Barriers to care for breast cancer: A qualitative study in Ireland

Abstract

Disparities in survival after breast cancer persist. Cancer registry data that are often used to assess associated factors only explain some of the differences. The purpose of this study was to obtain information from disadvantaged Irish women concerning possible barriers to care for breast cancer above and beyond risk factors collected by cancer registries. We used a qualitative interview study with disadvantaged women in treatment for breast cancer, following the methods of thematic analysis. Important themes potentially related to disparity occurred in each treatment phase. Before diagnosis themes included delays in diagnosis. During treatment themes concerned surgical complications, communication difficulties and use of alternative therapies. During the post treatment phase a strong theme was lack of compliance with hormone therapy. Overarching themes were stress related to disadvantage, including financial difficulties, obesity, alcohol use, fears of eviction from home, worry about dependent relatives. Future studies of the breast cancer survival gap arising from socio-economic disadvantage may benefit from a mixed-methods approach that combines cancer registry data with personal interviews to understand the persistence of survival disparities. As breast cancer rates continue to rise disparities in survival due to socio-economic disadvantage will continue, but can be addressed and mitigated.

Barriers to cancer treatment for people experiencing socioeconomic disadvantage in high-income countries: a scoping review

“…Yet, even for those who have public medical coverage, people who experienced socioeconomic disadvantage found it more challenging to afford out-of-pocket expenses or hidden costs directly required for their treatment such as supportive care drugs, nutrition supplements, access to allied health resources, childcare to attend appointments, transportation, and travel expenses (i.e., food, lodging, gas, parking) [ 68 – 71 , 73 − 75 ]. Consequently, not having these necessary supports led to higher rates of non-adherence [ 74 , 75 ] and/or meant that systemic therapy was poorly tolerated [ 73 ].…”

“…In high-income countries, the cancer care system often has supportive care resources (e.g., nutrition, patient and family counselling, psychiatry, social work, speech-language pathology, physiotherapy) to assist patients undergoing treatment. However, three studies cited there is a scarcity of resources and lack expertise to support patients who experience socioeconomic disadvantage and whose social care needs may also go unnoticed by HCPs [ 70 , 72 , 73 ]. For example, Lineback and colleagues [ 70 ] found that although patients with less favorable socioeconomic circumstances with esophageal cancer were provided with a care team such as a case manager or social worker, the cancer hospital itself was less able to solve multiple issues arising from mistrust, poor communication, and financial strain.…”

“…Contrary to these assumptions, Lawrie and colleagues [ 78 ] found that people experiencing homelessness are quite motivated to persist with the requirements of treatment if they are well supported and aware of the benefits of receiving treatment. Not only are the micro-aggressions produced by implicit bias and stigma harmful and yield poor outcomes, they also silo experiences of care, and further cement feelings of mistrust towards the cancer care system [ 73 , 77 , 78 ]. Gould et al, underline the “importance that access to health services is not merely instrumental, but also symbolic.…”

“…Structural inequities such as inadequate housing, poverty, and poor healthcare coverage, racialization, and stigmatization of substance use and mental illness not only result in poor access to healthcare, but also shape how people view accessing healthcare [ 63 ]. A number of studies ( n = 12) illustrate examples of how adverse structural conditions interact with a variety of physical and social factors which further compound barriers in accessing cancer treatment [ 37 , 38 , 65 , 67 , 69 , 73 , 74 , 76 , 77 – 79 ].…”

Addressing disparities and challenges in underserved patient populations with metastatic breast cancer in Europe

“…Although several new treatments for mBC have been recently introduced [ [12] , [13] , [14] , 16 ], positive outcomes depend not only on the response to treatment, which varies according to disease and patient characteristics, but also on access to those treatments, which is affected by a host of factors. The wide variation in these factors leads to disparities in cancer care between and within countries, including high-income countries, and not all patients benefit equally from the healthcare services available [ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] ]. For example, registry data from New Zealand found that the median survival after mBC diagnosis was 18.8 months (2010–2015), around half that of other developed countries [ 27 ].…”