Research report: Addressing the side effects of endocrine therapy: a new care pathway combining digital support and human expertise

Women taking hormone-blocking therapy for early breast cancer often face years of troublesome side effects with relatively little medical contact between routine check-ups. A new phase III trial presented at the ESMO 2026 congress suggests that a structured, hybrid care pathway combining a mobile application with personalised nurse support can meaningfully improve how these patients manage their symptoms, even if the effect on overall symptom burden fell just short of statistical significance. The HOPE study, led by Dr Maria Alice Franzoi and sponsored by the Comprehensive Cancer Centre Gustave Roussy, was presented orally on Monday 26 October as Abstract No. LBA92, one of around one hundred ESMO 2026 presentations involving physician-scientists from the French institute.

The clinical context is substantial. Approximately seventy percent of breast cancers diagnosed worldwide are hormone receptor-positive, meaning that tumour growth is driven by hormones, primarily oestrogen. For these patients, endocrine therapy is prescribed after curative treatment for a period of five to ten years.

The treatment works by blocking the body's natural hormone production, thereby preventing the stimulation of any cancer cells that may remain in the body. Its efficacy in reducing the risk of recurrence is well established, which is precisely why the treatment is maintained for so long after surgery and other curative interventions have been completed. Yet the same treatments can be difficult to tolerate.

Patients receiving endocrine therapy commonly experience hot flushes, joint pain, vaginal dryness, insomnia, cognitive difficulties and cancer-related fatigue. These symptoms often arise after curative treatment has finished, at a stage when medical follow-up becomes less frequent, with consultations typically scheduled only every six months. The gap between the intensity of symptoms and the sparseness of clinical contact creates a practical problem for patients who are expected to keep taking their medication for years, largely on their own, while managing side effects that can affect nearly every aspect of daily life.

The consequences of poor tolerance are not merely a matter of comfort. Evidence from the French CANTO cohort showed that sixteen percent of women receiving tamoxifen were already failing to adhere adequately to their treatment after just one year. Those women faced a risk of recurrence increased by a factor of 2.3 compared with women who remained adherent to their therapy.

In other words, the side effects that push patients away from their medication can translate directly into worse oncological outcomes, making supportive care for treatment-related symptoms a genuine clinical priority rather than an optional extra. Several supportive care interventions have individually demonstrated benefits in reducing symptom burden and improving adherence to endocrine therapy. Adapted physical activity and cognitive behavioural therapies are among the approaches with documented effects.

However, as Dr Franzoi explained, these interventions are often fragmented and rarely delivered in a coordinated way. Until the HOPE trial, no study had evaluated a comprehensive pathway that combined digital tools for symptom monitoring, access to educational resources, multiple supportive care programmes and personalised human support, all specifically designed for patients receiving endocrine therapy. HOPE was designed to fill that gap with a structured pathway built on two major components.

The first is a mobile application that enables regular symptom reporting, gives patients access to educational content, and delivers scientifically validated supportive self-management programmes covering adapted physical activity, yoga, meditation and cognitive behavioural therapies. The second component is personalised nurse support. Each patient receives an initial consultation with a specialist nurse who helps identify and prioritise her most troublesome side effects and guides her towards the most appropriate support modules within the application.

When symptoms fail to improve, or when limited engagement with the application is detected, nurses can proactively contact patients to understand and address any difficulties they may be experiencing. A distinctive feature of the programme is that it was developed through a co-creation process involving both patients and healthcare professionals, an approach intended to make the pathway realistic and easy to integrate into both clinical practice and daily life. The trial itself was a multicentre, randomised phase III study in which 180 enrolled patients were assigned either to the HOPE pathway or to standard care.

The primary evaluation focused on the effectiveness of the hybrid pathway in reducing symptom burden, measured using questionnaires covering several symptoms commonly associated with endocrine therapy. A further endpoint assessed patients' confidence in self-managing their symptoms, a measure of the autonomy the programme was designed to build. The enrolled population was notably diverse, which the investigators regard as one of the study's strengths.

Participants ranged in age from 29 to 87 years and represented a wide variety of educational backgrounds. More than fifteen different languages were spoken in the households of enrolled patients, groups that Dr Franzoi noted are often difficult to include in clinical studies. At three months, women enrolled in the HOPE pathway showed an average reduction in symptom burden of 3.41 points compared with those receiving standard care.

Dr Franzoi described this improvement as consistent with the team's expectations but not large enough to reach statistical significance. Exploratory analyses, however, suggested that patients who engaged more actively with the application experienced a greater reduction in symptom burden, with an average improvement of 4.26 points. The study also demonstrated a significant improvement in patients' confidence in managing their symptoms: women supported through the HOPE pathway reported being more confident in their ability to understand, monitor and manage endocrine therapy-related side effects than those receiving usual care.

Implementation data were encouraging as well. Sixty-six percent of patients completed more than half of the supportive care programme, and ninety percent considered the pathway useful and well suited to their needs, saying they would recommend it to other patients. Both patients and healthcare professionals highlighted the organisational value of the programme, viewing it as a practical and pragmatic way to deliver personalised, structured support tailored to individual needs.

Participants continue to be followed for one year and retain access to the application. Several additional analyses are ongoing, including evaluation of symptom burden at six and twelve months, the programme's impact on adherence to endocrine therapy, and objective measures of physical activity and sleep. A HOPE 2 study is already being prepared to provide more personalised and longer-term support, particularly for younger women receiving intensified endocrine therapy strategies, with new modules dedicated to hot flushes and the most disabling symptoms.

For now, the findings demonstrate that a highly diverse patient population can be effectively supported, and that patients' ability to manage treatment-related symptoms independently can be strengthened through a combination of digital tools and human expertise.

Subject of Research: A hybrid digital and nurse-supported care pathway for managing endocrine therapy side effects in early breast cancer

Article Title: Addressing the side effects of endocrine therapy: a new care pathway combining digital support and human expertise

Article References: Addressing the side effects of endocrine therapy: a new care pathway combining digital support and human expertise. Original publication (Bibliographic details unavailable.)

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Keywords: breast cancer, endocrine therapy, hormone receptor-positive, supportive care, digital health, mobile application, nurse support, HOPE trial, ESMO 2026, Gustave Roussy, treatment adherence, symptom management