Supporting Resource-Stratified Metastatic Breast Cancer Policy Development: A Global Policy Analysis
Authors: Cabanes Anna , Cardoso Fatima , Thrift-Perry Maia , Hunt Katherine Moose , Cruz Tauane Araújo 
Published: October 2018

Purpose Patients with metastatic breast cancer (mBC) have significant unmet needs that current policies do not fully address. Methods A comprehensive analysis of national cancer control programs and breast cancer (BC) policies and programs was conducted across 16 countries representing diverse geographies, socioeconomic status, and health care systems. Key policy components were identified, aligned with the journey of a patient with BC, and evaluated using standardized criteria that measured the adoption and implementation of national cancer control program goals and mBC-specific programs. The identified gaps for patients with mBC were aligned with promising practices implemented or spearheaded by civil society that demonstrated success at filling the gaps with the objective of creating an information resource that other organizations in the field can use as practice-based evidence. Results Despite considerable BC policy development and implementation, important gaps for patients with mBC persist across all areas of the patient journey and vary between countries studied. Inadequate public awareness, lack of trained specialists, inefficient coordination of care delivery, and limited access to innovative mBC treatments are barriers to effective care in select regions in high-income countries and overall in low- and middle-income countries. In addition, the provision of palliative care remains in its infancy in low- and middle-income countries, although this is an area of increasing policy development in high-income countries. Promising practices that evaluate patient advocacy efforts have revealed that adaptable models can support policy adoption and target specific gaps through an approach that can be tailored to countries’ resource contexts. For example, advocacy efforts identified in sub-Saharan Africa used a range of tools, in collaboration with key hospitals, to address barriers at the diagnosis stage and facilitate access to care. In the United States, a Clinical Trial Helpline launched in partnership with local patient groups aims to connect patients with mBC with innovative treatment options through clinical trials. Conclusion The 70th United Nations World Health Assembly’s cancer resolution discussed the need to leverage efforts and collaborative initiatives among stakeholders. This research exemplifies successful multistakeholder engagement solutions, which are tailored to the country context, and offer targeted ideas to further policy development. Phased BC control implementation strategies must ensure that the policies and programs address the needs of both patients with early BC and of those with advanced BC. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Anna Cabanes Research Funding: Pfizer, Genentech, Merk (Inst) Travel, Accommodations, Expenses: Pfizer, AstraZeneca Fatima Carodso Consulting or Advisory Role: Amgen, Astellas/Medivation, AstraZeneca, Celgene, Daiichi-Sankyo, Eisai, GE Oncology, Genetech, GlaxoSmithKline, Macrogenics, Merk-Sharp, Merus BV, Mylan Mundipharma, Novartis, Pfizer, Pierre-Fabre, Roche, Sanofi, Seattle Genetics, Samsung Bioepis, Teva Expert Testimony: Pfizer, Roche Maia Thrift-Perry Employment: Pfizer Stock or Other Ownership: Pfizer