The clinical management of patients with advanced breast cancer is complex and patients’ progress is often unpredictable, creating challenges for nursing care in this specialty. However, there is strong evidence that patients who progress quickly through two lines of treatment for secondary breast cancer may be in the last year of their life. New national drivers for end of life care highlight the importance of identifying patients who are in their last year of life to determine their needs, concerns and priorities for care, and to ensure appropriate community support is in place. At one cancer centre this has led to changes in clinical practice using an integrated approach with palliative care and holistic needs assessments. There have been significant benefits for patients and their families, including a reduction in hospital admissions during end of life and improved symptom management. Communication with GPs and community nurses has also been enhanced, which provides benefits for patients and clinical staff.