Abstract P6-11-08: Socio-economic factors affecting trastuzumab usage in breast cancer patients belonging to hilly regions of north India
Authors: Pasricha Rajesh , Singh Pragya , Ibrahim Ajas , Pandey Laxman , Bhadoria Ajeet Singh , Gupta Sweety , Joseph Deepa , Gupta Manoj , Ravi Bina 
Published: March 2020

Abstract
Introduction
Breast cancer is the most common malignancy in women worldwide and is a prototype of global cancer disparity. While breast cancer mortality is decreasing in developed countries, it continues to increase in low- and middle-income countries. Trastuzumab in combination with chemotherapy is the standard of care and essential drug for patients with Her2 positive breast cancer. Despite the availability of biosimilar, it is still out of reach for many patients in India for various reasons such as lack of drug funding or because of high treatment costs. This study examines access to trastuzumab and identified potential barriers to its use in a large tertiary care hospital in an underserved and resource-restricted hilly region of Northern India (Uttrakhand).
Material and methods
In a cross-sectional study all patients diagnosed with Her2 positive breast cancer who underwent treatment in our institute from January -December 2018 were included. All relevant details like age, stage, treatment details, receptor status (ER/PR/ Her2) were recorded. All Her2 positive patient who had 3+ score on immunohistochemistry (IHC) were considered positive. These patients were investigated to look into various factors for acceptance or non -acceptance of trastuzumab like socio-economic status, funding of treatment, education status and reasons for non-usage of the drug. Patients were categorized into high, middle and lower socioeconomic status by using an appropriate scale. The data were analyzed by using SPSS Version 20.0 and Open epi software. Chi-square test of significance was applied to test the association between variables.
Results
310 patients of carcinoma breast were included in study, out of which 68 patients were Her2 positive (22%). Of these 68 patients, 24 (35%) received trastuzumab. Most trastuzumab recipients belong to upper and middle socioeconomic status as compared to the lower class (83.3% vs 16.7%, p=0.001). The treatment of maximum (91.7%) users were met by out of pocket expenditure whereas only two patients were beneficiary of government health schemes. Most of the trastuzumab user patients were well educated (above high school level) compared to those who did not take the drug (83% vs 36%, p= 0.0001). Among 44(65%) patients who did not receive the drug, the majority had education level below high school (63% vs 36%) despite high income (54% vs 37%). 26 (59%) patients reported the financial issue as the main cause of not taking trastuzumab whereas the remaining 18 (41%) patients cited the reason that they were not offered this drug by treating physician probably assuming that patient will not be able to afford this treatment. Except for two patients, all trastuzumab nonrecipient patients were also financing their treatment themselves. These two non-user patient with financial support from the government denied the use of trastuzumab due to personal reasons.
Conclusions
The majority of Her2 positive patients were unable to receive trastuzumab treatment due to financial constraints, non-availability of health insurance and poor government support for treatment. Patient’s socioeconomic class, monthly income & their education level significantly influenced the usage of the drug. Treating oncologist should also overcome their personal biases about the socio-economic status of patients and should offer the drug wherever indicated as this was the second most common reason for non-usage of the drug. Improvement in education standard raises the socioeconomic status as well as disease awareness among the patient which would make them vigilant and receptive to life-saving beneficial but costly treatment like trastuzumab. Tremendous efforts are required for cost reduction, patient education as well as the implementation of the government health scheme to bridge this gap.
Citation Format: Rajesh Pasricha, Pragya Singh, Ajas Ibrahim, Laxman Pandey, Ajeet Singh Bhadoria, Sweety Gupta, Deepa Joseph, Manoj Gupta, Bina Ravi. Socio-economic factors affecting trastuzumab usage in breast cancer patients belonging to hilly regions of north India [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-08.