59 Over the past 2 decades, a number of quality of life assessment tools and patient-reported outcome measures have been widely used and validated, and about one third of phase III clinical trials in MBC, according to 1 report[36] , now incorporate quality of life measures. This has been strongly encouraged by US regulators, who have determined that valid quality of life endpoints can serve as meaningful indicators of clinical benefit when assessing drug efficacy and safety. In 2009, the US Food and Drug Administration issued guidance for industry for incorporating patient-reported outcome measures into drug registration trials[37] . As in other areas of medicine, in oncology, researchers and KOLs have issued a strong call for treating the patient as a whole person, rather than merely as a disease or a cluster of symptoms. However, cost constraints and sobering recent assessments demonstrate that there is still a very long way to go before what has been learned is widely applied [38] . Methods of the Quality of Life Landscape Analysis Over 150 published, peer-reviewed research articles relevant to the experiences and needs of people with advanced cancers, including quantitative and qualitative studies of patients living with MBC and their families, were reviewed. The intent of this literature review was not to examine the methods used to measure quality of life but rather to summarize some of the more important recent research findings about the reality of living with MBC. Results of 13 surveys completed by 7939 respondents living with MBC were reviewed (see Appendix 5). The surveys are from 2006–2014; most were designed by breast cancer organizations, usually with the financial support of pharmaceutical partners or research grants (see Table 6). Table 6: 13 Surveys Completed by Respondents Living With MBC Date Survey Name Sponsor 2006 Silent Voices: Advanced (Metastatic) Breast Cancer Needs Assessment Survey Living Beyond Breast Cancer 2009, 2010 BRIDGE Survey: Identifying the Unmet Needs of the MBC Community Pfizer with various support organizations 2011 A pan-European Survey of Patients with MBC Eisai; Imperial College, London 2011 Key Support and Lifestyle Needs of MBC Patients METAvivor 2011 Preferences of Patients with MBC Research Advocacy Network (RAN), Department of Defense, Breast Cancer Research Program Center of Excellence 2011 HER2+ MBC Patient Experiences on Treatment in the Biologic Era Genentech with various support organizations 2012 Metastatic Breast Cancer in Canada: The Lived Experience of Patients and Caregivers Canadian Breast Cancer Network and RETHINK Breast Cancer 2012 Informational Needs and QOL in 1st Year MBC Dana Farber Embrace Trial 2012 Impact of Toxicity on Patient Treatment Choices for MBC RAN, Genentech 2013 Count Us, Know Us, Join Us International Survey Novartis with various breast cancer organizations and Harris Interactive 2013 Control of Symptoms and Side Effects in MBC AdvancedBC.org 2013 Surveying Young Women with MBC Young Survival Coalition 2014 Cancer Experience Registry Cancer Support Community MBC = Metastatic Breast Cancer, QOL = Quality of Life