Evaluating the impact of a nurse-led clinic model of care on the symptom management of women prescribed adjuvant endocrine therapy for early breast cancer

The intervention in this study is a new nurse-led clinic (NLC) model of care designed to proactively monitor and manage symptoms for patients commencing adjuvant endocrine therapy (AET) for early, hormone receptor-positive breast cancer. This model replaces the current standard practice in Illawarra Shoalhaven Local Health District (ISLHD), where patients typically wait 6–8 weeks for a routine medical oncology follow-up appointment without formal interval monitoring. The NLC intervention consists of the following components and processes: • Electronic Symptom Monitoring: Patients complete electronic patient-reported outcome (ePRO) symptom assessments at baseline (defined as prior to commencement of AET), and at 2, 4, 8, and 12 weeks following treatment initiation. The ePRO tool incorporates validated measures, including the Functional Assessment of Cancer Therapy – Endocrine Subscale (FACT-ES) and the Australasian Menopause Society Symptom Score Card, and is administered via a secure online platform. • Proactive Nurse Review: A breast cancer care nurse reviews each ePRO submission within 72 hours of completion. • Targeted Clinical Support: Clinical support is delivered primarily via telephone or email, with face-to-face consultation arranged if clinically indicated. Following each ePRO review, patients may receive nurse-initiated contact where symptoms warrant intervention. The frequency and duration of contact are individualised based on patient need, typically ranging from brief (5–10 minute) telephone consultations to longer discussions (up to approximately 30 minutes) when more complex symptom management is required. Contact generally occurs at each assessment timepoint where symptoms are identified, rather than at fixed intervals. Support strategies provided by the nurse may include: Education and advice: Patients may receive a combination of written and digital resources, including patient information sheets, website links, and webinars/podcasts. These materials are not developed specifically for this study but are sourced from established organisations such as Breast Cancer Network Australia and the Australasian Menopause Society, as well as standard clinical education resources used within ISLHD. Symptom management guidance: Tailored advice is provided based on reported symptoms (e.g., management of menopausal symptoms, musculoskeletal pain, or sexual dysfunction). Facilitation of referrals: The nurse may coordinate referrals to internal ISLHD services (e.g., Menopause Service, psychology, lymphoedema physiotherapy) by initiating referral processes, liaising with relevant departments, and assisting with appointment coordination where required. Referrals to external services (e.g., general practitioners for chronic disease management plans) may also be recommended, with guidance provided to the patient on how to access these services. Escalation of care: Where symptoms fall outside the nurse’s scope of practice or are clinically concerning, the nurse may facilitate earlier review by a medical oncologist. • Adherence to the intervention is monitored through: Completion rates of scheduled ePRO assessments recorded within REDCap. Documentation of nurse review and patient contact within the platform. Nurse-completed activity time logs capturing all intervention-related activities (e.g., review time, patient contact, referrals).