Metastatic Breast Cancer: An NP and a Nurse-Patient on Hope and Honesty

As Metastatic Breast Cancer Awareness Day is observed on October 13, an oncology nurse practitioner and a former ICU nurse living with metastatic breast cancer (MBC) told Oncology Nursing News that patients with incurable disease need repeated, honest education, timely biomarker testing at progression, and care teams that see them as people rather than diagnoses.

An estimated 169,347 women in the United States were projected to be living with MBC as of January 1, 2025. Yet, as one patient noted, MBC often receives little attention during a month dominated by survivorship messaging, which leaves nurses and advanced practice providers (APPs) well placed to fill that gap.

Who shared their perspectives for Metastatic Breast Cancer Awareness Day?

La-Urshalar Brock, FNP-BC, CNM, is a family nurse practitioner on the breast and gynecologic oncology team at Winship Cancer Institute of Emory University, a PhD candidate at Laney Graduate School and the Nell Hodgson Woodruff School of Nursing at Emory University, and a member of the Oncology Nursing News advisory board. Cindy Massari is a former ICU nurse who has lived with MBC for several years. Each was interviewed separately.

Massari said her acute care background did not prepare her for what MBC would mean in her own life.

"I had very little understanding of MBC, other than I had many friends that had passed away from it," Massari said. "In nursing, I work in the acute care setting, so I would always see the worst case scenario." She added that "being a patient has taught me more about MBC than being a nurse."

How can APPs support patients transitioning from curative-intent treatment to MBC care?

For Brock, the starting point is education, and it rarely happens in a single conversation.

"I feel like the key thing is education to start off with, meaning talking about what their diagnosis means for them," Brock said. "Sometimes, patients do have a hard time just grasping the thought of now being metastatic versus curative intent. So the first thing would be just to really just kind of talk about it. And sometimes you have to talk about it a couple of visits, not that one time of the discussion, but maybe three or four visits in." A metastatic diagnosis, she added, is "hard to grasp for anybody."

Brock said she revisits disease biology as well. "Sometimes people forget and that's fine," she said. "We all have multiple things going on in our lives and sometimes you don't remember some things and sometimes you don't want to remember certain things."

Her approach centers on "confirming the diagnosis, reviewing the receptors, and then talking about the treatment that we want to put them on to best treat their metastatic breast cancer for that time period," Brock said. "But also we'll talk about how there are a lot of other drugs that have come out that are in the toolbox to use if and when we need."

What does honest communication look like at the bedside?

Brock described a recent visit with a patient who had no prior breast cancer diagnosis and whose metastatic disease was identified after she developed new lower back pain. Although the supportive oncology team had already spoken with the patient, she wanted to hear it again from Brock.

"She said, 'So what stage am I again?' And I told her and she said, 'Well, thank you for being so honest.' And I said, 'Well, I don't want to sugarcoat anything, but I also want to be transparent and honest as best as possible so we can move forward,'" Brock said.

"I always feel like that's just the most important thing for us as NPs and PAs, is just to be there for the patients, but educate as best as possible," she said.

Why does biomarker testing at progression matter in MBC?

Massari's experience illustrates how biomarker results can change the treatment path. She said she had been living with MBC for a few years when her disease progressed in 2023.

"At that time I had no knowledge of biomarkers. I did not know about ESR1 mutations," she said. Months earlier, her brother had sent her an article about breast cancer research he saw in a hospital waiting room. "I saw something about an ESR1 mutation, did not know what that was, and just filed it away," she said.

When her disease progressed, "my physician tested for that very same ESR1 mutation that my brother had sent me," Massari said. She was then started on elacestrant (Orserdu), an oral selective estrogen receptor degrader that the FDA approved on January 27, 2023, for postmenopausal women or adult men with estrogen receptor (ER)-positive, HER2-negative, ESR1-mutated advanced or metastatic breast cancer with disease progression following at least 1 line of endocrine therapy. In the phase 3 EMERALD trial (NCT03778931), median progression-free survival in the ESR1-mutated population (n = 228) was 3.8 months with elacestrant vs 1.9 months with fulvestrant or an aromatase inhibitor (HR, 0.55; 95% CI, 0.39-0.77; P = .0005).

"It's been three years now and I have no evidence of disease after being on that," Massari said.

ASCO guidance recommends that testing for the emergence of ESR1 mutations be routine at recurrence or progression on endocrine therapy for patients with ER-positive, HER2-negative MBC, with blood-based circulating tumor DNA as the preferred method and consideration of retesting at subsequent progression for patients whose results remain wild-type.

"I'm sure there's many metastatic breast cancer patients out there that may not know of them either," Massari said of biomarkers. "Having an ESR1 mutation will help determine their next line of treatment."

How does nursing knowledge shape self-advocacy for patients with MBC?

Massari said her clinical background gave her the vocabulary and confidence to participate in decisions.

"Being a nurse has helped me, has given me confidence to advocate for myself," she said. "My understanding of medical terminology and treatments is invaluable. It allows me to ask the right questions, to be able to question a physician or a healthcare professional without feeling intimidated."

She acknowledged that many patients lack that background and the support network she has. "A lot of people don't have the resources," she said. Her recommendation for those patients: "Go look for support systems, go to support groups. Your doctor can guide you to them, even go on social media. It's very important to have a support system."

What does Breast Cancer Awareness Month miss about living with MBC?

Massari said she supports the education October brings but described it as "kind of an odd time for someone with metastatic breast cancer."

"The October Breast Cancer Awareness Month celebrates the survivors. We don't ever end treatment. We don't get to ring that bell, so to speak," she said. "It's sort of like a taboo subject. We have one day to celebrate metastatic breast cancer."

Recent Oncology Nursing News coverage has also highlighted the day-to-day experience of MBC. An oncology nurse living with stage 4 breast cancer urged colleagues to listen closely to patients and manage pain fully, and a smartphone-based study of 108 patients with MBC found that quality of life fell on days when depression, anxiety, fatigue, and other symptoms rose above each person's usual levels.

How do patients with MBC cope with the psychological weight of incurable disease?

Massari said she decided early "that I was not going to allow cancer to take over my life." She focuses on her family, including a grandson born shortly before her MBC diagnosis, and on planning ahead.

"My husband and I travel. We always have a trip in the queue, so to speak, because it gives he and I something to look forward to, that there's a future," she said. "And that's how I cope."

What makes her feel supported by her care team is personal connection. "When they know you as a person and not just a patient, that's very, very important. Human connection is extremely important," she said.

Her request for oncology care teams is education that looks forward. "I would like to see the patients provided with more education regarding ongoing research and advances such as the biomarkers for the mutations and the targeted therapy," Massari said. "Doing so provides hope for the patient. Hope is number one. You have to have hope."

What are the key takeaways for oncology nurses?

• Plan for repetition. Patients transitioning from curative-intent treatment to MBC care may need the diagnosis, stage, and receptor status reviewed across several visits; Brock said it may take "three or four visits."
• Be honest without being harsh. Patients may ask the same question of multiple team members; clear, consistent answers about stage and the treatment plan can help them move forward.
• Ask about biomarker testing at progression. For ER-positive, HER2-negative MBC, ASCO guidance recommends routine ESR1 testing at recurrence or progression, preferably with circulating tumor DNA, and retesting at later progression if prior results were wild-type.
• Educate about the treatment pipeline. Explaining that additional therapies may be available "if and when we need" them can support hope and shared decision-making.
• Assess support systems. Not every patient has family or clinical knowledge to lean on; referrals to support groups and online communities can help close that gap.
• See the person. Patients with MBC remain in treatment indefinitely, and knowing them "as a person and not just a patient" matters to the experience of care.

References

1. Gallicchio L, Devasia TP, Tonorezos E, Mollica MA, Mariotto A. Estimation of the number of individuals living with metastatic cancer in the United States. J Natl Cancer Inst. 2022;114(11):1476-1483. doi:10.1093/jnci/djac158
2. La-Urshalar Brock, FNP, BSN, MSN. Winship Cancer Institute of Emory University. Accessed October 9, 2026. https://winshipcancer.emory.edu/bios/advanced-practice/brock-laurshalar-b.html
3. FDA approves elacestrant for ER-positive, HER2-negative, ESR1-mutated advanced or metastatic breast cancer. US Food and Drug Administration. January 27, 2023. Accessed October 9, 2026. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-elacestrant-er-positive-her2-negative-esr1-mutated-advanced-or-metastatic-breast-cancer
4. Burstein HJ, DeMichele A, Somerfield MR, Henry NL; Biomarker Testing and Endocrine and Targeted Therapy in Metastatic Breast Cancer Expert Panels. Testing for ESR1 mutations to guide therapy for hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer: ASCO guideline rapid recommendation update. J Clin Oncol. 2023;41(18):3423-3425. doi:10.1200/JCO.23.00638
5. Biese A. Oncology nurse shares insights from her stage 4 breast cancer journey. Oncology Nursing News. September 26, 2026. Accessed October 9, 2026. https://www.oncnursingnews.com/view/oncology-nurse-shares-insights-from-her-stage-4-breast-cancer-journey
6. Daily symptom shifts linked to quality of life in metastatic breast cancer. Oncology Nursing News. October 8, 2026. Accessed October 9, 2026. https://www.oncnursingnews.com/view/daily-symptom-shifts-linked-to-quality-of-life-in-metastatic-breast-cancer