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Patients ‘left behind’ due to inequalities in breast cancer care, report finds

Many people with breast cancer are not receiving the treatment they should, with inequalities in care leading to many groups being ‘systematically left behind, ignored and forgotten’, according to a new report.

This comes despite considerable advances in breast cancer research and treatment over the last three decades, which has led to a more than 40% reduction in breast cancer mortality in some high-income countries.

People living with metastatic breast cancer are particularly disadvantaged since rates of this type of cancer are unrecorded, and the needs of this population are unmet. The findings of The Lancet Breast Cancer Commission suggested that systematic recording of cancer rates must be established and call for increased prevention strategies and personalised treatment.

Current predictions suggest there will be three million new cases a year of breast cancer worldwide by 2040 and a million deaths, with people living in low- and middle-income countries disproportionately affected.

Tackling breast cancer gaps and inequities should be achieved through ‘global collaboration, and communication and empowerment’, the researchers said, stating that The Lancet Breast Cancer Commission is a ‘forward-looking and optimistic road map’ to address urgent challenges in breast cancer care and reduce breast cancer rates.

The findings highlighted a lack of information around rates of metastatic breast cancer, despite statistics showing that 20-30% of early breast cancers experience relapse.

Often, the physical, psychological, social and financial costs of breast cancer were found to be ‘immense but under-recognised’ since current global health metrics do not capture them.

Professor Charlotte Coles, professor of breast cancer clinical oncology and deputy head of department of oncology at the University of Cambridge, said: ‘Recent improvements in breast cancer survival represent a great success of modern medicine. However, we can’t ignore how many patients are being systematically left behind.’

She added: ‘We hope that, by highlighting these inequities and hidden costs and suffering in breast cancer, they can be better recognised and addressed by healthcare professionals and policymakers in partnership with patients and the public around the world.’

In response to the findings, the researchers established a UK-based pilot study that provides a snapshot of the economic burden and care needs of people affected by breast cancer. Nearly all of the 606 people living with breast cancer and carers surveyed experienced physical or wellbeing issues related to breast cancer, such as losing a job whilst undergoing treatment or experiencing sexual dysfunction.

Many cancer patients were also found to experience financial difficulty as a result of their illness, with 27% of patients with early breast cancer and 35% with metastatic breast cancer reporting money problems. A fifth of participants with early breast cancer and a quarter of those with metastatic breast cancer reported difficulty in covering the costs of travel for treatment.

Estimates of serious health-related suffering indicated the need for palliative care. In 2020, approximately 120 million days were spent with serious health-related suffering per year for people who died of their cancer. A further 520 million days were estimated for patients living with the disease.

Dr Carlos Barrios director of the the Oncology Research Center at Hospital São Lucas, Brazil, said: ‘Even in countries with well-developed healthcare systems, patients with breast cancer experience inadequate support and care. In countries lacking affordable health care facilities, patients experience these costs more commonly and intensely, too often leading to catastrophic spending and impoverishment.’

The The Lancet Breast Cancer Commission advocates the development of new tools to estimate the hidden costs of breast cancer and better communication between healthcare workers and patients to improve the quality of life for patients and guide policymakers to invest in breast cancer prevention and interventions that relieve suffering, such as early detection, cost-effective therapy, optimal management and financial protection.

The researchers estimate that up to a quarter of breast cancer in high-income countries could be prevented by modifying risk factors for breast cancer. This involves education and awareness-raising efforts, as well as ‘bold policy changes’ that reduce the number of people exposed to these risk factors, such as alcohol consumption and being overweight.

In addition, systematic approaches that identify those at increased risk of the disease are essential to enable equitable access to personalised prevention strategies, including cheap and effective medications that can avert breast cancer for many women and early detection programmes.

Professor Benjamin Anderson, professor of surgery and global health medicine at the University of Washington, concluded: ‘Access to evidence-based prevention and care that isn’t dependent on where an individual lives or their ability to pay would reap wide-ranging benefits for patients, families and healthcare systems striving to achieve universal health coverage.’

A version of this article was originally published by our sister publication Nursing in Practice.