Factors affecting access to treatment of early breast cancer: Case studies from Brazil, Canada, Italy, Spain and UK

Implications for future research, policy and practice

by Daniela Rodriguez-Rincon, Brandi Leach, Camilla d'Angelo, Amelia Harshfield, Catriona Manville

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Research Questions

  1. How do political, economic, social, scientific and technological, infrastructure-related and regulatory and legal factors influence policy about and access to treatment of (early) breast cancer in selected countries?
  2. Are limitations with current treatment options an influence on treatment strategies in the countries we studied?
  3. What innovation in treatments and the health system more widely are needed for early treatment strategies to change?

RAND Europe conducted a study on the societal impact of early breast cancer. This study was divided into three interconnected phases, which together aim to enrich the evidence base on the broader health, societal and economic impacts of treatment of early breast cancer, using a mixed methods approach. In the third phase of our programme we undertook a qualitative study using desk research and key informant interviews to explore the factors affecting access to and delivery of treatment for early breast cancer in order to identify what works and what can be improved. We focused on five countries (Brazil, Canada, Italy, Spain and the United Kingdom), and also present insights at a supranational level — for example policy and practice in the European Union — and make broader comments on factors affecting low and middle-income countries. We found that differences within countries are often related to regional discrepancies that arise from a decentralised structure of the healthcare system that has an impact on the financing, implementation, and/or delivery of care. We found that cultural and socioeconomic factors, such as a person's education or income, also affect equal access to treatment within an individual country. In all countries considered, breast cancer is a disease that benefits from strong patient advocacy, which has played an important role in raising the profile of breast cancer with patients, policymakers and the public, both at a national and international level. However, there is still little awareness of the impact of disease progression on society.

Key Findings

  • Public health systems cover the direct costs of care and protect early breast cancer patients from economic hardship.
  • Public health systems invest in prevention.
  • The HTA process for evaluating new health technologies and treatments ensures countries strive to invest in the best available treatment options.
  • Patient advocacy groups are effective at raising awareness of breast cancer among patients, the public and policymakers.
  • Public health systems and private insurance do not cover the indirect costs of breast cancer.
  • Existing effective treatment options for early breast cancer may lead policymakers and payers to underestimate the need to invest in new drugs.
  • Regionalisation within health systems contributes to differences in the care and management of early breast cancer within countries, and contributes to delays between the approval of drugs at the national level and their availability across the country.
  • Barriers to treatment for early breast cancer include income, language, culture, education and geography.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methodology

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Chapter Five

    References

  • Annex A

    Interview consent form

  • Annex B

    Interview protocol

  • Annex C

    Interview codes

Research conducted by

The research described in this report was sponsored by F. Hoffmann-La Roche Ltd and conducted by RAND Europe.

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