2021

Breaking down barriers to care for metastatic breast cancer patients


UCLA researchers recommend state-level policy changes to improve health insurance coverage, participation in clinical trials and access to care.

stressed person

Drawing on a series of studies and interviews with patients and caregivers, researchers from the Fielding School's UCLA Center for Health Policy Research and the UCLA Jonsson Comprehensive Cancer Center have published recommendations for California policymakers and patient advocates aimed at improving care and outcomes for women with metastatic breast cancer.

More than 30,000 women in California are diagnosed each year with this cancer, which has spread from the breast to other parts of the body. Survival rates are low, and patients often face significant hurdles to care — particularly in the areas of health insurance, clinical trials and palliative care — that could be remedied through policy changes, the team says. The researchers include Dr. Beth Glenn, UCLA Fielding School of Public Health professor of health policy and management, and Dr. Ninez Ponce, director of the UCLA Center for Health Policy Research and a Fielding School professor of health policy and management.

“Battling metastatic cancer is difficult enough for any person, and we should be breaking down the barriers that stand in the way of providing the best care possible,” said lead author Dr. AJ Scheitler, director of stakeholder relations at the health policy research center. “Our work aims to offer state-level policy solutions that should be further explored.”

These potential solutions emerged, in large part, from the researchers’ 2020 study of barriers to care, which was presented to the California Breast Cancer Research Program and incorporated insights from interviews with a broad range of patients, health care providers and other stakeholders, as well as from patients’ social media discussions. The interview responses and narrative data led to the discovery of a variety of obstacles, from high costs of care to a lack of support services.

The team then distilled their findings into informational policy sheets — available in English, Spanish and Chinese — that provide policy recommendations in those areas where improvements are most critical:

Removing health insurance obstacles

  • Obtaining approvals for treatment from insurance companies was cited as a major stressor by both patients and health care providers, due primarily to the time requirements and complexity of the process and patient fears that switching insurance plans could reduce their coverage. “I trust that if a drug has been approved for stage 4 cancer and an oncologist want to use it on me, we should just get it,” said one patient. “But that’s not how the world works.”
  • Recommendations: Because of the need for timely treatment, prior authorization requirements and step therapy procedures should be eliminated altogether for metastatic cancers — and should be improved for other cancers. 

Improving participation in clinical trials

  • Trials aimed at evaluating new medical treatments are crucial to patients, but many respondents cited a lack of awareness and user-friendly information about trials, difficulties getting to trial sites and confusion over whether the costs are covered by insurance. The authors further note that enrolling diverse racial and ethnic groups has been a persistent challenge.
  • Recommendations: Increase investment in programs that boost trial participation among Black and Latino patients and expand insurance assistance to cover costs associated with trials, such as travel expenses. 

Increasing access to palliative care

  • Often misinterpreted as just end-of-life care, palliative care — including pain management, psychological and social support, nutrition guidance and functional rehabilitation — helps patients manage their symptoms and improve their quality of life.
  • Recommendations: Better integrate palliative care and support services with cancer treatment, provide palliative care training to clinicians and educate patients about the benefits of this type of care. 

“Overall, the insights we gained from patients and others who had a wide variety of perspectives showed us that there’s a lot that can be done to improve the cancer care experience for this group. Removing the barriers to care is vital — and doable,” said co-author Dr. Riti Shimkhada, a senior research scientist at the health policy research center. “By improving access to and awareness of clinical trials and palliative care programs, and removing the hoops patients and clinicians face in accessing treatment, we have the potential to improve quality of life for patients with metastatic breast cancer.”

by Elaiza Torralba


The UCLA Fielding School of Public Health, founded in 1961, is dedicated to enhancing the public's health by conducting innovative research, training future leaders and health professionals from diverse backgrounds, translating research into policy and practice, and serving our local communities and the communities of the nation and the world. The school has 631 students from 26 nations engaged in carrying out the vision of building healthy futures in greater Los Angeles, California, the nation and the world.

Faculty Referenced by this Article

Dr. Beth Glenn
Beth Glenn
Health Policy and Management
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Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
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Dr. John Lu
Z. John Lu
Health Policy and Management
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Dr. Anthony Schiff
Anthony Hunter Schiff
Health Policy and Management
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Jeanne Miranda
Jeanne Miranda
Health Policy and Management
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Olivia Jung
Olivia Jung
Health Policy and Management
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Clifford Ko
Clifford Ko
Health Policy and Management
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Freund, Deborah
Deborah Anne Freund
Health Policy and Management
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Thomas D. Gordon
Health Policy and Management
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Burt Cowgill
Burt Cowgill
Health Policy and Management
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Dr. Kristen Choi
Kristen Choi
Health Policy and Management
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Paul Chung
Paul Chung
Health Policy and Management
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Emily Abel
Emily Abel
Health Policy and Management
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Dr. Frederick Zimmerman
Frederick Zimmerman
Health Policy and Management
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Avram Kaplan
Avram Kaplan
Health Policy and Management
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Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
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Galper, Michael
Michael Galper
Health Policy and Management
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Dr. William McCarthy
William J. McCarthy
Health Policy and Management
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Vickie Mays
Vickie Mays
Health Policy and Management
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Linda Rosenstock
Environmental Health Sciences Health Policy and Management
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Roshan Bastani
Health Policy and Management
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Barbara Berman
Health Policy and Management
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Diana Hilberman
Diana Hilberman
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Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
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Dr. Arturo Vargas Bustamante
Arturo Vargas Bustamante
Health Policy and Management
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Dr. Yvonne Flores
Yvonne Flores
Health Policy and Management
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Dr. Alice Kuo
Alice Kuo
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Thomas Priselac
Health Policy and Management
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Dr. Jennifer Wortham
Jennifer Wortham
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Ty Robbins
Health Policy and Management
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Jean Balgrosky
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Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
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Dr. Dylan Roby
Dylan Roby
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Michael Ong
Michael Ong
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Aronberg, Sandra
Sandra Aronberg
Health Policy and Management
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Dr. Paul Fu, Jr.
Paul Fu, Jr.
Health Policy and Management
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Comanor, Bill
William Comanor
Health Policy and Management
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Gerald Kominski
Gerald Kominski
Health Policy and Management
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Moira Inkelas
Moira Inkelas
Health Policy and Management
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Dr. Naomi Zewde
Naomi Zewde
Health Policy and Management
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Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

Health Policy and Management
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Leah Vriesman
Leah Vriesman
Health Policy and Management
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Robert Kaplan
Robert Kaplan
Health Policy and Management
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Dr. Elizabeth (Becky) Yano
Elizabeth (Becky) Yano
Health Policy and Management
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Nadereh Pourat
Nadereh Pourat
Health Policy and Management
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Jody Heymann
Jody Heymann
Epidemiology Health Policy and Management
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Dr. Lillian Gelberg
Lillian Gelberg
Health Policy and Management
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Jose J. Escarce
Health Policy and Management
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Emmeline Chuang
Health Policy and Management
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James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
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Corrina Moucheraud
Corrina Moucheraud
Health Policy and Management
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Ron D. Hays
Ron D. Hays

@UCLA since 1997

Health Policy and Management
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Mark Litwin
Health Policy and Management
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Pamela Davidson
Health Policy and Management
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Jack Needleman
Jack Needleman
Health Policy and Management
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Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
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Steven Teutsch
Health Policy and Management
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Arlene Fink
Health Policy and Management
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Lori Pelliccioni
Health Policy and Management
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Laura Erskine
Laura Erskine
Health Policy and Management
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Patricia Ganz
Patricia Ganz
Health Policy and Management
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Dr. Samuel Sessions
Samuel Sessions
Health Policy and Management
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Dr. Thomas Rice
Thomas Rice
Health Policy and Management
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Carol Mangione
Health Policy and Management
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Susan Ettner
Health Policy and Management
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Dr. Risha Gidwani
Risha Gidwani
Health Policy and Management
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Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

Health Policy and Management
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Dr. Xi Zhu
Xi Zhu
Health Policy and Management
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Dr. Aria Fallah
Aria Fallah
Health Policy and Management
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Alan Tomines
Health Policy and Management
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Kadiyala, Srikanth
Srikanth Kadiyala
Health Policy and Management
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Dr. Felicia Hodge
Felicia Hodge
Health Policy and Management
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Dr. Jonathan Fielding
Jonathan Fielding
Health Policy and Management
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David Hayes-Bautista
Health Policy and Management
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Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
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Neal Halfon
Health Policy and Management
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Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
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Dr. Kenneth Wells
Kenneth Wells
Health Policy and Management
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Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

Health Policy and Management
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Warren Scott Comulada
Warren Scott Comulada
Health Policy and Management
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Robert Brook
Health Policy and Management
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Annette Maxwell
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