Clinical and Nursing Outcomes Within a Fundamentals of Care-Oriented Case Management Pathway for Breast Cancer Surgery: The CARE-BOOST Prospective Study
The prospective CARE-BOOST study demonstrates that a Fundamentals of Care-oriented Case Management pathway for breast cancer surgery effectively identifies and resolves nearly all nursing needs across the perioperative trajectory, resulting in high rates of home discharge without unplanned healthcare utilization.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a person is diagnosed with breast cancer and faces surgery, the medical journey is often viewed through the lens of the operation itself: the removal of the tumor, the reconstruction of the breast, and the immediate physical recovery. Yet, for the patient, the experience extends far beyond the operating room. It encompasses the anxiety of waiting, the confusion of managing medications, the struggle to return to daily routines, and the fear of complications that might arise once they leave the hospital. Modern medicine recognizes that successful recovery depends not just on technical surgical skill, but on a continuous, supportive network that addresses these human needs. This network relies on the concept of "fundamentals of care," which focuses on the basic, essential elements of nursing: keeping a patient comfortable, managing symptoms, teaching them how to care for themselves, and ensuring they are never left without guidance. When these fundamentals are woven into a structured plan called case management, a dedicated professional guides the patient through every step, from the first pre-surgery visit to the weeks after returning home.
In a prospective study conducted at a specialized breast unit in Turin, Italy, researchers put this integrated approach to the test. They followed 105 women who were scheduled for elective breast cancer surgery between October 2025 and April 2026. The goal was not to invent a new medical procedure, but to observe how a specific model of care—where a nurse-led case manager actively identifies and solves patient needs—plays out in the real world. The team tracked every interaction, every piece of advice given, and every problem that arose, measuring how effectively this support system worked to keep patients safe and informed.
The process began before the women even entered the hospital. The case manager met with them to assess their overall health, their ability to perform daily tasks, and their emotional state. Using a method called "teach-back," where patients repeat instructions in their own words to confirm understanding, the team ensured that every woman knew exactly what to expect. This preparation was remarkably thorough; nearly all patients received this preoperative assessment and education. Once admitted, the case manager did not disappear. They continued to monitor the patients, adjusting care plans as needed and working directly with the medical team to manage pain, prevent complications, and prepare for discharge. The support did not end when the patient walked out the door. Instead, a structured telephone follow-up program began, with the first call happening within 48 hours of going home, followed by regular check-ins to see how recovery was progressing.
The results of this continuous engagement were striking. Across the entire journey, from the initial assessment to the final follow-up, the care team identified 642 specific nursing needs. These needs ranged from practical issues like managing wound care and medication to more complex concerns about mobility and emotional well-being. The system proved highly effective at resolving these issues. Of the 642 needs identified, 630 were successfully resolved, a success rate of 98.1 percent. The data revealed that the period after discharge was actually when the most needs were identified, with 252 new concerns surfacing once the women were back in their own homes. Yet, even in this phase, the resolution rate was exceptionally high at 99.2 percent, suggesting that the telephone follow-ups were catching problems before they could escalate.
The clinical outcomes for the group were equally positive. The average hospital stay was very short, with a median of just one day. Within 30 days of surgery, the vast majority of women remained at home without needing any unplanned medical help. Only one patient required a readmission to the hospital, representing just 1 percent of the group. While a small number of patients visited the emergency department or required minor treatments, the overall picture was one of smooth recovery. The study also looked at whether the complexity of the surgery changed the amount of support a patient needed. They found that the intensity of the case manager's work varied only slightly between women having simple procedures and those having more complex surgeries. This suggests that the support system was responsive to individual needs rather than being driven solely by the technical difficulty of the operation.
The researchers also examined what factors led to a higher number of identified needs. They found that the number of other health conditions a patient had was a significant predictor; women with more comorbidities tended to have more needs identified. However, the study did not find that age or the type of pre-surgery chemotherapy influenced the number of needs. The high rate of information retention, with patients remembering 95 percent of what they were taught, indicated that the educational approach was working well. The study concludes that this model of care, which blends direct nursing support with careful coordination, is feasible and effective at identifying and solving patient problems. While the study did not include a control group to prove that this model is superior to standard care, the high resolution of needs and the positive clinical outcomes provide a strong foundation for further research. The work demonstrates that when care is continuous and focused on the patient's fundamental needs, the path to recovery becomes clearer and more manageable.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.