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Reducing inequalities in metastatic breast cancer care

Metastatic breast cancer affects millions of people and accounts for the vast majority of breast cancer deaths, and inequalities in care are increasing.

Context

Breast cancer is the leading cause of cancer-related deaths among women worldwide. Globally, around 25–30% of women diagnosed with early-stage breast cancer go on to develop metastatic breast cancer.

Metastatic breast cancer – also known as secondary, stage IV or advanced breast cancer – cannot be cured in the vast majority of cases. Current and emerging treatment options enable many people to live longer and fulfilling lives with the disease, but not all people with metastatic breast cancer are able to access best-practice care. This is because current policies often fail to fully recognise or address the unique challenges faced by people with the disease. Many people, especially those from underserved populations, experience health inequalities in metastatic breast cancer care.

Efforts to improve care have been led by consortia such as the US MBC Alliance and ABC Global Alliance. These efforts sit alongside broader governmental commitments to further invest in cancer control and reduce inequalities, leading to concerted action on an international level, such as the Lancet Breast Cancer Commission and WHO Global Breast Cancer Initiative Implementation Framework.

To build on this work, achieve equity in care and address the unmet needs of people with metastatic breast cancer around the world, this project has established three priority areas of action for policymakers:

  1. Address structural and systemic barriers to care
  2. Ensure access to appropriate care along the pathway
  3. Improve patient experience, involvement and empowerment.

Project resources

Policy briefs

Policy briefs

Reducing inequalities in metastatic breast cancer care: an overview
Reducing inequalities in metastatic breast cancer care: Addressing structural and systemic barriers to care
Reducing inequalities in metastatic breast cancer care: Ensuring access to appropriate care along the pathway
Reducing inequalities in metastatic breast cancer care: Improving patient experience, involvement and empowerment
Infographic

Infographic

Driving change to reduce inequalities in metastatic breast cancer care
Inequalities in metastatic breast cancer care have been increasing, not just between countries but also within each country, even in high-income countries. We need to continue to raise awareness, particularly among decision-makers, so that every patient has access to the treatments and care they need, independently of their ability to pay.

Dr Fatima Cardoso, President, Advanced Breast Cancer Global Alliance; Director, Breast Unit, Champalimaud Foundation, Portugal

What we’ve achieved

HPP convened a group of experts from across the world – including patients, clinicians, patient advocates and academics – to explore opportunities and develop actionable policy recommendations to make care for metastatic breast cancer more equitable.

Comprehensive desk research, guidance of a Steering Committee and interviews with experts led to the development of an infographic and a set of four policy briefs focusing on the priority areas identified.

We will also be producing videos to showcase the key messages from the policy briefs, due for launch in early 2025.

It is our hope that this project and its recommendations support policymakers and health system decision-makers to prioritise the actions needed to reduce inequalities in metastatic breast cancer care.

Key partners and stakeholders

HPP is grateful to the project’s Steering Committee members, who guided the development of this project and its recommendations:

  • Dr Fatima Cardoso, President, Advanced Breast Cancer Global Alliance; Director, Breast Unit, Champalimaud Foundation, Portugal
  • Dr Véronique Diéras, Head of the Breast Cancer Group, Department of Medical Oncology, Centre Eugène Marquis; member of UNICANCER French Breast Cancer Intergroup, France
  • Professor Helena Earl, Professor Emeritus of Clinical Cancer Medicine, Department of Oncology, University of Cambridge, UK
  • Colleen Foran, patient representative, Canada
  • Dr Dario Trapani, Assistant Professor, Department of Oncology and Haemato-Oncology, University of Milan, Italy

HPP is also grateful to the experts who volunteered their time to contribute to this project via interview:

  • Vicki Durston, Director of Policy, Advocacy & Support Services, Breast Cancer Network Australia
  • Dr Beverley M Essue, Associate Professor of Global Health Systems, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
  • Veronica Foote, Head of Policy & Consulting, Working With Cancer, UK
  • Jenny Gilchrist, Nurse Practitioner – Breast Oncology, Macquarie University, Australia
  • Emma Lavelle, Policy Manager, Breast Cancer Now, UK
  • Essie Mac Eyeson, Senior Policy Officer, Breast Cancer Now, UK
  • Dr Mafalda Oliveira, Senior Consultant, Medical Oncology Department, Vall d’Hebron University Hospital, Spain
  • Professor Frédérique Penault-Llorca, Professor of Pathology, University of Clermont Auvergne; Director General, Centre Jean Perrin, France
  • Barbara Wilson, Founder & Director, Working With Cancer, UK

Project funding

This project was initiated and funded by Gilead Sciences Europe, working in collaboration with Harwood Levitt Consulting. Funding was provided to HPP for project preparation and management, research, drafting and coordination. This work was guided by a multidisciplinary Steering Committee and interviews with expert stakeholders. Steering Committee members and expert interviewees were not compensated for their time financially or through any other transfer of value. HPP worked to deliver project outputs that represent a consensus position from the Steering Committee but retained editorial control. All outputs are non-promotional and not specific or biased to any particular treatment or therapy.

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