Ensure all people presenting with uncontrolled local disease have:
their care needs assessed by a breast cancer multidisciplinary team, and
the therapeutic options for controlling the disease and relieving symptoms discussed by the team, and with the person. [2009]
Ensure people with ulcerated tumours are seen by a wound care team to:
plan a dressing regimen with the person, and
supervise management with the breast care team. [2009]
Ensure all people with uncontrolled local disease are assessed by a palliative care team so they can:
plan a symptom management strategy with the person, and
provide psychological support. [2009]
Consider bisphosphonates for people newly diagnosed with bone metastases to prevent skeletal-related events and reduce pain. [2009]
Denosumab is recommended as an option for preventing skeletal-related events in adults with bone metastases from breast cancer only if bisphosphonates would otherwise be prescribed. For full details, see the NICE's technology appraisal guidance on denosumab (TA265, 2012).
Use external beam radiotherapy in a single fraction of 8 Gy to treat people with bone metastases and pain. [2009]
Ensure people at risk of a long bone fracture have their disease assessed by an orthopaedic surgeon to see if prophylactic surgery is a suitable option. [2009]
For recommendations about the management of spinal metastases, see the NICE guideline on spinal metastases and metastatic spinal cord compression.
Offer referral to specialist palliative care to people if active treatment for brain metastases would be inappropriate. [2009]
When providing palliative and end of life care to people with advanced breast cancer, follow the recommendations in NICE's guidelines on end of life care for adults and care of dying adults in the last days of life.