Inequities in breast cancer care

<p dir="ltr"><b>Background</b>: Breast cancer from a global perspective is the most common cancer among women, with prospective treatments via clinical trials continually emerging for this non-communicable disease. Little is known about the use of Palbociclib within Te Whatu Ora Lakes (Rotorua Hospital) since funding approval in NZ, in 2020. Stage 4 breast cancer patients in NZ were previously required to self-fund this expensive targeted treatment if they wanted an alternative treatment option (143-146). For NZ patients diagnosed with Stage 4 breast cancer, Palbociclib could bridge equitable access with potential improvements in progression-free survival outcomes.</p><p dir="ltr"><b>Methods</b>: This retrospective clinical audit study used data from the local medical oncology database and the electronic records system Regional Clinical Portal, on the Te Whatu Ora Lakes Information Service’s system. Analysis of two local databases for the two years prior and following Palbociclib funding treatments. Kaplan-Meier and Cox regression models were used to determine the association between ethnic and Palbociclib funding groups.</p><p dir="ltr"><b>Results</b>: Cox regression ratios and PFS analyses were attempted but unable to be conducted due to the low numbers for analyses overall. However, PFS median times for both pre and post-funding treatment groups reported at 15.8 months, with PFS median times in the pre-funded Palbociclib groups reporting 22.2 months for Māori, and 6 months for non-Māori. PFS median times in the post-funded Palbociclib groups reported 19.8 months for non-Māori, and 9.9 months for Māori. Deaths were the cause for the reduced PFS median times for both Palbociclib treatment groups and were shown to be from other medical events.</p><p dir="ltr"><b>Conclusion:</b> Māori potentially faced higher baseline risks of dying compared to non-Māori. However, the study PFS outcomes were favourable to both ethnicities requiring Palbociclib. Fortunately, access to funded Palbociclib in NZ is not a cost-driven treatment for patients who can afford life-preserving treatment, in the stage 4 breast cancer context anymore. Further research is recommended to understand this further with a larger sample size.</p><p dir="ltr"><br></p><p><br></p>