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Prof. Vrdoljak et al.: Addressing disparities and challenges in underserved patient populations with metastatic breast cancer in Europe


n the occasion of Special Policy Report „Addressing Cancer Injustice in CEE Countries“ we are sharing valuable and important review from The Breast by prof. Eduard Vrdoljak et al.Addressing disparities and challenges in underserved patient populations with metastatic breast cancer in Europe„.




People with metastatic breast cancer face many challenges and disparities in obtaining optimal cancer care. These challenges are accentuated in underserved patient populations across Europe, who are less likely to receive quality healthcare for reasons including socioeconomic inequalities, educational or cultural status, or geographic location. While there are many local and national initiatives targeted to address these challenges, there remains a need to reduce disparities and improve access to healthcare to improve outcomes, with a focus on multidisciplinary stakeholder engagement.


Underserved patient populations (UPP) with mBC may be defined as less likely to receive quality healthcare owing to the patient- or system-related factors outlined above. Successful strategies aimed at reducing disparities and increasing access to optimal treatment and care must be developed for these UPPs.





To better understand the challenges facing UPPs with mBC, it is important to get the perspective and input of all stakeholders, including healthcare professionals (HCPs), patient advocacy group (PAG) representatives, policy makers, politicians and others. The challenges not only include access to the right treatment and care, but also improvements in HCP education, policy-related issues, support for patients, caregivers and employers, investment in medical innovations and efficient use of healthcare resources. A multidisciplinary team approach has been shown to improve patient care and health outcomes in BC [40], including survival [41]. Therefore, multidisciplinary collaboration can build on existing initiatives, identify remaining gaps, and develop new actions to drive access to the appropriate care for patients with unmet needs.


Multidisciplinary group of European experts in metastatic breast cancer, including healthcare professionals, patient representatives, policymakers and politicians, met to discuss and prioritize the critical needs of underserved patient populations with metastatic breast cancer in Europe.





Six key challenges faced by these communities were identified: the need for amplification of the metastatic breast cancer patient voice, better and wider implementation of high-quality guidelines for metastatic breast cancer, more collaboration between stakeholders, tailored support for patients from different cultural and ethnic backgrounds, improved data sharing, and work-related issues.



SOURCE & COPYRIGHTS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772562/figure/fig1/



The Expert Panel then conceived and discussed potential actionable goals to address each key challenge. Their conclusions present a set of interrelated approaches to address the different challenges and could serve as the basis for concerted improvement of the lives of patients with metastatic breast cancer in Europe.


Based on the outputs of the literature search and survey, challenges identified were grouped according to the following categories: socioeconomic and workplace issues, education and awareness needs, healthcare availability and access, and ethnicity and cultural issues. During workshop discussions, different groups of experts identified and prioritized multiple challenges associated with UPPs with mBC and classified them according to the categories above.




The principal unmet needs identified by the survey for the UPP with mBC were:

– Better treatments, including equitable early access to new drugs
– Access to quality specialized care (e.g. mBC-specific guidelines, early diagnosis, culturally sensitive care), especially a
   clinical specialist team with good communication skills
– Access to disease and treatment information, including clinical trial recruitment
– Psychological/emotional support
          * Greater recognition of mBC and its impact (not just on patients but also on their caregivers and employers) at a national level (e.g. mBC Awareness Day)


The challenges in addressing the unmet needs of the UPPs in mBC or in making these a priority identified by the survey were:

– A need for more multidisciplinary teams, incorporating psychologists, nutritionists, specialist nurses and community-based
  HCPs, as well as more specialist breast units and referral centers
– A need for better communication between HCPs and patients and a greater understanding of the needs of diverse cultural
  populations by physicians
– There is a lack of adequate cancer-control policies, and a need for more action by politicians to highlight the burden of
   mBC and promote initiatives to address unmet needs
– Separate systems of governance and ‘postcode lotteries’ within countries may result in disparities in treatment between
   different regions
– There is a bias towards prioritizing messages about early breast cancer over metastatic disease in many national
   awareness campaigns (e.g. Pink October)




The six challenges identified as the most feasible to address were as follows:

  1. Need for improved awareness and amplification of the mBC voice
  2. Better and wider implementation of high-quality guidelines for mBC
  3. Need for improved mBC understanding in non-oncologists and better communication between primary care physicians (PCPs), oncologists and patients
  4. Need for improved awareness of and tailored approaches to support patients with mBC in multicultural communities
  5. Need for improved mBC data gathering and clinical trials
  6. Issues within the workplace





    Improving outcomes for patients with mBC across Europe, and indeed the world, remains one of the biggest healthcare challenges in oncology. Mortality rates for metastatic disease remain high, so, from a certain point of view, all patients with mBC could be considered underserved. However, for those patients that are underserved owing to either individual factors, such as age, ethnicity, socioeconomic status and others, and/or persistent disparities in cancer care, the unmet needs are even greater.


    The challenges faced by UPPs with mBC are wide-ranging and varied and, therefore, addressing them successfully requires a coordinated, multidisciplinary approach that involves all stakeholders, from patients to politicians.


    The disparities that exist across Europe must be tackled by cooperation and collaboration both within and between countries. Effective interventions must focus not only on the patients but also address the system, to improve care across the continuum of mBC evaluation and treatment.


    Authors have highlighted some of the high priority access barriers to healthcare facing UPPs with mBC and suggest actionable goals that countries and health systems can aim to implement through multifunctional stakeholder groups, in accordance with local needs and in synergy with existing initiatives. It is hoped that this could encourage a move towards building a revised approach to the treatment and care of one of the biggest burdens on women’s health in the 21st century.




    Vrdoljak E. et al, Addressing disparities and challenges in underserved patient populations with metastatic breast cancer in Europe, Breast. 2021 Feb; 55: 79–90.