Access to Affordable Breast Cancer Care in Eastern Europe
Purpose of Review
The majority of Central and Eastern European (CEE) countries report inferior breast cancer survival rates compared with Western European countries. We review limitations in access to screening programs, surgery, radiotherapy, pathology, palliative care, and antineoplastic medicines as potential explanations for these disparities.
Most CEE countries do not have the quality and quantity of radiotherapy needed to adequately service the population. Surgical services are widely accessible, but sentinel node biopsy is not universally available. There are important limitations for CEE patients in accessing high-quality pathology. Many patients living with advanced cancer are in dire need of palliation services. Important inequalities exist in availability and patient costs, especially for newer, more expensive drugs, across Europe, while drug shortages affect several “essential,” old, and inexpensive drugs.
Improvements in radiotherapy, surgery, and pathology and access to medicines are needed, together with the provision of trained health care professionals.
KeywordsBreast cancer Eastern Europe Limited resources
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, Trama A, Visser O, Brenner H, et al. Cancer survival in Europe 1999–2007 by country and age: EUROCARE-5 2014;15(1):23–34. Doi: 10.1016/S1470-2045(13)70546-1.Google Scholar
- 9.Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–403. https://doi.org/10.1016/j.ejca.2012.12.027.; EUCAN national estimates (eco.iarc.fr/eucan).CrossRefPubMedGoogle Scholar
- 10.European commission. Cancer screening in the European Union report on the implementation of the council recommendation on cancer screening. Reprint May 2017.Google Scholar
- 11.Ades F, Senterre C, Zardavas D, de Azambuja E, Popescu R, Parent F, et al. An exploratory analysis of the factors leading to delays in cancer drug reimbursement in the European Union: the trastuzumab case. Eur J Cancer. 2014 Dec;50(18):3089–97. https://doi.org/10.1016/j.ejca.2014.09.011.CrossRefPubMedGoogle Scholar
- 13.Josip Banovich. Breast specialized surgeon from KBC split, Krizine, Croatia. Personal communication.Google Scholar
- 18.Dare AJ, Anderson BO, Sullivan R, Pramesh CS, Yip CH, Ilbawi A, et al. Surgical services for cancer care. In: Gelband H, Jha P, Sankaranarayanan R, Horton S, editors. Cancer volume, disease control priorities in developing countries. 3rd ed. Washington, DC: World Bank; 2015. http://dcp-3.org/chapter/1536/surgical-services-cancer-care.Google Scholar
- 21.Borras JM, Barton M, Grau C, Corral J, Verhoeven R, Lemmens V, et al. The impact of cancer incidence and stage on optimal utilization of radiotherapy: methodology of a population based analysis by the ESTRO-HERO project. Radiother Oncol. 2015;116:45–50. https://doi.org/10.1016/j.radonc.2015.04.021. published online May 19CrossRefPubMedGoogle Scholar
- 22.Borras JM, Lievens Y, Dunscombe P, Coffey M, Malicki J, Corral J, et al. The optimal utilization proportion of external beam radiotherapy in European countries:an ESTRO-HERO analysis. Radiother Oncol. 2015;116:38–44. https://doi.org/10.1016/j.radonc.2015.04.018. published online May 14CrossRefPubMedGoogle Scholar
- 24.Samiei M. Challenges of making radiotherapy accessible in developing countries. http://globalhealthdynamics.co.uk/cc2013/wp-content/uploads/2013/04/83-96-Samiei-varian-tpage-incld-Tpage_2012.pdf.
- 30.Connor SR, Bermedo MCS, editors. Global atlas of palliative care at the end of life. Geneva: World Health Organization; 2014. http://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf Google Scholar
- 31.Mosoiu D, Eniu A. Barriers towards establishing palliative care in Eastern Europe and prospects for improvement in the future: Romania as an example. In: Silberman M, editors. Palliative Care: Perspectives, Practices and Impact on Quality of Life, Nova Science Publishers, 2017, ISBN: 978-1-53612-084-4).Google Scholar
- 32.T. Brodowicz, I. Steiner, S. Beslija, T. E. Ciuleanu, M. Inbar, M. Krzakowski, Z. Kahan, V. et al, Time inclusion between final protocol approval and inclusion of the first patient into randomized clinical trials performed by the Central European Cooperative Oncology Group (CECOG): a 10 years experience, Journal of Clinical Oncology200927:15S, 6546–654621.1 Ramya Ramaswami, Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, Paul E. Goss, Disparities in Breast, Lung, and Cervical Cancer Trials Worldwide, Journal of Global Oncology, no. 4 (May 2018) 1–11. https://doi.org/10.1200/JGO.17.00226.
- 33.Metzger-Filho O, de Azambuja E, Bradbury I, Saini KS, Bines J, Simon SD, et al. Analysis of regional timelines to set up a global phase III clinical trial in breast cancer: the adjuvant lapatinib and/or trastuzumab treatment optimization experience. Oncologist. 2013 Feb;18(2):134–40. https://doi.org/10.1634/theoncologist.2012-0342.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Ramaswami R, Paulino E, Barrichello A, Nogueira-Rodrigues A, Bukowski A, Louis JSt., Goss PE, Disparities in breast, lung, and cervical cancer trials worldwide. J Glob Oncol. 4:1–11. https://doi.org/10.1200/JGO.17.00226.
- 36.Cherny NI, Sullivan R, Torode J, Saar M, Eniu A. ESMO international consortium study on the availability, out-of-pocket costs and accessibility of anti-neoplastic medicines in countries outside of Europe. Ann Oncol. 2017;28:2633–47. https://doi.org/10.1093/annonc/mdx521.CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Cancer medicines shortages in Europe, Policy recommendations to prevent and manage shortages. Economist Intelligence Unit (EIU) Healthcare study. available at http://www.eiu.com/graphics/marketing/pdf/ESMO-Cancer-medicines-shortages.pdf (accessed 27 Apr 2018).Google Scholar
- 43.World Health Organization: The seventieth world health assembly. Cancer prevention and control in the context of an integrated approach, in The seventieth world health assembly (ed): A70/a/CONF./9. Geneva, 2017.Google Scholar
- 44.Carlson RW, Scavone J, Koh W-J, et al: NCCN framework for resource stratification: a framework for providing and improving global quality oncology care. J Natl Compr Cancer Netw:in press, 2016.Google Scholar
- 46.Vivot A, Jacot J, Zeitoun J-D, Ravaud P, Crequit P, Porcher R. Clinical benefit, price and approval characteristics of FDA-approved new drugs for treating advanced solid cancer, 2000–2015. Ann Oncol. https://doi.org/10.1093/annonc/mdx053.
- 47.Eniu A, Carlson RW, El Saghir NS, Bines J, Bese NS, Vorobiof D, et al. Breast health global initiative treatment panel. Guideline implementation for breast healthcare in low- and middle-income countries: treatment resource allocation. Cancer. 2008;113(8 Suppl):2269–81. https://doi.org/10.1002/cncr.23843. CrossRefPubMedGoogle Scholar