Your metastatic treatment and care team

Most people see more than one health professional during their treatment for metastatic breast cancer.

You will be involved with some of your specialists for a long time. It’s important you choose a team you can talk to easily, with people who make you feel well cared for.

We explain the role of key health professionals who may be part of your team.

For other health professionals such as physios and lymphoedema specialists, go to Allied health care for early breast cancer. Learn about the importance of a multidisciplinary team and how it works.

Choosing your team

People with metastatic breast cancer who have an earlier experience with breast cancer do not have to see the same specialists.

Your medical oncologist usually leads the team, so this is your starting point.

While you may be referred to a particular specialist, you may have a choice in who you see. If you are a private patient, you choose who is part of your team. 

Take time to decide if you are comfortable with each member of your medical team.

The number and kinds of health professionals treating you at any one time will depend on:

• which organs are affected by breast cancer
• how well or unwell you are
• where you live
• where you are being treated.

Recommendations from other people can be valuable.

Note: If you live in a rural or remote area, you may not have many choices. You may also have to travel long distances to see your specialists and spend more time away from home. The option to choose between different specialists is considered best practice, but it may not be possible for you.

Second opinions

While you may initially be referred to one specialist, you do not need to stay with that specialist. If you are unhappy or uncomfortable with the specialist you have been referred to, it’s a good idea to ask for a second opinion.

Remember, you may have to see these people for several years as you go through treatment and follow-up care.

Choosing public or private care

You can choose whether you would like to be treated in the public or private sector. Even if you have private health insurance you can choose to have treatment in a public facility.

General practitioner (GP)

Many people with metastatic breast cancer find they need more contact with their GP than any other health professional apart from their medical oncologist.

Even though your medical oncologist is often the key specialist, you still need a GP for your day-to-day needs. They can:

• assess each problem and, if serious and cancer-related, speak with your medical oncologist
• explain medical information for you
• organise counselling and practical support
• refer you to other medical specialists and health professionals. 

Ask your specialists to send copies of all tests and planned treatments to your GP.

If necessary, your GP may be able to visit you at home or via telehealth. Find out more ways your GP can help.

How to find a GP

If you don’t have a regular GP, or one you are not comfortable with:

• Ask family, friends or people who live near you for recommendations.
• Speak to health professionals, such as pharmacists or members of your treating team, to find out if they have suggestions.
• Search for GPs near you on the Healthdirect website.

Medical oncologist

Your medical oncologist usually leads your treatment team. They will refer you to other specialists when needed and usually coordinate your treatment and care.

They specialise in diagnosing and treating cancer using:

• chemotherapy
• hormone-blocking therapy
• targeted therapies such as trastuzumab
• immunotherapy. 

What to consider

Some of the questions you might like to consider when choosing a medical oncologist are:

• Does the medical oncologist have a special interest and experience in managing metastatic breast cancer patients?
• Do they work as part of a multidisciplinary team?
• Are they linked to other services such as radiotherapy, psychology or palliative care?
• Are they easy to get to (close to home or public transport)?
• If you’re in a remote area, can they offer telehealth consultations, or help coordinate all your appointments into one trip to reduce your travel time?
• Could they help you access clinical trials, if you are thinking about them?
• Will they be comfortable to accept your approach to healthcare, whether you want to be involved in decision making or just told what to do?
• Will they understand and support your choices? For example, some people feel more in control with an intensive treatment plan, even if it means unpleasant side effects. Others are more concerned with their day-to-day quality of life and avoiding particular side effects such as hair loss.
• Are you confident you can voice your needs and feelings and they’ll be heard and taken into account?
• Would you feel comfortable discussing complementary therapies with this oncologist?

How to find a medical oncologist

Choosing your medical oncologist is an important decision. This relationship could influence how you feel about your treatment, how many questions you ask and your sense of being generally well cared for.

In the public system, the breast team at the hospital refers patients to the medical oncology department. If there is no oncology department, which can happen in smaller towns or rural areas, you'll be referred to another hospital.

In private healthcare, the breast surgeon will recommend someone within their team, or they can refer you to your choice of medical oncologist.

Some people like to involve their GP, family members or close friends in the decision. This can be helpful, but it is important to put your own needs and feelings first, rather than what others think is best for you.

Radiation oncologist

Radiation oncologists specialise in treating cancer using radiotherapy. Their role is to decide whether radiotherapy will be of benefit and, if so, to decide:

• the area to be treated
• the dose
• the length of treatment.

They work closely with medical oncologists. You do not need a referral.

Psychologist

Many people with breast cancer will seek counselling at some stage. A clinical psychologist can help you and your family talk through the things causing fear or worry.

In particular, they can help you:

• manage relationships issues
• cope with anxiety and fear
• work through loss and grief
• understand the effects your illness might have on you and your family.

Psychologists who specialise in supporting people who have been diagnosed with cancer are known as psycho-oncologists.

Ask your GP if you're eligible for treatment under a GP mental health treatment plan. This plan gives you to up to 10 Medicare-subsidised appointments in a calendar year with a clinical psychologist.

How to find a psychologist

We share the ways to find a psychologist at Psychology and counselling support.

Specialist surgeon

Surgery is sometimes used to treat metastatic breast cancer. For example, a surgeon may need to:

• remove a metastasis in the brain
• put a pin in a bone to strengthen an area affected by a bone metastasis.
• remove a cancer from the lungs or liver if it is causing a blockage, discomfort or other complications. 

If metastatic breast cancer is your first diagnosis of breast cancer, surgery on the breast may be considered. This is to try and control the cancer in the breast, after initial drug treatment. This surgery isn't always necessary or appropriate.

Nurses - breast care, oncology and/or palliative care

Oncology nurses give chemotherapy and other anti-cancer treatments. Sometimes they help with radiotherapy. They can also provide advice on managing the side effects of treatment.

A breast care nurse is a specialist registered nurse who provides information, education and support. They are often the key contact person in coordinating your care.

If you had a breast care nurse in your original breast care team, let them know if you'd like their support again. 

How to find a breast care nurse

• ask your medical oncologist or GP for a referral.
• Contact the McGrath Foundation. It has nurses throughout Australia who provide free support to people with metastatic breast cancer. Use the Foundation’s Find a breast care nurse tool.
• contact a breast care nurses directly – most are happy for direct contact, without a referral.
• contact the BCNA Helpline on 1800 500 258 and we can connect you with one.

Patient navigator or cancer care coordinator

A patient navigator is a person who helps guide you through complex information and difficult decisions during your treatment.

How to find a patient navigator or cancer care coordinator

This depends on the health care centre in which you’re receiving treatment.

Your specialist breast care nurse or specialist oncology nurse may do this, as they are usually part of your team. Or, another qualified team member may have this role, depending on where you have your treatment.

If you think a patient navigator might be helpful, ask your oncologist or your nurse whether this service is available.

Palliative care providers

Specialist palliative care services help people manage complex pain and symptoms.

They can assess and manage physical symptoms such as pain and poor appetite and can help to ensure your home environment is safe and comfortable. 

They also provide end-of-life care.

Large multidisciplinary teams include doctors, nurses, social workers and others with a range of specialist skills. 

They work together to help people from soon after their diagnosis. Their support includes care for your social, emotional, cultural and spiritual needs, and those of your family.

When to access palliative care services

Many people fear that seeing a palliative care specialist means they are nearing the end of life. However, palliative care specialists can provide care at any stage of your treatment for metastatic breast cancer.

You don’t need to stop breast cancer treatments when you receive palliative care. You can continue treatments to control your cancer and access palliative care when you need it, for example to help with:

• pain management
• managing any symptoms of your cancer. 

You can access palliative care services any time after your diagnosis. Use whatever services you find helpful on a regular basis, or when you need.

Find out more about palliative care.

Social worker

A social worker can help you and your family cope with the emotional, psychological and financial impact of breast cancer.

Oncology social workers provide counselling and support for issues such as:

• coming to terms with your diagnosis
• talking to children and family
• relationships
• sadness and anxiety
• dealing with grief
• coping with fear and loss.

They can also provide you with resources or practical assistance for:

• employment
• finances including pensions, superannuation and benefits
• accommodation if you have to travel for treatment
• legal services
• childcare.

If you spend time in hospital and there is a social worker, they can help arrange your discharge and any care you may need at home.

How to find a social worker

Ask your treating team if you can access a social worker at the hospital or clinic where you are having treatment. 

Pastoral care worker

Pastoral care workers help you to reflect on and talk about your life and its meaning. This may help you feel more hopeful and able to focus on things that bring you joy.

They respect all faiths and religious beliefs. They can help you to adjust to your situation and to explore possibilities for personal and spiritual growth.

How to find a pastoral care worker

Many hospitals, clinics and hospices have pastoral care workers. Ask your team if you can access care at your location. 

Psychiatrist

Around half of all people diagnosed with breast cancer experience some form of depression and anxiety. Support from a specialist can help you and your family. 

Like a psychologist, a psychiatrist will talk to you about how you feel and how you’re coping. Like GPs, psychiatrists can prescribe medication if they think it will help. 

How to find a psychiatrist

• Your GP can develop a Mental Health Treatment Plan and refer you to a psychiatrist. Find out about Mental Health Treatment Plans at Ways your GP can help.
• Use the Find a psychiatrist tool from the Royal Australian and New Zealand College of Psychiatrists

Pharmacist

Your pharmacist can help by:

• explaining how to take your medication
• discussing possible side effects
• suggesting ways to improve some side effects.

If you take several different tablets (‘oral medications’), it can be hard to remember what to take and when.

Ask your pharmacy to prepare a pack with all your regular tablets. They put the tablets together based on the day and time you need to take them. These are sealed in separate sections.

The pack makes it easy to see what you need to take and when, or if you’ve forgotten on a particular day.

Resources

Podcast: Forged in Fire: Relationships with your Medical Team and Self-advocacy

Podcast: Communicating with your health professionals

Webcast: Just diagnosed with metastatic breast cancer, what’s next?

Read about Ways to reduce the financial impact of breast cancer.

Virtual conference: Living the best life you can with breast cancer