Inequalities and Barriers to the Use of Supportive Care Among Young Breast Cancer Survivors: a Qualitative Understanding

Abstract

The development of supportive care for cancer patients has been shown to have a positive impact on both mortality rates and many aspects of life after cancer, particularly in young women. Meanwhile, there are still numerous inequalities in terms of cancer mortalities and quality of life among cancer survivors in France. The processes leading to unequal access to supportive care services, and the impact this has on the post-treatment period, have been poorly documented, however. The goal of this study was to understand the barriers to using supportive care services among young women breast cancer survivors under the age of 50 and to find out how this can contribute to inequalities. Thirty-six young breast cancer survivors, one third of which deemed socially deprived, were interviewed using a qualitative, inductive approach at two comprehensive care centres in France. Our findings primarily show that there are still a number of barriers to accessing supportive care for a large number of patients. The way information about supportive services is delivered is a major cause of inequalities in the use of these services. The guidance provided does not take into account either the patients' needs or their capacity to integrate the information and anticipate problems. Certain specific post-treatment issues have yet to be addressed. Some systemic barriers could be lifted by changing the way information on supportive care services is currently organised and thereby prevent the survivorship plans now being implemented in cancer care settings from reinforcing health inequalities.

Rehabilitation pathways in women with breast cancer in the first 12 months of the disease: a retrospective study

“…The limited use of inpatients and especially personalized intensive outpatient's rehabilitation plans observed in our retrospective analysis suggest the lack of rehabilitative offer and the existence of barriers to patients' access. Although only few studies have speci cally evaluated the barriers to rehabilitation in women with BC [19,20], literature data in the cancer population suggest that lack of awareness and lack of physician referral are the main causes that restrict the use of rehabilitation services [33]. In the case of BC, we also believe that interventions [19,20].…”

“…Increasing the level of information and understanding of oncological rehabilitative services is an important step to overcome the existing barriers and to promote a more equal and comprehensive access of rehabilitation interventions in women with BC [20].…”

“…Furthermore, literature data on the utilization of these services is rather scarce. The few available studies have reported the existence of numerous barriers, which arise from human, logistic and nancial sources, which may restrict access to rehabilitative care for women with BC [19,20].…”

Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment

“…Social support is a key point to explain inequalities in waiting times between the first imaging procedure and the first treatment ( 77 ). There is qualitative evidence that socially deprived young women face many barriers and have unequal access to supportive care services after breast cancer ( 78 ). As to the social protection system, persons with a lower SES are more frequently concerned by non-take-up of their social rights, either by lack of information, demand, or attribution ( 52 ).…”

Use of rehabilitation pathways in women with breast cancer in the first 12 months of the disease: a retrospective study

“…Furthermore, literature data on the utilization of these services is rather scarce. The few available studies have reported the existence of numerous barriers, which arise from human, logistic and financial sources, which may restrict access to rehabilitative care for women with BC [21,22].…”