scholarly journals Breast Cancer: Reimbursement Policies and Adoption of New Therapeutic Agents by National Health Systems

Breast Care ◽  
2019 ◽  
Vol 14 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Dario Trapani ◽  
Giuseppe Curigliano ◽  
Alexandru Eniu
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Priority Setting ◽  
Financial Distress ◽  
Quality Care ◽  
Premature Death ◽  
Health Coverage ◽  
Breast Cancer Patients ◽  
Middle Income ◽  
Timely Access

Background: Breast cancer is a cause of morbidity for more than half a million of patients in Europe, resulting in broad societal impacts that affect patients, families, and societies from a human, emotional, economic, and financial perspective. Expenditure for cancer medicines represents one of the principal driving costs of healthcare. The aim of this review is to describe the European policy and regulatory landscape of innovation uptake in breast oncology – with emphasis on value in cancer healthcare. Summary: In Europe, several reimbursement models or policy tools have been developed by countries to compose their benefit packages. The most commonly applied scheme is the product-specific eligibility model, prioritizing selected medicines and their indications. Mixed models are commonly developed, addressing the protection of more vulnerable people, ensuring protection from impoverishment caused by cancer and containing disparities. However, the risk to incur significant out-of-pocket expenses for essential or newer medicines for cancer is still substantial in Europe, especially in low- and middle-income countries, determining greater financial distress and poorer outcome for patients. Value-based priority setting is an essential mechanism to ensure timely access to the most valuable medicines for breast cancer patients. Estimations of the value of medicines can be provided within health technology assessment services and networks and informed by benefit scales and tools. Key Messages: There is ample room for reciprocal support across the diverse cultural and legal realities in Europe. The aim is common: save cancer patients from premature death by ensuring the timely access to the best care, protecting from financial hardships and distress to leave no cancer patient behind in poverty. Steps are to be taken to promote value-based priority setting, paving the way toward universal health coverage in Europe, where health of people is protected, and affordable best quality care is the only standard pursued and acceptable.

scholarly journals The experiences of family caregivers living with breast cancer patients in low-and middle-income countries: a systematic review

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Grace Kusi ◽  
Adwoa Bemah Boamah Mensah ◽  
Kofi Boamah Mensah ◽  
Veronica Millicent Dzomeku ◽  
Felix Apiribu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Cancer Patients ◽  
Family Caregivers ◽  
Breast Cancer Patients ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Integration of breast cancer care in a middle-income country: learning from Suandok Breast Cancer Network (SBCN)

BMC Cancer ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Imjai Chitapanarux ◽  
Wimrak Onchan ◽  
Panchaporn Wongmaneerung ◽  
Areewan Somwangprasert ◽  
Nongnuch Bunyoo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Cancer Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Chiang Mai ◽  
Northern Thailand ◽  
Middle Income ◽  
Cancer Network

Abstract Background Breast cancer incidence in Northern Thailand has shown a continuous increase since records began in 1983. In 2002 the urgency of the situation prompted Maharaj Nakorn Chiang Mai Hospital to initiate the Suandok Breast Cancer Network (SBCN). Methods The SBCN is a not-for-profit organization in the university hospital which serves as a training and education center and provides highly specialized medical care for patients in Chiang Mai and in 5 provinces of northern Thailand, with the key mission of improving breast cancer care. The short-term goal was to overcome the barriers to engagement with breast cancer and its treatment and the long-term goal was to increase the overall survival rate of breast cancer patients in our region. Results We enrolled breast cancer patients treated at Maharaj Nakorn Chiang Mai Hospital between January 2006 and December 2015 and divided into 2 cohorts: 1485 patients who were diagnosed from 2006 to 2009 (cohort 1: early implementation of SBCN) and 2383 patients who were diagnosed from 2010 to 2015 (cohort 2: full implementation of SBCN). Criteria to measure improved cancer waiting time (CWT) would include: time to diagnosis, time to surgery, and time to radiotherapy. The 5-year overall survival (OS) of the cohort 2 was higher than that in cohort 1, at 73.8 (72.0–75.5) compared to 71.5 (69.2–73.7) (p-value = 0.03). Conclusions Reasons behind the success of project include the uniformity of care encouragement, service network development and timely access to each step of breast cancer management. The model used in SBCN could be adopted as a learning guide to improve healthcare access and outcome for breast cancer patients in low- to middle-income countries.

scholarly journals Patient-Reported Outcome Measures Among Breast Cancer Survivors in Malaysia: A Comparative Study With Patients From High-Income Countries

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 103s-103s
Author(s):  
Z.Y. Lim ◽  
N. Rajaram ◽  
C.V. Song ◽  
R. Kaur ◽  
N.A. Mohd Taib ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Sexual Functioning ◽  
Cancer Care ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Breast Cancer Patients ◽  
Middle Income ◽  
Patient Reported ◽  
Perceived Importance

Background: Patient-reported outcome measures (PROMs) are essential for identifying how patients perceive the outcomes of their cancer treatment, and is the ultimate success of cancer care. Although a growing number of studies have focused on PROMs in high income countries (HICs), outcomes relevant to patients in developing countries are less understood. Furthermore, the lack of standardization in PROMs makes it difficult to interpret these data for research or quality monitoring. Aim: In this study, we compared the results of PROM measures between patients in Malaysia, a middle income country, and those in HICs, using standard PROMs questionnaires. We also explored the differences in perceived importance of patient reported outcomes within the multiracial Malaysian cohort. Methods: Breast cancer patients (n=1063) were recruited in hospitals serving suburban areas of Malaysia. Of these, 969 patients were eligible for analysis. The surveys were conducted through face-to-face interviews (68%) or were self-administered (30%). An outcome was considered important if it was scored between 7-9 on a 9-point Likert scale. We compared PROMs scores between Malaysian patients and data previously collected from patients in HICs using logistic regression models, adjusting for demographic and clinical characteristics. A two-step cluster analysis was conducted to explore differences in the perceived importance of PROMs between clusters of Malaysian patients. Results: Compared with 1777 patients from HICs, Malaysian patients were less likely to rate overall and recurrence free survival, as well as emotional, cognitive, social and sexual functioning as very important outcomes. Interestingly, more Malaysian women reported that pain (50% vs. 39%), breast symptoms (51% vs. 35%), and major complications (60% vs. 44%) were very important outcomes ( P < 0.001). Compared with young, married Malaysian women, the cluster of older married women (mean age of 57 vs. 52), who were less likely to have received breast reconstructive surgery (8.6% vs. 16.8%), was more likely to rate sexual functioning (32.8% vs. 25.0%, P = 0.036), body image (63.9% vs. 42.4%, P < 0.001), and satisfaction with the breast (50.7% vs. 37.0%, P = 0.011) as very important outcomes. Conclusion: The differences in breast cancer patient needs between and within populations should be considered carefully to better clinician-patient relationship, patient care and satisfaction and assess the outcomes of our cancer care. Future research is needed to find suitable targeted interventions to identify and address the diverse needs of breast cancer patients in low and middle income countries.

scholarly journals Undertreatment or overtreatment – how far from each other in geriatric oncology?

2020 ◽  
Vol 2 (1) ◽  
pp. 18-25
Author(s):  
Janusz Kocik
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Older Patients ◽  
Cancer Survival ◽  
Treatment Options ◽  
Geriatric Oncology ◽  
Premature Death ◽  
Screening Methods ◽  
Breast Cancer Patients ◽  
Choice Of Treatment

The mortality due to cancers of older patients, in age above 65 years of life, in comparison to younger is higher in majority of these diseases. It has been also reported that seniors are frequently denied the treatment according to current standards of therapy, thus suffer from undertreatment. There is solid evidence from controlled trials that older patients may tolerate pharmacological therapies in some cancers as well as young, providing they are under good supportive care. At the same time aggressive multimodal treatment may cause immediate or delayed side effects and exhaustion of reserves of the vital organs in elderly. This may cause a general deterioration, a decompensation of comorbidities, an evolution of geriatric syndromes and premature death, not directly caused by cancer. Such situation in aged cancer patients should be called the overtreatment. In diseases with better prognosis, with effective screening methods and large choice of treatment options like breast cancer, survival is getting better, although not in the eldest. The worse prognosis in old breast cancer patients may be caused to some extent by undertreatment. More fatal tumors like NSCLC await further optimization of cancer therapy towards better toxicity profile to avoid overtreatment.

scholarly journals Why Breast Cancer Patients Seek Traditional Healers

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Mazanah Muhamad ◽  
Sharan Merriam ◽  
Norhasmilia Suhami
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Western Medicine ◽  
Cultural Context ◽  
Traditional Healers ◽  
Breast Cancer Patients ◽  
System Delay ◽  
Middle Income ◽  
Health Related ◽  
Limited Health

Traditional healing is a common practice in low and middle income countries such as Malaysia. Eighty percent of Malaysians consult traditional healers or “bomoh” at some time in their life for health-related issues. The purpose of our study was to explore why breast cancer patients visit traditional healers. This is a qualitative study utilizing in-depth interviews with 11 cancer survivors who sought both traditional and Western medicine. The findings revealed the following reasons for which patients seek traditional healers: (1) recommendation from family and friends, (2) sanction from family, (3) perceived benefit and compatibility, (4) healer credibility, and (5) reservation with Western medicine and system delay. These factors work together and are strongly influenced by the Malaysian cultural context. The issue with the Western health system is common in a developing country with limited health facilities.

Navigating costs of care in women with breast cancer: Examining racial differences in non-treatment costs and financial toxicity in under-resourced populations struggling to afford medical care.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 156-156
Author(s):  
Kathleen D. Gallagher ◽  
Brittnee Barris ◽  
Eric Anderson ◽  
Katie Deehr ◽  
Shonta Chambers ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Medical Care ◽  
Cancer Patients ◽  
Racial Differences ◽  
Financial Distress ◽  
Healthcare Costs ◽  
Treatment Costs ◽  
Categorical Variables ◽  
Financial Toxicity ◽  
Breast Cancer Patients

156 Background: Patients with cancer struggle to afford needed medical care alongside daily financial obligations due to rising healthcare costs. This may be more pronounced among minorities who are less likely to seek resources to mitigate their financial distress. This study sought to identify racial differences in non-treatment costs for under-resourced women with breast cancer who sought assistance from Patient Advocate Foundation (PAF). Methods: This cross-sectional study utilized secondary survey data collected from breast cancer patients receiving case management services from PAF in 2018. Respondents answered questions describing their financial distress and COmprehensive Score for financial Toxicity (COST) tool (0-44 with lower scores indicating worse toxicity). Descriptive statistics were calculated using means and standard deviations (SD) for continuous variables and frequencies for categorical variables. Two sample t-tests were used for bivariate comparisons between racial groups. Results: Of 267 breast cancer patients surveyed, 54% were Caucasian, 29% were African American (AA), and 83% indicated a household income of < $48,000. Cohorts expressed strong dissatisfaction with their financial situation with AA impacted more acutely (78% vs 56%) and acknowledged inability to pay for treatment costs (83% vs 58%). Compared to Caucasians, AAs were more often concerned with transportation costs (33% vs 16%) and with day-to-day living expenses (83% vs 59%). Younger (≤55 years) AA respondents were twice as often unable to meet monthly expenses (60% vs. 27%). Older AA respondents ( > 55 years) reported greater distress than older Caucasians (74% vs 57%), while younger Caucasians reported greater distress than their AA counterparts (72% vs 65%). COST scores differed significantly between Caucasians (mean 13, SD 9) and AAs (mean 11, SD 8; p = 0.04). Conclusions: While the impacts of medical care costs were felt by all survey respondents, under-resourced AA breast cancer patients may be at higher risk for household material hardships as financial resources are diverted toward essential healthcare costs.

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