Inclusion of Metastatic Breast Cancer Treatments in the SUS (Public Health Care System): Strategic Actions
Authors: Gomes A.L. , Turbay T. , Cecagno L. , Venturela P. , Johnson G. , Caleffi M. 
Published: September 2018

Background and context: Thousands of women suffering from HER2+ metastatic breast cancer (MBC) in Brazil had limited access to treatment in the public health system (SUS). There were no innovative therapies (only standard chemotherapy) available for them. Trastuzumab is included in WHO´s essential medicines list and it began to be commercialized in Brazil in 1998, being available in SUS in 2012, but only for patients with local breast cancer. Pertuzumab was never available in SUS for any stage of the disease. Aim: Contribute to the inclusion of trastuzumab and pertuzumab in MBC treatments in the SUS. Strategy/Tactics: Federação Brasileira de Instituições Filantrópicas de Apoio à Saúde da Mama’s (FEMAMA´s) main strategy was to develop several projects with the same purpose. Program/Policy process: The cycles of debates with parliamentarians and public hearings (events) to discuss with politicians the incorporation of new treatments in 15 state legislative branches and also in the National Congress; Organization of 8 public hearings after the first event (mentioned above) and elaboration of a one-year plan of actions to be carried out alongside NGOs associated with FEMAMA for carrying out local actions; The Women´s Cancer Fight Forum (event) to strength and empower the role of NGOs in public health policies; The National Conference of Female Mayors and Governors and the National Conference of First Ladies (event), where women´s leaders from all regions and local NGOs worked together discussing problems and suggesting actions to combat them; The Ambassadors Project - Women in Defense of Breast Health, empowering patients to be spokespeople for the cause in their regions; Carry out surveys that show the difference in MBC treatments available for patients with health insurance and patients treated in the SUS; Participation in several events on this topic organized at the House of Representatives and at the Senate; Add this topic to the agenda of the National Health Council and of the 2015 National Health Conference; Awareness and mobilization campaigns for expanding access to treatment and empowerment of patients: Para Todas as Marias, Por Mais Tempo, Acesso Já, #PacientesNoControle - Atitude Exige Coragem; National campaign to promote the public consultation of the Ministry of Health on the incorporation of trastuzumab and pertuzumab treatments in SUS, #PatientsInControl. Outcomes: Several outcomes were obtained as a result of these projects and campaigns. However, our main result undoubtedly is assuring access to metastatic breast cancer treatments in the Brazilian health care system. On August 2017, the Ministry of Health announced the incorporation of trastuzumab for metastatic breast cancer in the public health system and on December 2017, it announced the incorporation of pertuzumab for the same patients. What was learned: Patients and articulated NGOs have power to change scenarios. Empowering patients by providing them with information and tools is an important way to promote changes.