Palliative And Oncology Care Model In Breast Cancer

This research study tests whether or not the earlier introduction of a team of clinicians
that specialize in the lessening (palliation) of symptoms and addressing quality of life
concerns may improve the end-of-life care, quality of life, and mood of women with poor
prognosis metastatic breast cancer.

Palliative care is a specific type of medical care given to patients to improve their pain
and other symptoms like fatigue, and to support patients and their families as they cope with
their illness. Palliative care includes physicians and advanced practice nurses who have been
specifically trained in how to help patients with serious illness.

Increasingly, the role of palliative care has been shown to benefit patients when introduced
early in the disease trajectory. For example, in patients with metastatic (or spread) lung
cancer, early involvement of palliative care improves patients' quality of life and mood.
Patients with some metastatic cancers, like breast cancer, have an unpredictable disease
trajectory, which makes it difficult to determine the best time to introduce palliative care
services.

Inclusion Criteria

- Diagnosed with metastatic breast cancer and:

1. have been informed of a diagnosis of leptomeningeal disease in the past eight
weeks; OR

2. have been informed of a diagnosis of progressive brain metastases after initial
radiation therapy in the past eight weeks; OR

3. have been diagnosed brain metastases and began whole brain radiation in the past
eight weeks; OR

4. had an unplanned hospital admission and was discharged within the past eight
weeks; OR

5. have been diagnosed with triple negative breast cancer and started second-line
treatment in the past eight weeks; OR

6. have started the third regimen in one year within the past eight weeks; OR

7. have HER2+ disease and started third-line therapy within the past eight weeks; OR

8. have ER+ disease and started third-line chemotherapy within the past eight weeks;
OR

9. enrolled on a clinical trial within the past eight weeks

- Receiving cancer care at MGH Cancer Center.

- Able to read and write in English.

- Eastern Cooperative Oncology Group status between 0 and 2.

Exclusion Criteria:

- Already receiving palliative care in the outpatient setting.

- Active, untreated, unstable, serious mental illness (e.g., active, untreated
psychotic, bi-polar, or substance-dependence disorder) interfering with ability to
participate.

- Cognitive impairment (e.g., delirium, dementia) interfering with ability to
participate.

- Requires urgent palliative or hospice care.