No longer invisible. Addressing the unique challenges of metastatic cancer survivorship
Welcome to the latest Series of Supportive Care Matters, a podcast hosted by Medical Oncologist and International Cancer Survivorship Expert, Professor Bogda Koczwara AM.
The landscape of cancer survivorship is evolving before our eyes. As treatment advances allow people with metastatic cancer to live longer, we’re witnessing the emergence of a population that exists in what medical oncologist Dr Lori Spoozak calls “the place in between” – not curable but not actively dying.
We’re witnessing the emergence of a population that exists in what medical oncologist Dr Lori Spoozak calls “the place in between” – not curable but not actively dying
In this eye-opening conversation, researchers Associate Professor Nick Hart and Dr. Andrea Smith (who herself lives with metastatic breast cancer) explore the unique challenges faced by those living with advanced cancer. While survivorship programs have traditionally focused on post-treatment care, metastatic patients are typically on treatment for life, navigating constant healthcare interactions, accumulating side effects and facing the certainty rather than just the fear of disease progression.
The discussion reveals how metastatic cancer patients have often fallen through the cracks – excluded from survivorship programs yet not appropriately served by palliative care services that focus primarily on end-of-life needs. This growing population faces what Dr. Smith describes as supportive care needs “on steroids” – intensified physical, psychological, financial and practical challenges that require specialised approaches.
Hart and Smith share their ground-breaking work developing the first international standards for metastatic cancer survivorship care, now translated into 14 languages to guide implementation worldwide. They emphasise that improving care requires action on multiple fronts: better education for healthcare professionals, redesigned care models, dedicated peer support programs and recognition that survivorship care is everyone’s responsibility rather than the domain of any single provider.
Whether you’re a healthcare professional, researcher, patient advocate or someone living with cancer, this conversation challenges conventional thinking about survivorship and offers a compelling vision for more inclusive, responsive care. Discover why supporting those living for years with incurable cancer represents both an urgent challenge and a tremendous opportunity to enhance quality of life for this overlooked population.
This conversation is proudly produced by the Podcast Team at The Oncology Podcast, part of the Oncology Media Group Australia.
Host:
Bogda Koczwara AM
Professor Bogda Koczwara AM
Professor Bogda Koczwara AM is a medical oncologist and a senior staff specialist at the Flinders Centre for Innovation in Cancer in Adelaide, Australia.
Professor Koczwara completed her oncology training at the Roswell Park Cancer Institute in Buffalo, New York, USA, and received a Master in Bioethics degree from Monash University, Australia.
Her clinical interests revolve around management of breast cancer, cancer survivorship, psycho-oncology and supportive care as well as health services development, integration with primary care and cancer education for health care professionals.
Connect with Bogda on Twitter: @bogda_koczwara
Guests:
Associate Professor Nicolas H. Hart
Associate Professor Nicolas H. Hart, PhD AES CSCS FESSA is an NHMRC Research Fellow in Cancer Survivorship and Program Director of Clinical Exercise Physiology at the University of Technology Sydney (UTS). His clinical research focuses on improving outcomes for people affected by cancer (i.e., cancer survivors and caregivers), where he sub-specialises in advanced and metastatic cancers, canvassing (1) survivorship and supportive care issues (including exercise, nutrition, psychosocial, and toxicity management), (2) cancer-specific outcomes (including disease biology, disease progression, and overall survival), and (3) model of care development and evaluation (including health services research and implementation science) to inform policy and practice. He has received >$20.6 million AUD in research income, published >180 peer-reviewed research articles and 3 book chapters; and supervised >22 PhD students to progress this area of work. He is the COSA Chair of Survivorship, MASCC Chair of Fatigue, MASCC Founding Chair of Exercise Oncology, and CST (Cancer Symptom Trials) Chair of Fatigue.
Dr Andrea Smith
Dr Andrea Smith is a Senior Research Fellow and Daffodil Fellowship holder at the Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW. Her research interests include improving supportive care for people living with metastatic or advanced cancer, in particular metastatic breast cancer. Her research projects include improving access to professionally run metastatic breast cancer support groups and peer-peer support, increasing funding and interest in metastatic survivorship research in Australia, and quantifying Australia’s advanced and metastatic cancer population. She is also a consumer advocate having been diagnosed with stage IV de novo metastatic breast cancer in 2016. In 2024, she co-founded and now chairs the consumer-led advocacy organisation Metastatic Breast Cancer Action Australia (MBC Action Australia).
Resources:
PAPERS:
Hart, N. H. et al. Survivorship care for people affected by advanced or metastatic cancer: MASCC-ASCO standards and practice recommendations. Support. Care Cancer 32, 313 (2024). Access online here.
Lai-Kwon, J. et al. Evolving Landscape of Metastatic Cancer Survivorship—Reconsidering Clinical Care, Policy, and Research Priorities for the Modern Era. J Clin Oncol JCO2202212 (2023) doi:10.1200/jco.22.02212. Access online here.
Lori Spoozak et al. Rallying Cry From the Place in Between. JCO Oncol Pract 16, 451-452(2020). Access online here.
Hart NH, et al. Unmet supportive care needs of people with advanced cancer and their caregivers: A systematic scoping review. Crit Rev Oncol Hematol. 2022 Aug. Access online here.
Jefford M, et al. Survivorship Care for People Affected by Advanced or Metastatic Cancer: Building on the Recent Multinational Association of Supportive Care in Cancer-ASCO Standards and Practice Recommendations. Am Soc Clin Oncol Educ Book. 2025 Jun. Access online here.
Langbaum T, Smith TJ. Time to Study Metastatic-Cancer Survivorship. N Engl J Med. 2019 Apr. Access online here.
Smith AL, et al. Survivorship research for people with metastatic or advanced cancer: A time for action. Asia Pac J Oncol Nurs. 2022 Feb 11. Access online here.
Lai-Kwon J, et al. Evolving Landscape of Metastatic Cancer Survivorship: Reconsidering Clinical Care, Policy, and Research Priorities for the Modern Era. J Clin Oncol. 2023 Jun 20. Access online here.
Hart NH, et al. Survivorship Care for People Affected by Advanced or Metastatic Cancer: MASCC-ASCO Standards and Practice Recommendations. JCO Oncol Pract. 2024 Sep. Access online here.
Hart NH, et al. World Health Organization package of interventions for rehabilitation for cancer: a MASCC-endorsed resource for global action to address unmet rehabilitation needs of people affected by cancer. Support Care Cancer. 2024 Jun. Access online here.
Henneghan AM, et al. Characterizing cancer-related cognitive impairments and impact on quality of life in women with metastatic breast cancer. Breast Cancer Res Treat. 2025 Jan. Access online here.
Campbell KL, et al. Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals. JCO Oncol Pract. 2022 May. Access online here.
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