Treatment Navigation in Breast Cancer Management: Process Cost Analysis Based on German Case Studies

Introduction: The high incidence of breast cancer combined with the growing number of innovative and complex treatment options, such as oral tumor therapies, is increasingly shifting oncological care to the outpatient sector. This development is placing substantial capacity burdens on office-based providers. Evidence suggests that the use of "treatment navigators" - qualified nonphysician personnel tasked with coordination and support - can improve efficiency and reduce workload for physicians. This study aimed to assess the economic effects of task delegation in the German outpatient breast cancer from the healthcare provider´s perspective.

The study followed a three-step approach: (1) identification, (2) quantification, and (3) evaluation of resources. For (1), a micro-costing-based process analysis was conducted to capture resource use in outpatient breast cancer care. Relevant services were identified via literature review. For (2), the (a) duration of individual services and (b) delegation potential were quantified through structured interviews with physicians in hematology, oncology, and gynecological oncology. In (3), personnel costs were calculated using the currently applicable wages for physician and defined in the German Uniform Evaluation Standard (EBM) and analogously for medical assistants. Based on service durations and delegation opportunities, potential cost and time savings per case study were estimated.

Eleven service categories comprising 40 individual tasks were identified in step 1. Four expert interviews were conducted in step 2. Full delegation (100%) was consistently reported for the performance of electrocardiograms, laboratory diagnostics, and the administration of medications. In contrast, delegation rates varied widely for tasks such as patient monitoring (0-100%), detailed medical history (0-90%), and documentation (0-87%). The highest time and cost-saving potentials were observed in the categories of patient counseling (up to 22.5 EUR or 45 min), monitoring (up to 51.75 EUR or 95.5 min), supportive measures (up to 39 EUR or 78 min), and disease management program consultations (up to 46.82 EUR or 93.6 min).

These findings highlight significant heterogeneity in delegation practices and efficiency gains across outpatient oncology and gynecology practices, reflecting structural differences in practice organization and staff qualification. Legal and financial frameworks in Germany support structured delegation, yet practical implementation remains inconsistent. Delegation to treatment navigators offers significant potential to improve efficiency and patient-centered care, particularly in light of rising case numbers and the growing relevance of oral tumor therapies. However, further research is needed to validate these findings and support broader implementation.