Disparity of care: Addressing the unmet needs of people with metastatic breast cancer (mBC)
By Guillaume Feugère and MJ DeCoteau
March 14, 2023
In its most advanced stage, breast cancer – which is diagnosed in close to 29,000 Canadian women each year and accounts for almost 15 per cent of all cancer deaths in Canadian women1 – remains an incurable disease.
For people living with the knowledge that their breast cancer has metastasized and travelled to other parts of their body, a stage of the disease called metastatic breast cancer,2 the isolation and sense of hopelessness can be as challenging as the physical symptoms of the disease. These people often feel forgotten – abandoned as “lost causes” whose only pathway is end of life care. Some have reported being shunned by those in the earlier stages of the disease, perhaps because they represent the outcome everyone fears the most. 3,4
There’s also the perception that there’s a lack of interest in researching treatments for mBC. The reality is, dedicated scientists around the world continue to pursue new therapies to more effectively treat mBC and some are achieving promising results.5
During a recent phone conversation, Dr. Karen Gelmon, an award-winning leader in oncology research at British Columbia Cancer, pointed out another important reality: all research work or projects focused on breast cancer at any stage are, ultimately, aimed at improving outcomes and quality of life for all people with this disease. The bottom-line hope is for people to never develop breast cancer at all or, if they do, for the disease progression to be avoided, slowed or stopped altogether.
Until this hope is realized, it’s critical for scientists, healthcare professionals and health system leaders to support work that addresses the unmet needs of people with mBC.
This was the thinking that led to Pfizer Canada and Rethink Breast Canada (Rethink) collaborating to provide quality improvement grants for pioneering projects focused on mBC. Since its launch in 2021, our joint grant program has provided nearly $550,000 in grants to six projects in areas of interest identified by patients consulted through a mBC advisory board. Having patients involved at every point – from criteria development to the review process – has been so important. It gives the patient voice the value it deserves.
While these projects are varied in their focus and scope, they all address a problem cited commonly by people with mBC: a disparity in care. Too often, the ability to access quality care depends on factors such as what part of the country a patient lives in, ethnic background, income and level of education.
In our joint grant program’s first year – when we received nine proposed project submissions – we provided almost $270,000 to support the systematic screening of patients’ symptoms during breast cancer treatment at St. Mary’s Research Centre in Montreal, to create a virtual evidence-based forum of mBC related topics to patients living with and undergoing treatment at the Tom Baker Cancer Centre in Calgary, and a nurse navigator-led program to improve the quality of care for older patients with mBC at the British Columbia cancer centre in Vancouver.
Last year, we received 11 submissions and awarded nearly $280,000 to three projects: an information resource centre at Women’s College in Toronto for Black women with mBC, a machine learning algorithm project at Alberta-based Oncology Outcomes that can detect mBC recurrences, and a virtual care pathway at Princess Margaret Cancer Centre in Toronto that will see nurse navigators supporting patient access to clinical trials and genomic sequencing.
These projects – all led by multidisciplinary teams, such as a mix of doctors and nurses, or of clinicians, researchers, and data technologists – share the common objective of improving care by empowering mBC patients with critical information and access to the right programs.
This type of collaboration and program co-created with Rethink also demonstrates how patients, caregivers and partners can work together, leaning on each other’s strengths to create change. And we’re seeing it has the potential to make an impact beyond mBC in other disease areas.
We expect the first cohort of projects to be completed this year and the second cohort to be finalized by 2024. In the meantime, applications are open for this year’s grant program until late March, which we hope will attract even more applicants. Please find more details here.
The patient advocates involved in shaping this program can see first-hand where the funding and effort is going and how it is making a difference where the need is the greatest. We continue to advance our core work in oncology research at Pfizer, and in patient advocacy and research in mBC at Rethink. Through our collective efforts in breast cancer research – from early stage to the most advanced form – our goal is to help all people at risk for breast cancer or already living with this disease.
Guillaume Feugère is a Montreal-based oncology medical affairs scientist with Pfizer Canada. MJ DeCoteau is the founder and executive director at Rethink Breast Canada, a registered Canadian charity that educates, empowers and advocates for people who are affected by breast cancer.
[1] Canadian Cancer Society https://cancer.ca/en/cancer-information/cancer-types/breast/statistics
[2] Madell, R. & Balingit, A. (2021). “Metastatic Breast Cancer: Prognosis and Survival Rate”. Retrieved from: https://www.healthline.com/health/breast-cancer/metastatic-prognosis
[3] Madell, R. & Balingit, A. (2021). “Metastatic Breast Cancer: Prognosis and Survival Rate”. Retrieved from: https://www.healthline.com/health/breast-cancer/metastatic-prognosis
[4] Mosher, C. Johnson, C. Dickler, M. et al. (2013). “Living with Metastatic Breast Cancer: A Qualitative Analysis of Physical, Psychological, and Social Sequelae”. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4097181/
[5] Madell, R. & Balingit, A. (2021). “Metastatic Breast Cancer: Prognosis and Survival Rate”. Retrieved from: https://www.healthline.com/health/breast-cancer/metastatic-prognosis