Optimizing Adjuvant Care in Early Breast Cancer: Multidisciplinary Strategies and Innovative Models from Canadian Centers

TL;DR

This paper explores team-based care models to manage the growing complexity of early breast cancer treatment in Canada, aiming to improve patient care while reducing pressure on specialists.

Contribution

The paper introduces a flexible, multidisciplinary care playbook for managing hormone receptor-positive, HER2-negative early breast cancer in Canada.

Findings

Team-based care models led by nurses, NPs, GPOs, and pharmacists can effectively manage treatment adherence and patient safety.

These models reduce the workload on oncologists and improve the sustainability of care delivery.

Real-world applications in Canadian centers demonstrate the adaptability and effectiveness of these models.

Abstract

Breast cancer is the most common cancer among women in Canada, and more patients are living longer thanks to improved treatments. One common type—hormone receptor-positive, HER2-negative early breast cancer—now has several effective therapies, some of which require frequent monitoring and follow-up. This increases pressure on cancer specialists, especially as cancer diagnoses continue to rise. Our study explores how care teams can meet this demand by adopting innovative, team-based care models. These include approaches led by nurses, nurse practitioners, general practitioners in oncology, and pharmacists. We describe how each model functions, how they support patient safety and treatment adherence, and how they can relieve pressure on oncology services. These models are already in use at some Canadian cancer centers and can be adapted based on local needs and resources. Rather than promoting a single solution, we offer a flexible guide for integrating these roles into routine care. By doing so, cancer teams can continue to deliver high-quality, patient-centered care in a more sustainable way as treatment complexity grows.

The adjuvant treatment landscape for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) early breast cancer (EBC) is rapidly evolving, with a diverse range of therapeutic options—including endocrine therapies, bisphosphonates, ovarian function suppression, olaparib, CDK4/6 inhibitors, and emerging agents such as immunotherapy. While these advances have markedly improved patient outcomes, they also introduce challenges related to implementation, monitoring, and resource allocation. Notably, therapies like CDK4/6 inhibitors require particularly close monitoring, creating logistical and capacity challenges for medical oncologists, whose workloads are already stretched due to rising cancer incidence and treatment complexities. These challenges underscore the need for innovative care delivery solutions to ensure patients with EBC continue to receive optimal care. This paper offers a comprehensive guide—a playbook—of multidisciplinary-team-based care models designed to optimize adjuvant treatment delivery in EBC. Drawing on real-world evidence and successful applications across Canadian centers, we explore models led by nurses, nurse practitioners (NPs), general practitioners in oncology (GPO), and pharmacists. Each model leverages the unique expertise of its team to manage treatment toxicities, facilitate adherence, and enhance patient education, thereby promoting effective and sustainable care delivery. Importantly, these models are not intended to compete with one another, but rather to serve as a flexible recipe book from which breast cancer care teams can draw strategies tailored to their local resources and patient needs. By detailing implementation strategies, benefits, and challenges—in many instances supported by quantitative metrics and economic evaluations—this work aims to inspire care teams nationwide to optimize the adjuvant management of patients with HR+, HER2– EBC.

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