Designing a triple-negative breast cancer patient journey: A multi-stakeholder initiative to improve clinical pathways and communication in Italy.

Abstract

e13507 Background: Triple negative breast cancer (TNBC) is associated with poor prognosis and complex management, requiring a dedicated and adequate care pathway. To address this need, Fondazione The Bridge and Bridge for Future-University of Pavia, in collaboration with AIOM (Italian Society of Clinical Oncology) and FAVO (Italian Federation of Voluntary Associations in Oncology), developed a patient-centered TNBC Patient Journey (PJ) for the Italian healthcare setting, to provide accessible information to all stakeholders who are not expert in the breast cancer care such as patients (pts), caregivers, patient associations, other healthcare professionals, healthcare managers and politicians. Methods: A multidisciplinary core group of 9 professionals, including a breast oncologist, radiologist, surgeon, geneticist, patient representative, health policy expert and health economist was established. Firstly, they analysed existing guidelines and care pathways present in literature. Secondly, additional professionals (psycho-oncologist, cardio-oncologist, nutritionist, gynaecologist, pathologist, nurse, plastic surgeon, radiation oncologist, general practitioner and specialist in bone, fertility, nuclear medicine, palliative care) from Breast Units (BUs) and pts’ associations were involved through structured interviews to identify best practices. Starting from these interviews, some key statements defining an optimal TNBC care pathway were selected and validated using a modified Delphi process. Besides, a National survey among Italian BUs was performed to assess the relevance of each statement and its real implementation in every BU. Finally, outcomes were translated into a PJ and a Vademecum. Results: From February 2024 to June 2025 the working group developed 2 main documents: a PJ, mainly addressed to pts and caregivers in a less technical language, and a Vademecum containing clinical explanations, best practices and gaps in pts care; this second tool was designed to provide a clear and deep information about the data reported in the PJ. The manuscripts have been enhanced with visual elements and colour images designed to facilitate reading and draw the reader’s attention. Both documents described the ideal journey of pts distinguishing different pathways in relation to BRCA1/2 status mutation (carriers vs non-carriers). The materials were disseminated nationally through online publication on the websites of involved organizations, printed distribution, press events and meetings with policymakers. Conclusions: This initiative highlights the feasibility and value of a multidisciplinary, co-designed approach to develop accessible, patient-centered tools in TNBC care. The PJ supported standardized and informed care while emphasizing the need for adaptable pathways in a rapidly evolving therapeutic landscape.