindness.
And the right people are those who listen.
Citation
L. Fallowfield, B. E. Kiely, L. Travado, R. Ventura, J. Dullehan, F. Cardoso, Best practices for communication of prognosis and end-of-life discussions with patients with advanced breast cancer: A report from the advanced breast cancer global alliance, The Breast, Vol 84 (2025), https://doi.org/10.1016/j.breast.2025.104595
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