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Breaking Down Barriers to Care for Patients with Metastatic Breast Cancer

UCLA Health reported on Fielding School researchers, including Dr. Beth Glenn and Dr. Ninez Ponce, recommending state-level policy changes to improve health insurance coverage, participation in clinical trials and access to palliative care

Wednesday, November 24, 2021

To improve health outcomes for women with metastatic breast cancer, UCLA researchers have published recommendations for California policymakers and patient advocates that include removing obstacles to health insurance, boosting participation in clinical trials and increasing access to palliative care. These are the most critical areas for improvement through policy changes, say researchers from UCLA’s Jonsson Comprehensive Cancer Center and the Fielding School’s UCLA Center for Health Policy Research.

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.

AJ Scheitler

“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.”

The recommendations draw, in large part, from a series of studies, interviews and social-media discussions with patients and caregivers in a 2020 study of barriers to care, which led to the identification of a variety of obstacles from high costs of care to a lack of support services.

Obtaining approvals for treatment from insurance companies is 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. Many respondents cite a lack of awareness and user-friendly information about clinical trials aimed at evaluating new medical treatments, difficulties getting to trial sites and confusion over whether or not the costs are covered by insurance. The authors further note that enrolling diverse racial and ethnic groups has been a persistent challenge.

Researchers recommend that 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. They also suggest increasing investment in programs that boost trial participation among Black and Latino patients and expanding insurance assistance to cover costs associated with trials, such as travel expenses.

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. The team suggests policies that 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.

Riti Shimkhada

“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 761 students from 26 nations engaged in carrying out the vision of building healthy futures in greater Los Angeles, California, the nation and the world.