Patients diagnosed with metastatic breast cancer can experience years living with their cancer (Reed and Corner 2012). This group are often referred late in their cancer trajectory to palliative services. In an attempt to reverse this trend a Secondary Breast Cancer CNS (SBCCNS) post was funded by the local hospice as a three-year fixed term trial. The SBCCNS works as a member of the hospice and oncology team providing an in-reach key worker role to oncology clinics and wards.

The evaluation of the role is on-going. Initial review after six months of the role has identified the following benefits:

• Patients are providing positive feedback. Having a named key worker who can be available in primary and secondary care is seen as reassuring.

• Undertaking joint home review visits with the primary care CNS. Improve communication between the primary and secondary care teams.

• Holistic needs assessment and individualised care planning that encourages early referral to services including financial assessment, family support/counselling, dietetic input etc.

• Instances of admission avoidance to the acute Trust or directing admission to an appropriate setting e.g. hospice in-patient unit.

• Offering an alternative venue in day hospice for symptom control clinics and blood transfusion administration.

Patients with secondary breast cancer may spend years receiving anti-cancer treatment and trying to live their lives. This can result in reduced access to palliative services provided by hospice teams. Taking the service to the patient and introducing the potential benefits of palliative care services appears to be an initiative that patients accept.