Societal impacts of treatment of early breast cancer: implications for future research, policy and practice

Women wearing pink for breast cancer and putting their hands together

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Early breast cancer has impacts beyond clinical outcomes, and indirect impacts in particular are not well understood. Researchers found that the economic impact of early breast cancer is not being linked to investing in treatment for early breast cancer.

Further, existing effective treatment for early breast cancer may lead policymakers and payers to underestimate the need for investment in further improvements and innovation in the treatment and delivery of care in early breast cancer.

Background

Breast cancer is the most common cancer in women worldwide and the leading cause of death, with incidence and survival rates varying across geographies. Early diagnosis of breast cancer is associated with earlier treatment, better survival prospects and improved quality of life.

Although innovation in treatment approaches (e.g. HER targeted treatment) has increased survival rates, the risk of recurrence after early breast cancer treatment is still relatively high and some treatment challenges do exist. Innovation in treatment for early breast cancer is still needed.

To make the case for this investment, more comprehensive evidence is required on the range of impacts on early breast cancer treatment.

Goals

This RAND Europe study, supported and funded by Roche, aimed to enrich the evidence base on the broader health, societal and economic impacts from early breast cancer treatment. The teams' goals were to provide an overview of the existing evidence in three main areas:

  1. The types of impacts from treatment of early breast cancer
  2. The impact of treatment of early breast cancer on non-clinical outcomes, and
  3. The political, economic, social, scientific and technological, infrastructure, regulatory and legal factors influencing decision-making on treatment of early breast cancer.

The study aimed to be of use to policymakers and others interested in understanding the current status of the evidence around the wider costs to society of the progression of breast cancer.

Methodology

The study consisted of three phases:

  1. A mapping review of the literature on outcomes from early breast cancer treatment
  2. A systematic review to evaluate patient and societal impacts of disease progression in women who had early breast cancer
  3. A PESTLE (political, economic, social, technological, legal and environmental) analysis consisting of grey literature review and key informant interviews in selected countries

Findings

  • Existing effective treatment for early breast cancer may lead policymakers and payers to underestimate the need for investment in further improvements and innovation in the treatment and delivery of care in early breast cancer.
  • The cost of treating metastatic disease and breast cancer recurrence is greater than the cost of treating early breast cancer.
  • Early breast cancer has impacts beyond clinical outcomes. In particular there are a range of non-clinical outcomes associated with treatment and disease progression.
  • Taking non-clinical outcomes into account, the cost of early breast cancer extends beyond the direct cost of care. It includes costs associated with quality of life, out-of-pocket expenses and costs as a result of loss of productivity.
  • The indirect impacts of early breast cancer treatment are not fully understood.
  • Some data are available to show a significant difference in quality of life (often a reduction) between those in whom the disease has progressed and a control population.
  • The economic impact of early breast cancer is not being linked to investing in treatment for early breast cancer. Therefore there is a need to communicate the importance and highlight the benefits of new treatment options for early breast cancer.