• Improving Outcomes Globally without Leaving Anyone Behind

    Global

     

    Breast cancer is not a public health problem unique to the U.S. In fact, in some parts of the world, breast cancer is a much scarier diagnosis than in others. About 10-15 percent of cases in high-income countries (like the U.S.) are diagnosed at stage III or IV (advanced disease) – the rest will be detected early, when there are more treatment options and outcomes are better. But in less resourced settings, this number is far higher, with 50-80 percent of all cases diagnosed at an advanced stage. Further, healthcare systems in these countries may lack access to treatments, trained healthcare professionals and other basic resources we take for granted.

    Patients need governments and local healthcare professionals to prioritize and implement effective policies and programs that can save their lives. This is why we are so excited about a recent partnership between Susan G. Komen and Pfizer Oncology. Our organizations partnered to take on the global burden of breast cancer (specifically advanced and metastatic disease). Pfizer laid the foundation for the work with a global analysis of National Cancer Control Plans (NCCPs) and existing programs and policies, identifying gaps in care, and opportunities for policy development. Komen was then able to lend expertise from our global work, bringing promising practices to the discussion that have the potential to make a huge impact. Komen and Pfizer also involved Fatima Cardoso in the team - a renowned MBC expert that is leading the Advanced Breast Cancer (ABC) Global Alliance.

    We spoke with Komen’s Director of Global Programs, Anna Cabanes, Ph.D., MPH, and Maia Thrift-Perry, MA, MPH, Director of International Oncology Public Affairs at Pfizer about how this partnership came together, and what both groups hope to accomplish.

    Komen: How did this collaboration come together? What did each organization bring to the table?

    Thrift-Perry: Our team at Pfizer had been working on an analysis of cancer policies across 16 countries, in the hopes of identifying both the gaps and strengths that each country’s cancer policies possessed. We were looking specifically at care for those living with metastatic breast cancer (MBC), because 50-80 percent of women in low-and-middle income countries are diagnosed with a late-stage breast cancer (stage III or IV). Here are some of the things our review revealed:

    1. There is significant policy development across BC in all countries. There is still a need for improved awareness and education of the broader community on metastatic breast cancer specifically as well as expanding the notion of survivorship and access to scientific research on advanced cancer care.
    2. Improved methods of collecting and measuring patient data. With regard to MBC specifically, none of the NCCPs reflected a need to collect stage of diagnosis or recurrence, which limits policymakers’ ability to make informed decisions to address the MBC burden in their communities. As a result of this gap in information, we see policy lags behind treatment access in many countries.
    3. Even though most NCCPs note that integrated care, tailored to the specific needs of breast cancer and MBC patients can lead to improved patient outcomes (and efficiency gains within the system!), none of the countries with an NCCP actually recommended specific coordinated care actions for advanced breast cancer.
    4. Policy development success depends on collaboration between all stakeholders and sharing experiences across countries (both successes and failures). Crucial contributions are provided by clinicians, civil society, patient organizations and the private sector.

      Having a proper NCCP in place in a country is like building a house, where there are certain steps that must be taken in a specific order to ensure that the final product is solid, safe and serves its purpose. For example, we may know three people who are each building a house. But when we look closer, one house already has a foundation, and some framing. Another doesn’t yet have floor plans. The third is finished, just waiting for furniture and decor. It would not make sense to show up with paint at the house without floor plans, or with cement at the house that already has a solid foundation. Similarly, we need to understand how each country’s health policies are unique to determine what (if anything) can be improved. Once our analysis was complete, the natural next questions were “How can we share this information with the broader MBC community?” and, “What can we do to fill the gaps that we found?”

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      Pfizer laid the foundation for the work with a global analysis of National Cancer Control Plans (NCCPs) and existing programs and policies... Komen was then able to lend expertise from our global work, bringing promising practices to the discussion that have the potential to make a huge impact.

      Cabanes: This presented a perfect opportunity to bring our two groups together. Nearly 20 years ago, Komen began exploring outreach outside of the U.S., because breast cancer knows no borders, and doesn’t care where a woman lives or what language she speaks. In our global work, Komen serves as a “bridge” – partnering with international nonprofits, corporations and Ministries of Health to bring together people and organizations who share our passion to end suffering from breast cancer. Through these partnerships, we can develop programs that are sensitive to cultural differences and tailored to the specific needs of the community. To date, we have been involved in the development of several promising practices in breast cancer education, training and/or care throughout the world.

      It was very exciting to work on this project with Maia and Pfizer because it was like solving a puzzle – matching the current need in one community with an evidence-based practice that can help address it.

      Komen: What is the status of the analysis? And what comes next?

      Thrift-Perry: Our Pfizer-Komen-ESO team has had a couple of opportunities to present our data on the Global cancer stage, first at the International  Advanced Breast Cancer Consensus Conference 4 (ABC4) and then at the European Society for Oncology (ESO) Asia last November. The work presents solutions that any stakeholder can implement. In other words, the proposed solutions are not just to be implemented by policymakers or government officials, but we provided examples at all levels. We are all stakeholders working to improve the situation of breast cancer patients around the world. We all have the responsibility and opportunity to act in our capacity. It is great to present the work in these forums because we can reach different audiences and wider audiences.

      Cabanes: The strength of this project is that it is focused on solutions, and that the sum of its work is greater than the parts. Our collaboration goes beyond the usual types of partnerships and will allow us to leverage and amplify our individual and collective work. This is something that we all should look to do more often.

      Next, we are looking at providing the information in a clear and simple way, so organizations and individuals can assess the gaps in breast cancer and MBC policy that are within their reach to improve, and implement projects geared to fill these gaps.

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      Maia Thrift-Perry, Pfizer

      "We are all stakeholders working to improve the situation of breast cancer patients around the world. We all have the responsibility and opportunity to act in our capacity."

      Komen: Why is it so important for organizations like Pfizer and Komen to collaborate to tackle these types of issues?

      Cabanes: At Komen, our policy has long been that where a woman lives should not determine whether she lives. But even in the U.S., it has taken too much time to bring MBC to the forefront of breast cancer education, research and care, and it’s still not there. We know that early breast cancer and metastatic disease are managed differently, and thus the needs of patients that have early-stage or late-stage breast cancer are totally different. By applying our knowledge, we can give other countries and communities a head start on meeting the needs of those living with MBC today. Through this partnership, we are bringing appropriate, effective solutions to each country that we hope will improve outcomes for everyone facing breast cancer, without leaving anyone behind. And we’re better able to make such important strides by combining our organizations’ expertise.

      Thrift-Perry: The notion that any one organization can tackle this problem alone is simply false. We are all united toward a common goal, so we should be working together – maximizing our effort and resources – to accelerate the change we hope to see. And, hopefully, create a world where everyone has access to quality screening, diagnostic and treatment services for breast cancer.

       

       

      For more information on MBC, explore The Global Decade Report, which was developed by Pfizer Oncology, working collaboratively with the European School of Oncology (ESO) under the framework of the International Consensus Conference for Advanced Breast Cancer (ABC)- https://breastcancervision.com/educate#

      For more information on Promising Practices

      For more information on Global MBC Advocacy efforts, please refer to the following link http://www.abcglobalalliance.org/ 

      The ABC Global Alliance was established by the European School of Oncology and is a multi-stakeholder platform for all those interested in collaborating on common projects relating to advanced breast cancer (ABC) around the world.

      For more information on previously mentioned 2017 oral presentations, please follow the link to the ABC4 Global Results presentation).

      For more information on ESMO Asia.

       

      1. World Health Organization (2012) Globocan 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. Available from: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx  
      2. World Cancer Research Fund International (n.d.) Breast cancer statistics. Available from: http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/breast-cancer-statistics  
      3. Unger-Saldaña, K. (2014) Challenges to the early diagnosed and treatment of breast cancer in developing countries. World Journal of Clinical Oncology. 5(3): 465-477
      4.  http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/breast-cancer-statistics  
      5. World Health Organization (2017) National Cancer Control Programmes (NCCP). Available from: http://www.who.int/cancer/nccp/en/
      6. Pfizer Oncology, European School of Oncology and ABC3 (2016) Section 2: Policy, Society and Community Impact. Global Status of mBC Decade Report

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