Global Analysis Looks at Policy Gaps and How to Advance Breast Cancer Control in Asia

LUGANO, Switzerland – Education conducted by civil society can play an important role in filling breast cancer policy gaps and advancing cancer control, including advanced breast cancer, researchers report at the ESMO Asia 2017 Congress. (1)

This sub-analysis of a 16-country study investigated whether National Cancer Control Plans (NCCPs), policies and programmes address each step across the breast cancer patient journey– including early breast cancer and advanced disease – and looked at what activities could be implemented that would advance breast cancer control. The patient journey steps were: recognition and awareness, diagnosis, coordinated care, treatment, and ongoing management.

Lack of awareness about breast cancer in Asian women as well as in healthcare providers, particularly primary care providers and nurses, can delay the breast cancer diagnosis because women present late for evaluation; a delayed breast cancer diagnosis can also occur because healthcare providers fail to recognise the signs and symptoms of breast cancer or breast cancer recurrence.

The research presented at the Congress highlights potential solutions through advocacy initiatives to address the limited awareness of breast cancer symptoms among women and healthcare providers in China. The authors detail a collaborative initiative, implemented with a two-fold objective: to educate the Chinese public and to train frontline healthcare workers on the importance of early detection and signs of breast cancer.

“Studies by other researchers show that social and cultural perceptions of breast cancer are some of the reasons why Asian women do not visit a doctor until the cancer is in its advanced stage,” said lead author Mrs Katherine Hunt, programme manager, Global Programmes, Susan G. Komen, Dallas, US. (2) “Fatalism, inability to act without her husband’s permission, fear of casting stigma on her daughters, fear of being ostracised, and fear of being contagious are some examples of barriers contributing to delays in seeking medical care. These barriers can be addressed with education programmes tailored to local culture, religion, and social norms.”

Hunt said: “The study shows that in addition to working with women, it is also effective to work with primary healthcare providers. The timely referral of patients can play a significant role in obtaining diagnosis and referral to the appropriate treatment.”

“Educating people in communities and healthcare providers is key to dispelling myths and misconceptions about breast cancer,” she continued. “By increasing people’s knowledge about breast health, they are empowered to make informed decisions. For this, it is crucial that education is tailored to local culture and beliefs, and that accurate information is provided.”

Commenting on the study, Masakazu Toi, Professor of Breast Surgery, Kyoto University, Kyoto, Japan, said: “Since early detection of the disease paves the way for precision medicine and multidisciplinary treatment that can result in improving survivaln outcomes for breast cancer patients, the healthcare providers and the community need to promote the full range of the patient journey steps, i.e. recognition and awareness of the disease, diagnosis, coordinated care and treatment.”

“For multiple reasons as indicated, the promotion activity might be less in these countries as compared with other countries,” he continued. “Therefore, the information should be shared in our communities and we need to develop a sophisticated system to decrease breast cancer related mortality. In addition, the advanced diagnosis planning may be helpful for the early detection.”

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Notes to Editors

Please make sure to use the official name of the meeting in your reports: ESMO Asia 2017 Congress

References

1. Abstract 91O_PR ‘Analysis of the gaps on metastatic breast cancer policies and advocacy efforts to support policy development across the patient journey in Asia’ will be presented by Katherine Hunt during Proffered paper session 3 on Sunday, 19 November 2017, 08:30 to 10:45 (SGT) in Hall 405. Annals of Oncology, Volume 28, 2017 Supplement 10.
2. Tam Ashing K, Padilla G, Tejero J, Kagawa-Singer M. Understanding the breast cancer experience of Asian American women. Psychooncology. 2003;12(1):38–58.

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Abstract 91O_PR

Analysis of the gaps on metastatic breast cancer policies and advocacy efforts to support policy development across the patient journey in Asia

K. Hunt¹, F. Cardoso², M. Thrift-Perry³, A. Cabanes¹, T. Cruz¹, K. Faircloth^3
1Global Programs, Susan G. Komen, Dallas, TX, USA, ²Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal, ³International Public Affairs, Pfizer, Inc, New York City, NY, USA

Background: In Asia, efficient metastatic breast cancer (mBC) diagnosis, treatment and care is hindered by cultural beliefs and the stigmatization of breast cancer (BC). Despite increasing recognition and efforts from policymakers, advocacy groups and the wider healthcare community, there is urgent need for targeted action and stakeholder collaboration to improve patient outcomes.

Methods: A comprehensive analysis of National Cancer Control Plans (NCCPs), policies and programs was conducted in Japan and South Korea, two developed Asian healthcare systems. Policy components were aligned to the BC/mBC patient journey, and evaluated using standardized criteria on adoption of NCCP goals, and BC/mBC policies and programs. Advocacy initiatives were identified in the policy analysis in Japan and South Korea and through an advocacy promising practice implemented in China.

Results: There has been considerable BC/mBC policy development in Asia but gaps persist across all areas of the patient journey. The analysis finds that cultural beliefs act as barriers to diagnosis and treatment, and deter policy development. For instance, BC/mBC stigmatization is not efficiently tackled due to low levels of trained primary care healthcare professionals (HCPs). This deficiency is also reflected in limited patient awareness and disease prevention, inefficient care coordination, disproportionate emphasis on surgery versus treatment, and use of complementary and alternative medicines. Similarly, access to palliative care and rehabilitative support remain important prevalent needs. Advocacy efforts identified in Japan, South Korea and China sought to fill policy gaps. In China, a model aimed at strengthening primary HCPs through a culturally-adapted BC education toolkit showed promising results for replication in other settings.

Conclusions: Engaging with stakeholders across the patient journey is critical to address cultural barriers and unmet needs of BC/mBC patients. Policy initiatives and promising practices in this research exemplify successful multi-stakeholder engagement to inform further advocacy and policy development.

Legal entity responsible for the study: Susan G. Komen; Pfizer, Inc.

Funding: Pfizer, Inc.

Keywords: policy, Asia-Pacific, patient advocacy, metastatic breast cancer