Embedding a pharmacist-led clinic in early breast cancer treatment pathways

I still feel a sense of anticipation at the start of every breast cancer clinic, never quite knowing what the day will bring. Will someone be seeking advice and reassurance as they navigate the emotional strain of a cancer diagnosis? Or will a patient need expert management of treatment-related toxicities? Perhaps I might end up seeing a patient who is euphoric, knowing they will soon be completing their treatment and can go skiing on the French slopes of Val d’Isère.

Breast cancer is the most common cancer in the UK, with approximately 55,000 women and 400 men being diagnosed every year. An estimated 600,000 people in the UK have a history of breast cancer, a number projected to double to 1.2 million by 2030. This increase is driven by continued advancements in treatment and care, alongside a growing focus on earlier detection and faster diagnosis.

At St George’s Hospital (SGH) in London, consultants assess patients at the start of treatment to determine the most appropriate therapeutic pathway. However, as patients transition to long-term adjuvant therapies — including endocrine treatments, bisphosphonates, cyclin-dependent kinase (CDK) 4 and 6 inhibitors, as well as human epidermal growth factor receptor 2 (HER2) targeted therapies — there is a clear need for structured, personalised support that consultants alone are unable to meet. 

In addition, newer therapies are continuing to be introduced into early breast cancer treatment pathways. For example, ribociclib was recommended for use on the NHS in August 2025 for early breast cancer. At SGH, we anticipated a significant increase in the number of patients eligible for this treatment. With rising patient demand, the implementation of a pharmacist-led clinic offered a practical and timely solution to support service capacity while maintaining high-quality patient care.

Setting up the clinic

In July 2025, I established the pharmacist-led early breast cancer clinic at SGH. It was designed to fit within the current multidisciplinary pathway, complementing existing medical and nursing services. While consultants remained responsible for treatment initiation, stable patients in the adjuvant setting were referred to the pharmacist-led clinic for ongoing management. The clinic took approximately five months to establish. This was my first experience of setting up a service, and I received strong support from my colleagues, enabling me to co-lead stakeholder meetings and develop the clinic’s standard operating procedure.

The clinic now runs weekly as a morning session, accommodating up to 6 patients in 30-minute appointment slots. During consultations, I review each patient’s treatment and address any concerns they may have. I conduct a structured toxicity assessment and ensure that all necessary monitoring such as blood tests, mammograms and echocardiograms is up to date. Many patients also experience treatment-related menopausal symptoms, such as arthralgia and vaginal atrophy, so a significant part of the consultation involves providing tailored advice and strategies to manage this. A breast cancer diagnosis can take an emotional toll, so I also place a strong emphasis on supporting the psychological wellbeing of my patients. Additionally, I prescribe systemic anti-cancer therapies as part of their ongoing treatment.

Initially, the clinic was structured so that patients alternated between an appointment with me and with their consultant; however, as my confidence and experience in managing these patients has developed, this approach is no longer required and patients are now managed in my clinic unless consultant input is needed. Similarly, when the clinic was first set up, I discussed each patient with a designated consultant prior to clinic to confirm treatment plans and required investigations. With increasing experience, this step has also become less necessary, reflecting the growing autonomy of my role. However, I remain mindful of my limitations and escalate concerns appropriately when needed.

Impact and next steps

As a pharmacist with experience in a range of specialist roles, including cardiovascular disease, lipid disorders and adult critical care, my initial knowledge of breast cancer was limited. However, drawing on my experience in running pharmacist-led clinics, I was able to adapt my skills to meet the needs of this new challenge. In addition, I committed to independent learning, attending study days and webinars hosted by pharmaceutical companies, as well as shadowing breast cancer consultants within their clinics to further develop my expertise.

My next step is to formally evaluate the effectiveness, value and overall impact of the clinic. This will include collecting data on main outcomes, such as the number of patients seen, consultant time saved and the number of systemic anti-cancer therapy prescriptions issued. Patient experience and satisfaction is being assessed through the collection of patient feedback surveys. These findings will be essential in supporting the continued funding and potential future expansion of the service.

Since establishing the clinic, I have witnessed first-hand the profound impact a dedicated pharmacist can have within the breast oncology service. The positive feedback and heartfelt comments from my patients not only reinforce the value of this role but also make every moment in the clinic deeply rewarding. This experience has shown me how much we, as pharmacists, can contribute to the holistic care of cancer patients — not just through medication management, but through the genuine relationships we build and the support we provide. That sense of anticipation at the start of each clinic still lingers, but now it is accompanied by a strong sense of purpose and fulfilment.