OBJECTIVES:  Determine which factors influence the likelihood to receive an anti-tumor treatment for HER2+ metastatic Breast Cancer (mBC) METHODS:  This retrospective chart review conducted in 2016 collected information from patient medical records in the UK, Italy, Spain and the Netherlands. 204 oncologists documented all HER2+ mBC patients seen during a 2-3 week period. The 3068 documented patients were classified as those receiving an anti-tumor treatment (ATT) and those receiving supportive care only (SCo, no ATT). RESULTS:  10% of patients with HER2+ mBC did not receive a first ATT at metastatic stage and received SCo. Patients receiving SCo were diagnosed later (74 y.o. on average vs. 59) and had a degraded performance score (65% with PS 2+ vs. 14%) compared to patients receiving 1^st mBC ATT. Patients in the SCo group were also more frequently diagnosed with de novo mBC (70% vs. 52%), with cerebral metastases (26% vs. 7%) and with metastases in at least 2 sites (60% vs. 53%). 55% of the patients who received a first metastatic ATT subsequently received a second ATT. The remainder (45%) received SCo .Patients receiving SCo after 1^st mBC ATT were on average older than those receiving a 2^nd ATT (70 y.o. vs. 58) and had a degraded PS (89% with PS 2+ vs. 15%). More of the patients receiving SCo had cerebral metastases: 35% vs. 17%. The factors influencing initiation of SCo after conclusion of the 2^ndATT were similar to those described earlier: age, PS and metastatic burden. CONCLUSIONS:  While the majority of HER2+ mBC patients received a 1^st line ATT, half did not receive a 2^nd line of ATT, indicating that there is an need for a novel method of anti-tumor management for patients currently ineligible to receive standard anti-tumor treatment due to their age, performance status, metastases or other factors.