Breast Cancer Global Quality Care, Barriers, and Strategies for Intervention
Breast Cancer Global Quality Care, Barriers, and Strategies for Intervention
Breast cancer rates vary worldwide. These rates differ among age, women and men, and different ethnicities. In 2020 there were 1.1 per 100,000 new cases of breast cancer in men and 118.8 per 100,000 in women. Worldwide breast cancer is more common in women. Generally, breast cancer rates were higher in developed countries than developing countries. It is felt that lifestyle and factors related to reproduction may play a role for this difference. Another explanation may be due to reduced mammography screening rates and reporting that is not complete. In developing countries, breast cancer is the most common cause of death due to cancer in women and the second in developing countries (Komen.org, 2019). This literature review will describe the quality of breast cancer care globally and the different factors that impact breast cancer. Approaches to consistent quality care worldwide is discussed and ways to improve care and outcomes. Finally, organizations that strive to improve research and best practices are observed.
Global Quality of Breast Cancer Care and Health-related Research and Methods
The United States is showing a 39% decline in breast cancer deaths from 1991 to 2015. There is an estimated 1.67 million people diagnosed with breast cancer annually. Lung cancer has the highest mortality rate, with breast cancer being the second highest. Countries with low- and middle-incomes (LMICs) are seeing higher rates of breast cancer deaths, up to 70% more than high-income countries. Global guidelines for breast cancer prevention, screening, and treatment are necessary to improve these statistics (Barrios, Reinert, & Weretsky, 2018).
Oxford University Press published an article regarding global quality care for breast cancer (Verhoeven, Allemani, Kaufman, Mansel, Siesling, & Anderson, 2020). Breast cancer incidences are rising in all countries. LMIC’s are not seeing as much improvement in survival rates than high-income countries (HICs). Clinical guidelines that are implemented internationally is one approach to improving the quality of care globally. Patients who are diagnosed with breast cancer should have the opportunity to meet with their providers and discuss the different treatment options. This is considered a multidisciplinary approach. However, not all countries require this type of approach.
Behavioral, Demographic, and Dultural Factors that Impact Breast Cancer
The American Association for Cancer Research publishes the report, The State of Cancer Health Disparities in 2022 (AACR.org, 2022). Cancer health disparities are driven by socioeconomic, cultural, social, and environmental factors. Social determinates of health (SDOH) have a great influence on the quality of life of individuals as well as their health and well-being. The different SDOH overlap from societal and community levels. One of the key objectives of the Healthy People 2030 initiative is to focus on these SDOH to find ways to improve the health and well-being of all nations (Health.gov, n.d.).
Certain behaviors can influence risk of breast cancer development. One study shows that women who give birth in younger years and breastfeed longer reduce their risk for estrogen receptor (ER) positive and negative breast cancer. Women who follow a vegetarian diet have less risk of developing breast cancer than those who have high intake of animal fat in their diet. Also, lack of activities in women increased their risk of breast cancer risk (Kashyap, Pal, Sharma, Garg, Goel, Koundal, Zaguia, Koundal, & Belay, 2022).
Breast cancer is a national burden. In India breast cancer has become the fastest growing cancer and has doubled from 1982 to 2005. The disease is usually detected at more advanced stages due to SDOH of education and location of residence. It is important for all countries to have access to breast cancer screenings, especially in rural areas (Kashyap, et al., 2022).
Cultural differences also play a role in breast cancer risk. There are different stereotypes around cancer that affect individuals all over the world which can be influenced by culture. Some societies feel that cancer will lead to death, therefore they decide not to have screenings or obtain a diagnosis. Unfortunately, this is what leads to higher deaths due to delayed diagnosis and treatment (UICC.org, 2023).
Acute and Long-term Breast Cancer Care
Preparing educational presentations is a way to educate targeted populations regarding breast cancer screenings. The first step is to find the barriers in different cultural groups and design the presentation around those barriers. The presentation follows a character with similar myths about screening mammograms. Throughout the presentation the character is reassured about their hesitation and proceeds to get the mammogram. It is also important to make sure the presentation is in the appropriate language of the targeted cultural population (Fung, Vang, Margolies, Li, Blondeau-Lecomte, Li, & Jaandorf, 2021).
Principles of breast screening care were established in 1986 because it was felt that it takes specialty teams to assess breast cancer. These specialties included a clinician, radiologist, and a pathologist. This came to be known as the multidisciplinary team approach. This approach is used worldwide. When different disciplines are involved with the diagnosis and treatment of cancer, the outcomes are better. A framework is established for the patient’s care early on. Everyone is involved from the beginning. The patient has a clear understanding of the whole treatment plan. Multidisciplinary care is known as the gold standard of cancer treatment (Blackwood & Deb, 2020).
When it comes to follow up care for breast cancer patients, there is some debate on who should provide the care, their oncologist or primary care provider. The majority of women studied did prefer their cancer care be provided by their oncologist. Most primary care providers oversee cancer screenings and tests; however, surviving patients preferred their oncologist to provide this care. If patient’s wait on their oncologist for routine testing, they could delay their care due to wait times to see them (Cancer.gov, 2017). Part of the multidisciplinary approach should include transitioning back to primary care provider for routine cancer follow up.
Issues related to breast cancer and improvement examples
There are structural barriers that exist which make it hard to get breast cancer screenings. Location of services can be a barrier for people who live in remote areas or do not have transportation. Screenings may not be available at convenient times. Better access to care for breast cancer patients requires action. There are many barriers to quality care that people face. The Susan G. Komen’s mission is to advocate for public policy so everyone regardless of age, gender, race, and socioeconomic status receives the care they require. One act that is being included in legislation is the Access to Breast Cancer Diagnosis Act (H.R.2428). This act will stop payers from denying access to diagnostic imaging when screening mammograms suggest further workup (Komen.org, 2019).
Patient feedback about their breast cancer treatment is a way to ensure that quality care is being provided. A study was conducted on whether patient-reported outcome measures (PROMs) were helpful in having a positive effect on patients, their providers, and overall outcomes. PROMs had a positive impact on health outcomes, showing reduced anxiety and pain. Also, quality of life was higher. Most patients reported that the PROMs were easy to access and complete. Since the focus is shifting towards quality care, PROMs are a great way to analyze the care given. The results will assist providers to make improvements needed (Van Egdom, Oemrawsingh, Verweij, Verhoef, Klazinga, & Hazelzet, 2019).
Breast Cancer Costs and Methods of Improving Care
The treatment for breast cancer is the highest cost of all types of cancer. In 2020 the total cost annually for breast cancer care was $29.8 billion. There are three phases of care for breast cancer diagnosis and treatment: initial phase or first year after diagnosis, end-of-life phase, or year before death from cancer, and continuing care phase or in between the previous two phases. End of life care has the highest average per-patient cost and continuing care has the lowest. The CDC is working to reduce health care costs by detecting breast cancer early with screenings. There are proven benefits for more screenings, such as reducing number of breast cancer deaths, decreased number of diagnoses at later stages, increased life expectancy with early detections, and reduced health care spending due to lesser costs for treatments (CDC.gov, 2022).
There are several barriers to breast cancer care such as structural, sociocultural, personal, and financial. Another barrier includes training of providers to adequately detect and treat breast cancer patients. Human resources can play a factor in overcoming this barrier. Adequate allowances of resources need to be allocated to help provide trained healthcare personnel in screening for breast cancer, as well as diagnosing and treatment. Health systems will have increased demand for services as breast cancer access is improved. This will require additional healthcare personnel. To keep retention of employees, strategies are necessary. These may include providing continuing education, providing adequate working environment, and competitive wages. Stakeholders should work together to ensure all health professionals are trained in breast cancer awareness and care (Fredhutch.org, n.d.).
The Enhancing Oncology Model (EOM) is a payment model under the Medicare fee-for-service that can improve patient care and reduce healthcare spending. The incentive is to have providers take accountability of the care of patients who are receiving systemic chemotherapy. There are seven types of cancer that providers oversee, and breast cancer is one of those. Over a six-month period, each EOM participant is responsible for the total cost of care. Based on the performance quality and cost of expenditures, the participants may earn incentives or may owe a recoupment. The purpose of this model is to help with the coordination of the patient’s care and ensure that patients feel supported throughout their journey (CMS.gov, 2023).
One cost of healthcare that is not directly related to disparities is Medicare fraud and abuse perpetrators (FAPs). According to a study by JAMA Internal Medicine, 6,700 premature deaths were caused by FAPs in 2013. The Centers for Medicare & Medicaid Services (CMS) is tasked with identifying and getting rid of these FAPs who target vulnerable Medicare patients (Kuhrt, 2019).
Breast Cancer Organizations and Strategic Planning Methods
The Breast Cancer Research Foundation (www.bcrf.org) is the highest-rated breast cancer research organization in the country. Their mission is to prevent and cure breast cancer. They plan to do this by advancing the world’s most promising research. They are a non-profit organization started in 1993 by Evelyn Lauder, her friend Larry Norton, and her husband. Mrs. Lauder also was the creator of the famous signature pink ribbon which was distributed through the Breast Cancer Awareness campaign to raise awareness about breast health. BCRF has 255 researchers with the goal of preventing and curing breast cancer. There has been great progress since their founding in 1993. Donations are used to fund the research.
Breast cancer programs that are accredited by the National Accreditation Program for Breast Centers (NAPBC) is a way to prove that their team has health care providers who work together to provide the best care to their patients. There are certain quality standards that must be followed, and it is a great distinction to acquire. The NAPBC has many useful resources for organizations to utilize in planning, implementing, and marketing their services. There are many advantages of this accreditation, including education on best practices, access to community forums to search for best practices, and marketing tools (FACS.org, n.d.).
