Value-Based Healthcare in Early-Stage Breast Cancer: De-Escalation, Patient-Centered Outcomes, and Sustainable Care Delivery

Early-stage breast cancer has become one of the most significant areas for oncology innovation in high-income countries. This malignancy predominantly affects populations with a markedly favorable prognosis. Early-stage breast cancer (stages I and II) often sees survival rates surpassing 95% for localized disease under modern multimodal treatment.Standard multimodality treatments, such as surgery and adjuvant therapy, still produce substantial acute and long-term toxicities. Side effects ranging from lymphedema to cardiotoxicity can impair quality of life for decades and generate high direct and indirect costs. Value-Based Healthcare (VBHC) reframes care around the equation of patient-relevant outcomes divided by costs across the full cycle of care. In this disease group, the excellent baseline prognosis creates a unique window for treatment de-escalation without compromising survival, while standardized measurement of patient-reported outcome measures (PROMs) and rigorous economic evaluation can drive more efficient, equitable, and sustainable models of care.The central challenge this Research Topic seeks to address is the mismatch between outstanding oncologic outcomes and the persistent overuse of intensive therapies. This leads to avoidable toxicity, elevated costs, financial toxicity for patients, and inefficient resource allocation. Despite clear evidence of superior prognosis in low-risk subgroups, many patients still receive full-dose regimens originally designed for much higher-risk disease.Recent advances provide concrete pathways to higher value. Phase II and III trials (such as PRIME II and PROSPECT) have demonstrated that reducing or omitting intensive treatments is safe in selected populations while preserving excellent control rates. Cost-effectiveness analyses, international initiatives defining standardized outcome sets through ICHOM methodology, and real-world symptom-monitoring platforms have all improved the patient experience and early detection of complications. Value frameworks from ASCO and ESMO now increasingly incorporate genomic risk factors in their net-benefit assessments.This collection will showcase implementation strategies, economic evaluations, policy innovations, and multidisciplinary models that align incentives with the outcomes that matter most to patients. These include survival, function, quality of life, and financial well-being, while ensuring high-value care can be scaled globally.This Research Topic is dedicated to the application and advancement of Value-Based Healthcare (VBHC) principles specifically in early-stage breast cancer across the entire care continuum. This ranges from diagnosis and risk stratification (including genomic assays) to de-escalated treatment, survivorship, and recurrent/metastatic disease. Contributions must emphasize measurable improvements in patient-relevant outcomes relative to costs, with particular attention to real-world implementation in diverse healthcare systems.We welcome Original Research, Review, Mini Review, and Perspective articles on themes including:• Treatment de-escalation strategies (e.g., radiotherapy omission or abbreviated systemic therapy) and their impact on oncologic outcomes, toxicity, and costs.• Patient-Reported Outcome Measures (PROMs), standardized outcome sets, and quality-of-life assessment.• Cost-effectiveness analyses, health technology assessment, and economic modeling of de-intensified regimens.• Implementation science, barriers and facilitators, and multidisciplinary VBHC delivery models.• Shared decision-making, equity, financial toxicity, and survivorship care.• Health policy, value-based payment models, and real-world evidence for risk-stratified care. Topic editors: Jonas Wolf, Taís Moreira, Felipe Borges Almeida Source: https://www.frontiersin.org/research-topics/81696/value-based-healthcare-in-early-stage-breast-cancer-de-escalation-patient-centered-outcomes-and-sustainable-care-delivery