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Background and context: More than 9000 women are diagnosed each year with breast cancer in Romania and one third of them will develop advanced disease. The metastatic breast cancer (MBC) management aims to optimize disease control while ensuring the best possible quality of life (QoL). In Romania, the new MBC treatments made possible longer survival, but social and psychological support is still extremely limited, and specific guidelines and standards for these services have not been developed. No study regarding distress level, quality of life and specific unmet need of metastatic breast cancer (MBC) patients in Romania was ever carried so no data are available to substantiate introduction of support services for these patients. An evidence based standard of care for support services, based on specific MBC patients needs, has to be developed to ensure an harmonization of support services in Romania. Aim: To improve quality of care for metastatic breast cancer (MBC) patients through the implementation of a standard of care for support services. Strategy/Tactics: The project uses an action research approach that starts with a qualitative study to identify both metastatic breast cancer (MBC) patients' specific needs (regarding information and support services when facing the challenges of diagnosis, treatment, and prognosis) and also their health and social providers' knowledge, experiences and perceptions about MBC. In-depths interviews will be performed with both patients and providers followed by data analysis. Based on the identified needs and literature, specific information materials for metastatic breast cancer (MBC) patients and support services guidelines will be developed. To build support, the materials (the study report, the information materials and the guidelines) will be disseminated among providers and patients through a Web page, a workshop with medical providers representatives from hospitals in the northwest region of Romania, presentation in different scientific events and collaboration with the other cancer patient associations in Romania. A policy proposal regarding the introduction and use of specific support services guidelines within the standard of care for metastatic breast cancer patients in Romania will be developed and presented to the Ministry of Health. Outcomes: An evidence based standard of care for support services and adequate information materials will create a basis for improved service provision for MBC patients; implementing a standard of care in the daily routine of service provision for MBC patients will support health and social providers to ensure better communication and patient empowerment that will have a direct impact on the treatment's efficiency as it increases patients' participation; it will also help MBC patients to better cope with the disease, to make personal decisions regarding treatment options and also to participate to the improvement of their quality of life.

This paper aims to analyze the leadership models of the European Commission in terms of the function of setting the agenda of the European Union and in terms of political leadership. In this context, at the European level leadership is shared between several actors, making it difficult for the European Commission to exercise leadership traditionally, mostly for its lack of direct decision-making powers. Thus, the most relevant political roles of the President of the European Commission are to set the European agenda and to persuade and influence the other stake-holders to follow his directions for deepening European integration. In this regard, the article comparatively analyzes the leadership of Jacques Delors, Jean-Claude Juncker, and Ursula von der Leyen to identify the leadership model proposed at the beginning of their term, and to what extent, they exercised a political role. The tools used in the analysis are the inaugural speeches and the following three variables: how they organized the Commission to strengthen the political role of the President, how they mobilized resources from the other institutions of the European Union, and the formation of coalitions and networks. The article concluded that the leadership model proposed by Ursula von der Leyen falls within the supranational pattern of Delors' time, moving away from the model of political leadership proposed by Juncker. The accuracy of the research is limited by the fact that Ursula von der Leyen is only in her first year as President of the European Commission.