Financial aid helps improve survival of indigent patients with breast cancer

A trend towards a favourable overall (OS) and disease-free survival (DFS) at 21 months follow-up has been observed among patients with early breast cancer enrolled to a government program that grants medicines access to indigent individuals, reports a study presented at ASCO Breakthrough 2023.

Significant factors for treatment delay include infection with COVID-19 and unavailability of trastuzumab.

In this study, lead researcher Jason King Dalusung Talao from the National Kidney and Transplant Institute, Quezon City, Philippines, and his colleagues assessed the impact of the Breast Cancer Medicines Access Program (BCMAP) of the Department of Health. They also identified factors causing treatment delay and offered recommendations for the improvement of the program.

BCMAP sought to provide ready access to free medications for the adjuvant chemotherapy treatment of stage I‒IIIb breast cancer patients to ease the financial burden associated with costly cancer treatment.

This retrospective cohort study included all enrolled patients (n=52) at the BCMAP from October 2020 to December 2021. The researchers followed them until July 2022 to determine the survival rates.

Of the eligible breast cancer patients, more than two-thirds completed systemic treatment based on physician discretion. The OS rate was 95.9 percent, while the DFS rate was 88.7 percent. Less than 10 percent had disease progression, and two of them died. [ASCO Breakthrough 2023, abstract 6]

Notably, treatment delay was significantly associated with COVID-19 infection (p=0.0001) and unavailability of trastuzumab (p=0.0216).

“According to the American Cancer Society, when breast cancer is detected early, the 5-year relative survival rate is 99 percent as compared to a patient with distant metastasis, which decreased to 29 percent,” the researchers said. “Therefore, enhanced screening techniques for early disease detection and prompt treatment are necessary to improve cure and survival rates.”

In the Philippines, the incidence of breast cancer stood at 17.7 percent in 2020, making it the most common malignancy affecting Filipino women.

An earlier meta-analysis that determined the risk factors for breast cancer among women in Southeast Asia confirmed the association of both modifiable and nonmodifiable factors with the disease.

Among the modifiable factors evaluated, parity (nullipara; odds ratio [OR], 1.85, 95 percent confidence interval [CI], 1.47‒2.32), body mass index (overweight; OR, 1.61, 95 percent CI, 1.43‒1.80), and use of oral contraceptives (OR, 1.27, 95 percent CI, 1.07‒1.51) were associated with a higher likelihood of developing breast cancer. [Asian Pac J Cancer Prev 2017;18:3201-3206]

Among nonmodifiable risk factors, the highest odds were observed with family history of breast cancer (OR, 2.53, 95 percent CI, 1.25‒5.09), followed by age (≥40 years; OR, 1.53, 95 percent CI, 1.34‒1.76) and menopausal status (OR, 1.44, 95 percent CI, 1.26‒1.65).

In this analysis, the investigators searched for studies published between 1997 and 2017 using the databases of PubMed, ProQuest, and EBSCO. They processed the obtained data using Review Manager 5.3. A total of 1,211 articles were identified, of which 15 (one cohort and 14 case control) met the eligibility criteria.