The unmet needs of women with metastatic breast cancer in Mexico: A qualitative study.
Authors: Ferrigno Guajardo Ana , Allende-Pérez Silvia , Platas Alejandra , Cosio-Barroso Izchel , Peña-Nieves Adriana , Espinosa Fernandez Jose Rodrigo , Velazquez-Martinez Areli , Cabrera-Galeana Paula Anel , Platas Ana , Villarreal-Garza Cynthia 
Published: May 2024

e13547 Background: Patients with metastatic breast cancer (mBC) have distinct unmet needs compared to those with early-stage disease. Recognizing this population's unique priorities is imperative to identify areas of opportunity to improve their care. This study aimed to explore the experiences and unmet needs of Mexican patients with mBC, a population for which information is scant. Methods: Patients aged ≥18 years with a diagnosis of mBC receiving systemic therapy or palliative care at a tertiary care center in Mexico City were invited to participate in a semi-structured interview. Those with intellectual disability, severe psychologic disorder, poor functional status (ECOG > 2), or not interested in participating were excluded. Results: Of 13 patients interviewed (median age: 50 years), 46% had an educational level of middle school or lower, 50% were unemployed, 39% were in a relationship, and 23% were not undergoing active treatment. Key unmet needs emerged in 3 domains: (A) Information: The patients noted that the medical team was willing to provide information about their disease, but often the explanations provided were overly technical or lacked detail. They expressed a desire for clearer communication about their prognosis and treatment options, but also wanted to limit the information received to minimize delivery of bad news. (B) Physical/emotional: The patients emphasized the need for readily available and accessible medications, regardless of institutional affiliation or place of residency. They noted that more widespread knowledge about available services (e.g., nutrition, dentistry, psychology) was necessary and wanted to explore complimentary medicine interventions that could help address their symptoms. The patients expressed a desire for immediate psychological support to be offered when initially diagnosed with distant disease and identified interaction with women going through similar circumstances as useful. (C) Navigating daily life: The patients noted a need to receive financial assistance for non-drug medical costs (e.g., nutritional supplements), as well as for transportation to and from medical appointments. They also identified lack of assistance with household chores and childcare as potential areas of improvement. They recognized virtual consultations as an attractive alternative to in-person appointments that could decrease time-toxicity and expenses. Conclusions: This study is the first qualitative exploration of unmet needs among Mexican women with mBC. Our findings highlight multifaceted unmet needs that patients experience and may negatively impact quality of life. Further research and the development of targeted interventions that aim to address pervasive gaps in clinical communication, emotional support, financial assistance, and supportive care access is urgently needed to alleviate distress in this vulnerable population.