Global analysis of metastatic breast cancer policy gaps and advocacy efforts across the patient journey.

Metastatic breast cancer (mBC) is an area with high unmet need across the world. Despite significant progress to meet patient need, current breast cancer (BC) policies fail to recognize the unique challenges of patients who are further along the cancer patient journey. This analysis aims to understand BC/mBC policy development at a global level and identify opportunities for further development. A comprehensive analysis of National Cancer Control Plans (NCCPs) policies and programs was conducted across 16 countries, which represent a diverse range of healthcare systems, economies and geographic regions. Examples of promising practices, implemented or initiated by civil society, are provided to demonstrate successful methods to address the identified policy gaps. The analysis finds that disparities in BC policy development exist across and within countries. Progress in BC policy is fragmented and skewed towards the early part of the patient journey e.g. awareness and stakeholder education, with key gaps remaining in diagnosis and patient identification. In addition, access to innovative mBC treatments, ongoing support and palliative care remain a challenge, while care coordination is limited due to inefficient referrals. Although government and policymaker action is fundamental, collaboration between different stakeholders is imperative to address unmet needs of BC/mBC patients alike. Policy initiatives and promising practices that demonstrate successful multi-stakeholder engagement can be replicated or used to inform further advocacy and policy development with the aim to address patient unmet needs.

The impact of multimorbidity on quality of life among midlife women: findings from a U.S. nationally representative survey.

BACKGROUND: Little is known about the prevalence and cumulative burden of coexisting health conditions including chronic joint and muscular pain, urinary incontinence (UI), depression, osteoporosis risk, moderate/severe vasomotor symptoms, and vulvar/vaginal atrophy (VVA). We surveyed a nationally representative U.S. sample of midlife (age 40-64 years) women to ascertain the prevalence, general health-related quality of life (HRQoL), and health-seeking behaviors associated with these six conditions. METHODS: This cross-sectional, telephone survey collected data from a sample of English- and Spanish-speaking U.S. women. The survey contained demographic and menopausal status questions, and also five condition-specific symptom/disease risk-screening instruments. The EuroQol 5 dimensions (EQ-5D) questionnaire was used to measure HRQoL. Health-seeking behavior was measured based on clinician discussion of and recent treatment for each condition. RESULTS: Three thousand fifty eight women (mean age 53.4 years) completed the survey. The majority were white (75.6%), married (60.5%), employed full- or part-time (59.0%), and postmenopausal (69.8%; based on self-report). The prevalence [95% confidence interval] of 0, 1, 2, and ≥3 conditions was 35.2% [33.5-36.9], 34.2% [32.5-35.9], 17.9% [16.6-19.3], and 12.7% [11.5-13.9], respectively. Osteoporosis risk (30.6%) was most prevalent, followed by VVA (27.8%) and UI (26.6%). UI and VVA coexisted most frequently (11.3%), followed by osteoporosis risk and VVA (9.8%). EQ-5D scores decreased with increasing number of illnesses (0, 1, 2, and ≥3 conditions, means: 0.92, 0.87, 0.77, 0.61, respectively; p<0.01). Health-seeking behavior varied by condition. CONCLUSION: Over 25% of women surveyed had multiple coexisting conditions. Lower HRQoL was associated with multiple conditions and with each added condition.