Purpose <p>The diagnosis of metastatic breast cancer (MBC) marks a transition from curative to palliative care, bringing significant psychosocial challenges, often exacerbated by racial and ethnic disparities. This mixed-methods study, grounded in the socioecological model, sought to examine distress levels among MBC patients and caregivers across academic and safety-net healthcare settings and to explore how individual, interpersonal, and system-level factors—shaped by intersecting identities such as race/ethnicity and socioeconomic status—influence unmet supportive care needs and intervention preferences.</p> Methods <p>Surveys and interviews were conducted with a racially and ethnically diverse group of MBC patients (<i>N</i> = 27) and caregivers (<i>N</i> = 19), recruited from a comprehensive cancer center with academic practice and safety-net hospital affiliates.</p> Results <p>Quantitative analyses found no significant differences in distress levels between patients at safety-net and academic hospitals or between patients and caregivers. Qualitative analysis identified six categories of supportive care needs: personalized supportive care, comprehensive health and symptom management, emotional and psychosocial support, interpersonal and family support, sexual health and intimacy support, and equitable access to care—with patients and caregivers strongly preferring targeted, multilevel interventions to address these needs.</p> Conclusion <p>Findings underscore the multifaceted nature of MBC care needs and the importance of developing targeted interventions to address the individual, interpersonal, and systemic challenges faced by patients and caregivers.</p>