Care Pathways

Breast Cancer Care pathway

Overview of the care pathway

The multidisciplinary breast cancer care pathway automatically collects the ICHOM standard set for breast cancer as well as the DICA breast cancer indicator set. On top of these outcome sets, the pathway ensures remote patient monitoring on treatment side effects during systemic treatment and shortly after surgery. Tailored information to the patient is included throughout the care journey based on their individual care pathway variant. Side effects are being monitored by using the PRO CTCAE item bank including physiological and psychological side effects. When thresholds are met, tips to deal with side effects are either sent to the patient in case of low or mild severity or to the specific care team member in case of moderate to high severity. The multidisciplinary team members use Awell to coordinate and organize care around the patients.

The pathway includes all major treatment modalities including chemotherapy, immunotherapy, radiotherapy, hormonal therapy, surgery and the main combined strategies such as neoadjuvant and adjuvant treatment.

A PREMs questionnaire (patient-reported experience measure) is also collected at several points in the pathway in order to provide additional context on the experience of the patients, besides the patient-reported outcomes collected throughout.

We can divide the breast cancer care pathway into 3 phases:

  1. Baseline / choice of treatment
  2. Acute treatment phase
  3. Long-term follow-up post-treatment (annual survey for 10 years)

The backbone of the care pathway is summarized in the figure below, for this flow we relied mainly on the ICHOM standard set of Patient-Centered Outcome Measures for Breast cancer.



From your EMR to scheduling or billing, Awell easily connects with your systems so you can create powerful care pathways that tie disjointed systems together.


The following patient-reported-outcomes are visualized in the care pathway:

  • PRO-CTCAE heatmap

Information brochures & video's

In the care pathway a number of information brochures and video's are included:

  • Chemotherapy side effect: Nail discolouration
  • Chemotherapy side effect: Fever
  • Chemotherapy side effect: Vaginal dryness
  • Chemotherapy side effect: Feelings of anxiety, sadness, anger and discouragement
  • Chemotherapy side effect: Diarrhoea
  • Chemotherapy side effect: Watery eyes
  • Chemotherapy side effect: Muscle aches
  • Chemotherapy side effect: Fatigue
  • Chemotherapy side effect: Dry skin
  • Chemotherapy side effect: Hand-foot syndrome
  • Chemotherapy side effect: Nausea and vomiting


The breast cancer care pathway offers numerous benefits that will increase efficiency on the one hand and improve the quality of care for both patient and provider on the other.

  • Automatic data collection based on the ICHOM¬†Standard Set
  • Automatic scoring calculations
  • Integrated with your systems (Electronic Medical Record, scheduling, medical billing, online pharmacy & fulfilment, e-prescribing, insurance eligibility....)
  • Decreased administrative burden for the care team
  • Automatic alerts to the care team if patients reports alarming Patient-reported-outcomes
  • Patient can access information brochures about treatment, symptoms, etc
  • Dynamic tips on how to self-manage side effects sent to patients
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