Convenience at a Cost: The Hidden Burden of Oral Breast Cancer Therapies and the Absence of Integrative Support
Bridging the Care Gap: Enhancing Supportive Resources for Patients on Oral Breast Cancer Therapies
The evolution of breast cancer treatment has led to a growing population of patients with early-stage disease managed with oral systemic therapies, including endocrine agents and targeted treatments. While these therapies offer advantages such as convenience and reduced reliance on hospital-based care, they have also exposed significant gaps in integrative care and supportive resources. Notably, patients undergoing oral treatment often receive less comprehensive, multidisciplinary support compared to those receiving intravenous chemotherapy or radiation therapy.
Patients receiving chemotherapy and radiation typically benefit from structured, protocol-driven care pathways that include frequent in-person visits, ongoing symptom monitoring, and access to interdisciplinary services such as oncology nurse navigation, psychosocial support, and nutritional counseling. These established frameworks facilitate the early identification and management of treatment-related toxicities and promote a more holistic approach to patient care. In contrast, patients prescribed oral therapies are frequently managed in a less centralized manner, with fewer routine clinical interactions and limited structured follow-up. This fragmentation may hinder the timely assessment of adherence, symptom burden, and psychosocial distress (Clancy et al., 2020; Moore, 2010).
The literature consistently demonstrates that patients receiving oral endocrine therapy experience significant unmet supportive care needs. These include insufficient education regarding side effect management, limited access to symptom monitoring, and a lack of decisional and emotional support (Milata et al., 2018). Furthermore, the shift toward patient self-management inherent in oral therapy regimens increases the risk of nonadherence, particularly in the absence of robust clinical support systems (Moore, 2010). Nonadherence remains a critical concern, as it is associated with suboptimal treatment outcomes and an increased risk of disease recurrence.
Emerging evidence highlights the importance of structured, multifaceted interventions to address these gaps. Strategies such as nurse-led follow-up, digital adherence monitoring, and interdisciplinary care coordination have been shown to improve adherence and patient-reported outcomes (Ganna et al., 2025; Waseem et al., 2022). However, these approaches are not consistently implemented across healthcare settings, reflecting persistent systemic barriers, including limited reimbursement models and the historical emphasis on infusion-based care delivery. As a result, patients receiving oral therapies may remain relatively “invisible” within the healthcare system, despite the complexity and long-term nature of their treatment (Ahmed & Loiselle, 2023).
Addressing these disparities requires a paradigm shift toward more inclusive and equitable models of cancer care. Integrative care frameworks must be expanded to include patients receiving oral therapies, with an emphasis on standardized follow-up protocols, routine assessment of adherence and symptom burden, and enhanced access to multidisciplinary resources. Oncology nurses are uniquely positioned to lead these efforts, given their central role in patient education, care coordination, and advocacy.
In conclusion, while oral therapies have transformed the management of early-stage breast cancer, they have also exposed critical gaps in integrative care delivery. Bridging these gaps is essential to ensure that all patients receive comprehensive, patient-centered care that supports both clinical outcomes and quality of life. Without intentional efforts to improve visibility and resource allocation for this population, disparities in care are likely to persist.
References
Ahmed, S., & Loiselle, C. G. (2023). Patient adherence to oral anticancer agents: A mapping review of supportive interventions. Current Oncology, 30(12), 744.
Clancy, C., Lynch, J., O’Connor, P., & Dowling, M. (2020). Breast cancer patients’ experiences of adherence and persistence to oral endocrine therapy: A qualitative evidence synthesis. European Journal of Oncology Nursing, 44, 101706. https://doi.org/10.1016/j.ejon.2019.101706
Ganna, S., Rahimi, S., Lu, A., Laborde, K., & Trivedi, M. (2025). Interventions to improve oral endocrine therapy adherence in breast cancer patients. Journal of Cancer Survivorship, 19(3), 930–939. https://doi.org/10.1007/s11764-023-01513-y
Milata, J. L., Otte, J. L., & Carpenter, J. S. (2018). Oral endocrine therapy nonadherence, side effects, decisional support, and decisional needs in women with breast cancer. Cancer Nursing, 41(1), E9–E18. https://pubmed.ncbi.nlm.nih.gov/27532743/
Moore, S. (2010). Nonadherence in patients with breast cancer receiving oral therapies. Clinical Journal of Oncology Nursing, 14(1), 41–47. https://doi.org/10.1188/10.CJON.41-47
Waseem, H., Ginex, P. K., Sivakumaran, K., et al. (2022). Interventions to support adherence to oral anticancer medications: Systematic review and meta-analysis. Oncology Nursing Forum, 49(4), E4–E16.
