Purpose Women with breast cancer in low- and middle-income countries (LMICs) have worse health outcomes than their counterparts in high-income countries (HICs). Improved outcomes in HICs are attributable to more rigorous breast cancer control policies, implementation of evidence-based guidelines, and greater national investment in health care. In resource-limited settings, identifying the most effective resource-appropriate policies can be a challenge. The proposed study will provide a framework to identify unmet breast cancer policy and infrastructure needs in LMICs and will aid in the prioritization of key elements of successful breast cancer control programs. Building on previous work, we will develop a framework for policy analysis and conduct a breast cancer policy needs assessment through a comparative analysis of attitudes and preferences for breast cancer control elements in 30 countries. Methods The proposed observational survey-based study will measure and compare attitudes and preferences for breast cancer control across 24 LMICs and six reference HICs from across the six WHO regions, stratifying countries by health care spending and mortality-to-incidence ratios. This study will be a cross-sectional survey of medical, policy, and advocacy experts in breast cancer from each of the selected countries. Research will be conducted in three phases. First, we will conduct key informant interviews of international breast cancer experts. Then we will develop and pilot a survey tool. Finally, we will conduct the full survey in countries. The study will use analysis of variance, conjoint analysis, and best-worst scaling to analyze survey results. Results This study will assess current breast cancer control needs, prioritize elements of a comprehensive breast cancer control plan, and determine attitudes about the potential of emerging technologies to improve breast cancer control. Conclusion This study will facilitate the improvement of health outcomes for women with breast cancer by assessing the specific unmet breast cancer policy and infrastructure needs in LMICs and prioritizing elements to improve breast cancer control programs. The study thus provides a resource-appropriate framework to improve breast cancer control policy, reform, and implementation. 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 . Barri M. Blauvelt Stock or Other Ownership: AstraZeneca, Biogen, Celgene, Ecolab, Elite Pharmaceuticals Consulting or Advisory Role: Boehringer Ingelheim, Novartis
Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers
