In this report, Charles River Associates (CRA) and Cancer Support Community (CSC) examine the extent to which policies associated with long-term support, well-being, and treatment innovation for triple negative breast cancer (TNBC) patients can exacerbate or ameliorate inequities in TNBC health outcomes among at-risk, under-resourced populations in the United States (US). In particular, the objective was to
- Describe evidence of inequitable access to long-term patient support services, and the resulting disproportionate impact in the form of worse mental and physical health outcomes and financial burden, among typically underrepresented communities and
- Highlight how health policies in the US can address the drivers of inequitable resources and support patient access to long-term support services and innovative treatment.
To accomplish these objectives, CRA conducted a comprehensive review of the literature pertaining to the TNBC policy landscape, which was enhanced by integrating insights from the patient advocacy group CSC to capture the real-world patient perspective and experience. We included data insights from CSC’s Cancer Experience Registry® (CER®) in this review to supplement our research. The methods of the CER® have been previously described., The CER® consists of responses from TNBC patients and survivors (N = 210) participating between January 2015 and August 2021. Together, CRA and CSC evaluated potential policies and programs for long-term patient support and treatment innovation that could support the needs of at-risk, under-resourced populations and reduce health inequities that lead to disparities in outcomes. The report was conducted for, and funded by, Gilead Sciences, Inc. (Gilead).
We focused on federal, state, and community-level policies and programs. The analysis references six states: California (CA), Georgia (GA), Louisiana (LA), Massachusetts (MA), Michigan (MI), and Pennsylvania (PA) and includes additional states with constructive policy examples highlighted in the literature. The states of focus were selected based on their high level of breast cancer incidence among Black women and to ensure regional representation across the US.
This paper is the final one in a series of three studies conducted by CRA for Gilead that identified evidence of inequities and disparities for TNBC patients throughout their sequence of care. In the first paper, our literature review identified barriers to screening and diagnosis for TNBC that worsen health outcomes in under-resourced populations in the US. In the second paper, we described how TNBC is particularly challenging to treat because there are few treatment options compared to other types of breast cancer, and health outcomes are compounded by harmful coverage restrictions and treatment-associated costs that place a significant burden on under-resourced patients.