Sociodemographic and geographical variation in access to systemic anti-cancer therapies for women with advanced breast cancer: a systematic review
Pearson, Sally Anne Taylor, Sally Marsden, A. O'Reilly, J. D.
Pearson, Sally Anne
Taylor, Sally
Marsden, A.
O'Reilly, J. D.
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Abstract
Background: Equitable access to guideline concordant treatment
with systemic anti-cancer therapies (SACT) is a key determinant
in overall survival, progression free survival and improvement
in quality of life for Advanced Breast Cancer (ABC). Variation in
treatment receipt has been reported though remains poorly
understood. A comprehensive understanding of factors which
influence access and receipt of guideline concordant treatment
is lacking. The review sought to address this through identifying
and investigating factors associated with access to and receipt of
guideline concordant SACT for women with ABC.
Methods: Systematic searches of the literature were undertaken
using EBSCO CINAHL Plus, Ovid MEDLINE, Ovid EMBASE,
PsychINFO, Cochrane Library, JBI database and NHS Evidence.
Methodological quality was assessed by two reviewers using
the Joanna Briggs Institute critical appraisal tool (JBI, 2017) with
the application of an overall GRADE quality rating. Studies were synthesised using a narrative synthesis approach. High levels of
heterogeneity between studies precluded meta-analysis.
Results: Thirteen international studies (n=13) published between
2009 and 2020 were included and reported 201,677 patients
with ABC. Overall receipt of SACT ranged from 4% to 70%, factors
associated with receipt were:
• Age: younger patients had an increased likelihood of treatment
receipt in a timelier manner
• Race/ethnicity: patients of white origin were more likely to
receive treatment in a timelier manner than patients of non-white origin.
• Socioeconomic status: patients with higher socioeconomic
status were more likely to receive treatment than their
counterparts
• Comorbidities: patients with fewer comorbidities were more
likely to receive treatment
• Place of care: patients treated at teaching, research and private
institutions were more likely to receive timelier treatment
• Geographical location: treatment receipt varied by
geographical location
Conclusion: A number of factors were associated with treatment
receipt. Barriers included older age, non-white race, lower
socioeconomic status, significant comorbidities, hospital setting
and geographical location. However, due to limitations in overall
methodological quality findings should be interpreted with
caution. Implications for nursing, practice and research include
the development and piloting of targeted interventions to address
specific barriers in a socio-culturally sensitive manner and further
research to understand the experience of women and clinicians is
required.
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Date
2021
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Citation
Pearson SA, Taylor S, Marsden A, O'Reilly JD, Howell S, Yorke J. Sociodemographic and geographical variation in access to systemic anti-cancer therapies for women with advanced breast cancer: a systematic review. Breast. 2021;59:S40-S1.