[DRAFT] National Optimal Cancer Pathway for suspected and confirmed Metastatic Breast Cancers:

Point of Suspicion (PoS) to Treatment/Best Supportive Care for adult patients (16 and over)
Suggested
Maximum
Times
Follow up scan/ Ward referral /
GP Referral mammogram / tumour Emergency RDC Referral from Clinical Trials Incidental Direct contact refer to Acute
④⑦ markers ①②④⑤⑦ admission ①②④⑤⑦ other MDT follow up pathway finding from patient Oncology Service
Day 0 – Point ①②④⑤⑦ (AOS)
of Suspicion ①②④⑤⑦
(PoS)

Person Centred Care Key

Relapse New Presentation DeNovo Diagnosis
① Key worker (allocation and
DAY 1
transition)

② Meeting People’s Needs

First outpatient / ③ Treatment summaries

clinic appointment / assess
<DAY 7 performance status
①②④⑤⑦ ④ Health optimisation/ Making
Every Contact Count

⑤ Prehabilitation
Staging –
Request Genomic
Blood test
testing if applicable
Imaging Request diagnostic bundle ⑥ Rehabilitation
(See Genomics
Consider Clinical Trials

Biopsy of primary or metastasis

pathway)
(see appendix re: indications for PET CT)
⑦ * Patient Reported Outcome
<DAY 8
Measures (PROMS)

* Please see narrative for details

Non malignant?
Manage as per local MDT outcome to be
<DAY 10 shared with Primary
protocol or reassure and
MDT discussion
discharge. Care
GP safety netting; if All diagnostic and staging results available
ongoing clinical Discussion of treatment
suspicion or ongoing options
<DAY 15
<DAY 14 symptoms consider re-
Record Metastatic
referral
diagnosis on Cancer
③
Information System /
Remove from Primary
Pathway Key
Breast cancer follow-up

Point of Suspicion
Aged <25 Refer to Outpatient / clinic appointment
Children's or ①②④⑤⑦ Diagnostic Pathway
<DAY 21 Teenage and Diagnosis and treatment plan
Young Adults discussed with patient GP safety netting or
services ①②④⑤⑦ remove from the SCP
MDT

Endocrine therapy +/-

Discuss with TYA /
Chemotherapy Children's services
Diagnostic Referral to specialist provision / Generalist Anti-HER2 therapy Bone modifying
palliative care if required palliative care Radiotherapy therapy Treatment Pathway
Pathway
Biological Therapy
<28 days Surgery Informatics and
from PoS Intelligence

Monitoring scan

Outpatient appointment
– review monitoring scan

Treatment
Disease progression
Pathway
<21 days
from DTT

Second / next line of treatment ①②③⑥⑦

Time to
Treatment
<31 days Specialist supportive/ Systemic Anti Cancer
Radiotherapy Surgery
from PoS palliative care Therapy (SACT)

Treatment summary shared with Palliative Care and offered to

Treatment toleration / termination discussed with
patient
patient if required
③