In incurable breast cancer all therapy is palliative, i.e. intended primarily to relieve symptoms, preserve health-related quality of life (HQL) and, if possible, prolong life without undue toxicity and loss of HQL. In this situation the measure of success if the extent to which palliative therapy achieves these goals. Unless the effects of therapy on symptoms and HQL are measured, it will never be certain whether the goals of palliation are being achieved. Recent studies in metastatic breast cancer have begun to focus on these goals, and the results are encouraging. It is becoming clear that HQL is improved by using appropriately aggressive chemotherapy, with the benefits outweighing the deleterious effects of treatment toxicity. In addition, there are some unexpected results indicating that pre-treatment HQL may be a better predictor of response, on-treatment HQL and length of survival than other known prognostic variables. These advances in our understanding of HQL in metastatic breast cancer will aid in the development of rational treatment policies for the management of this disease.