The impact of geographical and sociodemographic variation on access to Systemic Anti- Cancer Therapies for Secondary Breast Cancer: A systematic review

Abstract

Abstract Background: The review aimed to investigate factors which influence receipt of systemic anti-cancer therapies (SACT) for women with secondary (metastatic) breast cancer (SBC). We aimed to identify and examine individual, clinical and contextual factors related to geographical location and health care systems which may act as barriers and enabling factors. Methods: Studies were included which reported factors associated with receipt of treatment with SACT for women >18 years with an SBC diagnosis. Information sources searched were EBSCO CINAHL Plus, Ovid MEDLINE, Ovid EMBASE, PsychINFO and the Cochrane Library and Joanna Briggs Institute (JBI) database. Assessment of methodological quality was undertaken using the using the JBI method and findings were synthesised using a narrative synthesis approach. Results: Fifteen studies published between 2009 and 2021 were included in the review. Overall treatment receipt ranged from 4% for immunotherapies to 83% for unspecified systemic anti-cancer therapies. Time to treatment ranged from median 54 days to 95 days with 81% of patients received treatment <60 days. Younger women and women of white origin with a higher socioeconomic status had an increased likelihood of timely treatment receipt. Treatment receipt varied by geographical location and place of care was associated with variation in treatment receipt with women treated at teaching, research and private institutions being more likely to receive treatment in a timely manner. Conclusions: Our review was to our knowledge the first of its kind to identify and investigate factors associated with timely receipt of SACT for women with SBC. We identified a potential interaction between geographical location and place of care which adds to the existing literature. Findings should however be interpreted with a degree of caution due to the limitations identified. Further research is required to address these limitations. Our review findings have practical implications for the development and piloting of targeted interventions to address specific barriers in a socio-culturally sensitive manner. Addressing geographical variation and place of care may require intervention at a commissioning policy level. Further qualitative research is required to understand the experience and of women and clinicians. Other: The review was undertaken as part of a PhD fellowship funded by The Christie Hospital NHS Foundation in collaboration with the Manchester Cancer Research Centre (MCRC) at The University of Manchester. The review protocol was registered in PROSPERO CRD42020196490.