Healthcare system gaps in access to HER2-directed chemotherapy in early-stage HER2-positive breast cancer: A scoping review.

Abstract

e13031 Background: HER2-directed targeted treatment with Trastuzumab and chemotherapy has been the standard therapy for early-stage HER2-positive breast cancer, increasing survival rates. However, many studies have shown gaps in disease management and care of the disease. Many eligible patients do not receive this therapy due to healthcare system-related factors such as type of treatment facility, insurance limitations, referral timings, and locational convenience. Some studies have shown that the underuse of HER2-directed targeted treatment with chemotherapy can be correlated with lack of care coordination, especially for economically disadvantaged populations. Acknowledging and understanding these limitations in management is essential to provide proper and equal healthcare amongst all patients. Methods: This scoping review looked at studies with the date range of 2005-2026 and found in PubMed, EMBASE, and Google Scholar, when Trastuzumab became the standard of care for early-stage HER2-positive breast cancer. Inclusion criteria included studies examining health system factors that influenced initiating, receiving, and completing HER2-directed management among patients that were diagnosed with early-stage HER2-positive breast cancer. We synthesized findings narratively due to inconsistencies in methodology and reported outcomes. Results: Twenty studies that met the inclusion criteria were reviewed. One study illustrates that out of 418 patients, one third of the prescriptions were filled with financial help and among 48 prescriptions never filled, one third was due to being unable to afford the therapy. Additionally, delayed oncology referrals worsen the outcomes of early-stage breast cancer therapy. Another study illustrates that waiting more than 12 weeks to initiate Trastuzumab had worse overall survival rates while another study explains waiting more than 6 months increased the chance of relapse. Additionally, women with lower annual incomes were more likely to discontinue therapy compared to women making an annual income of $50,000 or more. Collectively, the studies reviewed highlight that lower sociodemographic status, insurance and financial barriers, and delayed oncology referrals can negatively impact access to treatment for early-stage HER2-positive breast cancer. Conclusions: Health system barriers limit the care and access to HER2-directed targeted treatment. Changes that focus on care management, decreased delay in referrals, more geographical access to treatment centers, and decreased insurance-related delays can improve delivery of HER2-directed chemotherapy. Selection bias due to used keywords and inclusion criteria, and findings being reflective only of studies found in the mentioned bibliographic databases are the main limitations of this review.