Closing the global cancer divide- performance of breast cancer care services in a middle income developing country

Abstract

BackgroundCancer is the leading cause of deaths in the world. A widening disparity in cancer burden has emerged between high income and low-middle income countries. Closing this cancer divide is an ethical imperative but there is a dearth of data on cancer services from developing countries.MethodsThis was a multi-center, retrospective observational cohort study which enrolled women with breast cancer (BC) attending 8 participating cancer centers in Malaysia in 2011. All patients were followed up for 12 months from diagnosis to determine their access to therapies. We assess care performance using measures developed by Quality Oncology Practice Initiative, American Society of Clinical Oncology/National Comprehensive Cancer Network, American College of Surgeons’ National Accreditation Program for Breast Centers as well as our local guideline.ResultsSeven hundred and fifty seven patients were included in the study; they represent about 20% of incident BC in Malaysia. Performance results were mixed. Late presentation was 40%. Access to diagnostic and breast surgery services were timely; the interval from presentation to tissue diagnosis was short (median = 9 days), and all who needed surgery could receive it with only a short wait (median = 11 days). Performance of radiation, chemo and hormonal therapy services showed that about 75 to 80% of patients could access these treatments timely, and those who could not were because they sought alternative treatment or they refused treatment. Access to Trastuzumab was limited to only 19% of eligible patients.ConclusionsThese performance results are probably acceptable for a middle income country though far below the 95% or higher adherence rates routinely reported by centres in developed countries. High cost trastuzumab was inaccessible to this population without public funding support.

Breast health in developing countries

“…The Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries was formed in 2009 and is composed of leaders from the global health and cancer care communities, with the objective of developing strategies to reduce costs, increase access to health services and strengthen health systems to meet the challenge of cancer and other diseases 45 . Able leadership and the political will to reform and finance the delivery of cancer care services, informed by reliable data and health policy research in each individual developing country's health ministries, are required to improve breast health outcomes, and to finally close the cancer divide and ensure equity of access to optimal treatment of breast cancer 46 .…”

Health system strengthening: Integration of breast cancer care for improved outcomes

“…The publicly available services for diagnosis and treatment have expanded over time. Trastuzumab is covered, but budget limitations mean that not all those who are eligible receive the drug 30 . Once patients present to health facilities, access to diagnosis, surgery, and treatment is timely, and those who choose to receive treatment (75%‐80% of those presenting) do so 30 .…”

“…Trastuzumab is covered, but budget limitations mean that not all those who are eligible receive the drug 30 . Once patients present to health facilities, access to diagnosis, surgery, and treatment is timely, and those who choose to receive treatment (75%‐80% of those presenting) do so 30 . However, late presentation (40% of those presenting, a number which has not changed over a decade) is a problem, with significant variation among the 3 main ethnic groups 31…”

Economic Analysis of Intravenous vs. Subcutaneously Administered Trastuzumab for the Treatment of HER2+ Early Breast Cancer in Malaysia

“…While Malaysian incidence rates seem to not have increased as rapidly as mortality rates, early detection and efforts to increase awareness and prevent occurrence should continue to be a focus. Nonetheless, efforts to increase access to diagnosis and provision of effective treatment should also not lag behind in the overall strategy [4].…”