Therapeutic advances in treatment have led to people living longer with advanced breast cancer (ABC). Nonetheless, people can experience complex debilitating physical and emotional treatment and disease-related symptoms that have a profound impact on quality of life (QOL).1 Most people experience disease-related symptoms at first diagnosis of ABC (de novo or recurrence of disease) or at disease progression. However, some people will be diagnosed with new asymptomatic disease or disease progression on routine follow-up investigations. The symptoms experienced are dependent on site and burden of disease, with the most common sites of metastatic disease in ABC being bone, lung, liver, and brain.2 Moreover, psychological distress, commonly presenting as anxiety or depression, is seen in association with physical symptoms and living with the uncertainty of a treatable but not curable disease.3,4

Treatment intent for ABC is to alleviate symptoms, increase time to disease progression, improve and maintain QOL, and prolong overall survival. Improvements in outcomes for those living with ABC can be attributed to novel therapies, the development of best practice guidelines, and care delivered by specialist multidisciplinary teams.5, 6, 7 Systemic anticancer treatment (SACT) approaches to treatment have been addressed in other articles in this special edition.8, 9, 10

It is common for people with ABC to experience multiple symptoms concurrently,11 which are often interrelated with one affecting the onset and severity of another.12 Some symptoms have a shared aetiology, such as being caused by the same site of disease, but this is not always the case.13

Nurses play a vital role in the ongoing assessment of disease-related symptoms and effectiveness of interventions to alleviate these, as it is likely that symptoms will change over time.12 The use of patient-reported outcome measures (PROMs) and other tools to systematically assess symptoms and side effects is discussed elsewhere in this special edition.14,15 Having knowledge and understanding of different symptoms and how they occur in combination or influence each other enables nurses and other health care professionals to manage symptoms effectively rather than treating symptoms in isolation. In addition, early involvement of palliative care is important to use specialist expertise in symptom management and supportive care.5

This report provides an overview of the clinical manifestations of ABC and associated oncologic emergencies (Table 1). Treatments such as bisphosphonates for hypercalcemia and radiotherapy for malignant spinal cord compression and interventions for disease-related symptom management such as drainage of pleural effusion to improve QOL and prevent life-changing consequences are also discussed.