Breast cancer is the most common type of cancer affecting woman in the EU. Multidisciplinary Breast Units (BUs) were introduced in order to deal efficiently with breast cancer cases, setting guideline-based quality procedures and a high standard of care. However, daily practice in the BUs is hampered by the complexity of the disease, the vast amount of patient and disease data available in the digital era, the difficulty in coordination, the pressure exerted by the system and the difficulty in deciding on cases that guidelines do not reflect. DESIREE aims to alleviate this situation by providing a web-based software ecosystem for the personalized, collaborative and multidisciplinary management of primary breast cancer (PBC) by specialized BUs. Decision support will be provided on the available therapy options by incorporating experience from previous cases and outcomes into an evolving knowledge model, going beyond the limitations of the few existing guideline-based decision support systems (DSS). Patient cases will be represented by a novel digital breast cancer patient (DBCP) data model, incorporating variables relevant for decision and novel sources of information and biomarkers of diagnostic and prognostic value, providing a holistic view of the patient presented to the BU through specialized visual exploratory interfaces. The influence of new variables and biomarkers in current and previous cases will be explored by a set of data mining and visual analytics tools, leveraging large amounts of retrospective data. Iintuitive web-based tools for multi-modality image analysis and fusion will be developed, providing advanced imaging biomarkers for breast and tumor characterization. Finally, a predictive tool for breast conservative therapy will be incorporated, based on a multi-scale physiological model, allowing to predict the aesthetic outcome of the intervention and the healing process, with important clinical and psychological implications for the patients.

Despite the tremendous improvement in early diagnosis and treatment of breast cancer, a large proportion (up to 40%) of patients with breast cancer will eventually develop metastases. Patients with metastatic breast cancer (MBC) have a median overall survival of 2-3 years, and a relative 5-year survival of 34%. Current advances in therapy have extended the life of those patients with MBC, however these patients still suffer (for longer periods) from deleterious side-effects (either related to the disease itself or to the treatment) such as fatigue, pain, nausea and vomiting, insomnia, dyspnoea, emotional, social and cognitive dysfunction. Among all these side-effects, fatigue is the most common and distressing treatment-related side-effect, as up to 90% of patients with MBC experience fatigue over the course of treatment. All these symptoms negatively affect patients’ QoL and thus an urgent solution is needed to help those with advanced breast cancer to “live well” for as long as possible. PREFERABLE’s vision is to improve the standard of care in MBC by improving the quality, effectiveness and cost-effectiveness for patients in a palliative setting using a non-pharmacological intervention combining supervised and unsupervised app-based exercise. Based on the results from a multinational randomised controlled phase 3 clinical trial (EFFECT trial; (cost)- effectiveness study), the different perspectives of patients with MBC on exercising (PERSPECTIVE study), and through mapping the differences in the European healthcare systems, the PREFERABLE project will generate solid and conclusive evidence of the beneficial effect of exercise on cancer-related side effects and patients’ quality of life in the palliative setting. By this, PREFERABLE will contribute towards reshaping medical practice and improving clinical guidelines and recommendations.

With over 12 million cancer survivors relying on supportive care across the EU, it is essential to provide them with (cost-)effective interventions tailored to their specific needs. Many survivors suffer from long-term side effects that can lower their quality of life (QoL), functioning, and productivity. Exercise interventions have proven to be uniquely beneficial in managing both physical and psychological complaints. However, their effects are strongest when tailored to a patient's specific burden, e.g. fatigue, low physical fitness, anxiety and depressive symptoms or chemotherapy-induced peripheral neuropathy. Moreover, the use of exercise interventions in supportive cancer care is still limited due to a lack of availability, a lack of accessibility caused by time and travel constraints and low awareness. To tackle these hurdles, the PREFERABLE-II consortium sets out to design and demonstrate the (cost-)effectiveness of a novel exercise intervention that: 1) will be tailored to the side effect that bothers the survivor the most, by use of a modular design, 2) can be implemented at home, with live-remote supervision from a national broadcast centre, 3) is available to all cancer survivors, and 4) incorporates improved patient-centred communication and shared decision making. Results of our RCT, enrolling 350 cancer survivors, will be translated into guideline recommendations for exercise-oncology. Extensive ethical, legal and social impact components of the project will reveal barriers and facilitators of live-remote supervised exercise and provide policy recommendations to further support implementation. Finally, we will create communication standards and an education module for healthcare professionals to train the future workforce. As such, PREFERABLE-II contributes to improving the QoL of cancer survivors by lowering the burden of side effects, while also improving availability, access and awareness off exercise-based supportive care interventions.