Chan Angela, Nixon Nancy, Al-Khaifi Muna, Bestavros Alain, Blyth Christine, Cheung Winson Y, Hamm Caroline, Joly-Mischlich Thomas, Manna Mita, McFarlane Tom, Minard Laura V, Naujokaitis Sarah, Peragine Christine, Railton Cindy, Edwards Scott
Faculty of Medicine, BC Cancer, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T8, Canada.
Curr Oncol. 2025 Jul 14;32(7):402. doi: 10.3390/curroncol32070402.
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.
激素受体阳性（HR+）、人表皮生长因子受体2阴性（HER2-）早期乳腺癌（EBC）的辅助治疗格局正在迅速演变，有多种治疗选择，包括内分泌疗法、双膦酸盐、卵巢功能抑制、奥拉帕尼、CDK4/6抑制剂以及免疫疗法等新兴药物。虽然这些进展显著改善了患者的治疗效果，但也带来了与实施、监测和资源分配相关的挑战。值得注意的是，像CDK4/6抑制剂这样的疗法需要特别密切的监测，给医学肿瘤学家带来了后勤和能力方面的挑战，由于癌症发病率上升和治疗复杂性增加，他们的工作量已经不堪重负。这些挑战凸显了需要创新的护理提供解决方案，以确保EBC患者继续获得最佳护理。本文提供了一份全面指南——一本基于多学科团队的护理模式手册，旨在优化EBC的辅助治疗。借鉴加拿大各中心的真实世界证据和成功应用经验，我们探索了由护士、执业护士（NP）、肿瘤学全科医生（GPO）和药剂师主导的模式。每种模式都利用其团队的独特专业知识来管理治疗毒性、促进依从性并加强患者教育，从而推动有效且可持续的护理提供。重要的是，这些模式并非相互竞争，而是作为一本灵活的食谱，乳腺癌护理团队可以从中汲取适合其当地资源和患者需求的策略。通过详细阐述实施策略、益处和挑战——在许多情况下有定量指标和经济评估的支持——这项工作旨在激励全国的护理团队优化HR+、HER2-EBC患者的辅助治疗管理。
