In software engineering, this agile value highlights the fact that people and the communication behind developed processes and tools for achieving software development success are more important than these processes and tools themselves. Even if the team has the best, most appropriate tools, having the right people along with effective communication is still of greater importance. Regarding language for BCT professionals, this value is maintained as it is, without changing any of its wording [18,20].

In the BCT context, “working together is much more than policies, strategies, structures and processes” [27]. This can be seen in the shared decision-making (SDM) process for BCT, where the patient and everyone else is involved in delivering valuable information and reducing any mismatch between information that is delivered and the information that is needed in the complex treatment process [28]. When a patient is involved in SDM, it permits consideration of the patient’s preferences in the treatment, increasing their satisfaction and transforming the treatment process into a patient-centered one [29]. Improving patients’ engagement skills, using elicitation, performing clarification exercises for their preferences, and using formal and informal coaching are recommended to increase patients’ engagement in SDM in the BCT lifecycle. However, lack of time and resources are the biggest barriers mentioned regarding SDM [29]. This would prioritize individuals and their interactions over the tools [26,28,29]. Patient-centered communication and education, as well as coordination of care, are vital components for achieving the triple aims defined by the Institute for Healthcare Improvement that aim to improve the care experience for patient and family, improve the population’s overall health, and reduce health care capital costs [30]. According to research findings, the effectiveness of communication changes depending on the stage of the disease, and, for it to be effective, it must be adapted to the changing requirements and preferences of breast cancer patients [31,32]. Even after cancer treatment, regardless of the channel used, communications and interactions are still necessary. For example, a storytelling support group was run over the internet to break the social isolation that follows cancer [33,34].

In cancer care, the multidisciplinary team is a core central point of communication and collaboration. The National Health Service in the United Kingdom defines the multidisciplinary team (MDT) as “a group of health and care staff who are members of different organizations and professions (e.g. GPs, social workers, nurses, anesthesiologist, radiologist, pathologist, etc.,) that work together to make treatment and related services decisions of individual patients. MDTs are used in both health and care settings” [35]. In BCT planning, individuals in the MDT and their interventions can optimize care planning. For example, a nurse can stimulate interdisciplinary strategic planning that satisfies the clinical setting and improves outcomes through playing a key role in assessing the patient’s holistic needs [36]. A breast radiologist plays a vital role in the assessment and management of pain while leveraging patient communication and education, can add significant value to the care delivery process and patient care, and can improve outcomes [37]. Breast cancer patients who participated in a well-organized MDT contributed to facilitating a clear definition of their needs related to diagnosis, treatment, surveillance, and monitoring. This significantly enhanced breast cancer care planning, clarifying SDM in terms of booking appointments, referring procedures, and allocating respective roles and their responsibilities for patient care [38-40]. As a result, this MDT communication approach with the patient enhances survival rates and improves quality of life [40-44]. Although the research community reports that the MDT and patient interaction are prioritized over processes, some barriers may still hinder the effectiveness of these interactions; these are reported to include absence of leadership, individual personalities, cultural and belief systems, the need for regular clinical meetings, health care workers with double positions, availability of the workforce, specific goals of care, implementation in national health insurance, hospital bureaucracy, issues with hospital infrastructure, patients themselves, and high turnover [44-46]. In the BCT context, collaborative decision-making constitutes far more than relying on factual information, as patient communication may generate a decision that contradicts the evidence; the evidence may suggest a different plan. This highlights the reality that communication between the MDT and patient allows for the consideration of all factors [47].

Effective tools and processes, such as value-based breast cancer care, cannot be effectively addressed without interactions [48]. This does not neglect the role of tools and processes in the BCT context. Tools and processes should be used to improve the provision of patient-centered BCT planning and interactions [18]. The National Coalition for Cancer Survivorship (NCCS) provides the Cancer Survival Toolbox, a tool that aids cancer patients to learn how to communicate, obtain information, make decisions, negotiate, and speak up for their patient rights as they manage their cancer treatment [49].

When a person is diagnosed with breast cancer, it not only affects the individual but also has a significant impact on their family members. According to some studies, it is viable and beneficial to shift care delivery toward person- and family-centered care to clarify and address patient preferences, legitimize care-partner contributions, and grant appropriate access to information for family members and other care partners who are key players in enacting high-quality cancer care [50]. Research indicates that involving family members as care partners in communication intervention at the point of care increases patient understanding of illness, patient access to and use of the patient portal, and viewing of clinician visit notes among patients with more actively engaged care partners [50].

In conclusion, the agility of this BCT value fully conforms to the corresponding software engineering value. This leads us to classify this BCT value as achieving agility.

This software engineering agile value places “working software over comprehensive documentation.” This indicates that it is a higher priority to rapidly deliver functioning software than to spend great attention and effort on documentation tasks [18]. This does not neglect the importance of documentation. The aim is to improve future software releases through obtaining feedback quickly [18]. This value is translated into BCT language as follows: “Documentation and quality of documentation is as high priority as delivering an appropriate patient-centered treatment plan.”

Documentation is vital for medical records and legal purposes in parallel to the patient’s health and immediate needs. Patient-centered treatment planning’s main objective is to involve patients and their families in meaningful and in-depth conversations with their medical professionals to develop an accurate, well-thought-out treatment plan that appropriately uses all available medical information while also taking the medical, social, and cultural needs and preferences of the patient and family into account [26]. The treatment plan is designed, developed, communicated, and executed based on the patient’s individual characteristics, preferences, and responses to treatment in collaboration with an MDT that includes members with different specialties, thus ensuring that their best interests are considered and the best benefits are delivered. Therefore, all this necessary information should be documented as required by the MDT [26].

The documentation of a breast cancer patient may require up to 20 distinct professional groups. Across these different professions, most of this paperwork is normally completed by resident doctors [51]. Across different medical specialties, most of the documentation is carried out by gynecologists or gynecological staff. Most of the time dedicated to paperwork is required for therapy [51]. All this necessary information from different resources is required to be documented for organization, doctor-patient communication, quality assurance and management, managing future changes (as changes are inevitable during BCT), and, mostly, for diagnostic needs and follow-up after each therapy [51].

In a study carried out by the American Society of Clinical Oncology (ASCO), a treatment plan and summary template increased communication between patients and their health care providers among almost 90% of assessed patients and health care professionals [52]. This highlights the importance of documentation for communication and demonstrates not only the need to prioritize documentation but also the need to prioritize documentation quality requirements [51].

Thus, the agility of this BCT value does not conform with the corresponding agile value in software engineering.

In software engineering, this agile value places “customer collaboration over contract negotiation.” It highlights that contracts do not clearly detail customer needs; rather, customers themselves do. Thus, continuous feedback loops are a priority in this agile value to ensure that the developed product is effective and useful as per the customer’s needs. This indicates that agile development is customer-centric. However, this does not neglect the role of contracts. This value can be translated into BCT language as follows: “patient collaboration over treatment plan design agreement.”

BCT professionals interpret patients’ collaboration based on continuous feedback from them. This is observed in patient collaboration and in visits that begin early in the BCT process and should happen frequently. This close collaboration culture with patients has been reported to lead to significant benefits for them, particularly when they are unable to make decisions [44]. Close collaboration helps oncologists and their teams ensure they are delivering an effective, useful treatment solution to patients. When they talk to patients and their families, they build feedback into the treatment cycle and reduce risks [28,29,41].

Encouraging patient collaboration can be achieved through providing them the care and information they need according to their stage of breast cancer, as each stage varies in the aspects of information and associated delivery of care [31,32]. What was effective at one stage may not produce similar effectiveness in another stage. Therefore, it is highly recommended to look for communication alternatives that meet needs and preferences at each stage [53]. Sharing a treatment plan and summary template enhances patients’ and their families’ collaboration [52].

In conclusion, this leads us to classify this BCT value as achieving agility.

The world is not static. Therefore, a workable plan should never be static. This software engineering agile value highlights that changes in software development happen due to changes in the market, customer preferences, priorities, project management conditions, and business needs [18]. Thus, the agile mindset encourages reviewing and readjusting the plan based on new, emerging information. Regarding the BCT context, this value can be maintained as it is without changing any of its wording.

Changes in a BCT plan are inevitable and can occur for several reasons. Changes involve but are not limited to diagnosis results, follow-up assessments, surgical outcomes, health conditions, tumor characteristics, treatment response, side effects and tolerance, structural changes, resources, policies, disease recurrence, drug resistance, monitoring assessments, new research, and others. All these alert us to the need for a personalized response to the changes as a priority over following a static plan. For example, changing the sequence of treatment, in terms of radiotherapy and surgery, could improve outcomes and reduce side effects in terms of treatment complications and address safety and technical feasibility [54]. Lifestyle changes that involve exercise, diet, smoking, and alcohol have empowered patients psychologically and reduced the risk of recurrence and death [55-57].

Breast cancer is a complex disease in which not all patients can benefit from the same treatment. Thus, it is essential to go beyond conventional BCTs [58]. Changes in BCT may require developing a novel treatment that could be described as personalized [58]. Changes to the treatment plan could happen if the aim has changed. Aims could include preventing cancer recurrence, slowing growth of cancer, and managing symptoms of incurable cancer [59]. Accordingly, changes entail allocating roles that are put into place to address the aim of BCT and provide referral to clinical trials that are regulated to effectively address the desired treatment aim with minimum side effects [60]. Furthermore, a change may require halting the treatment to recover from adverse side effects [60].

Managing BCT entails evaluating the patient’s response to treatment from the perspectives of surgery, imaging, and medical oncology. Adjuvant treatment is guided by an appropriate surgical and pathological assessment and follow-up care that concentrates on identifying recurring illness with the goal of enhancing long-term survival [61]. Whatever the change that requires a response, the BCT team will strive to improve the patient’s quality of life.

Magnetic resonance imaging (MRI) is used to accurately identify stages of breast cancer by assessing the size and extent of the tumor within the breast and evaluating if it has spread to nearby lymph nodes or other structures [62]. This information is essential in determining an appropriate treatment approach that is ready to respond to changes. A major change in the treatment plan may involve the need for surgery and additional treatment [62-64].

In BCT, personalized treatment is a means of responding to a change and delivering patient-centric medicine. Knowing the molecular characteristics of breast cancer subtypes is necessary to create a tailored therapy and diagnosis [65]. It is necessary to establish molecular profiles and metrics for tailoring the appropriate treatment and evaluating its benefits and risks. Dose ratios and regimens are likely to change according to an identified combination therapy [66]. BCT decisions are based not only on the assessment of prognostic factors but also on the assessment of pathological and clinical findings. A multitopic-based integrated data approach to address many breast cancer risk variables can bring tremendous insight and promises to change treatment for the better [67].

In conclusion, this BCT agile value shows how change is necessary for the benefit of the patient.