A pragmatic qualitative study to explore women and clinicians experience of access to systemic anti-cancer therapies for the treatment of secondary breast cancer

Purpose An estimated 57,000 women are currently living with secondary (metastatic) breast cancer across the UK. Equitable access to treatment has been associated with improved clinical outcomes, however geographical disparities have been reported which remain poorly understood. The purpose of our study was to explore women and clinicians’ experience of geographic access to systemic anti-cancer therapies for the treatment of secondary breast cancer. Method The study setting was the integrated cancer system across the northwest region of Greater Manchester UK. A pragmatic qualitative study design was used. Women aged >18 years with a confirmed SBC diagnosis and clinicians responsible for the care and treatment of women with a secondary breast cancer diagnosis were interviewed using semi structured interviews to elicit their experience and perspectives on geographic access to treatment. Data were analysed using thematic analysis to identify emergent themes. Results Eighteen interviews with women and 12 interviews with clinicians were completed. Four meta themes were identified for geographic access, the influence of the health care system, person centred factors and the impact of Covid-19 on treatment access and receipt. Conclusion Our study was the first of its kind to explore women and clinicians experience of geographic access to systemic anti-cancer therapies for the treatment of secondary breast cancer. Findings provided a greater understanding of distance decay and the influence of the health care system on treatment access. This included the importance and availability of clinical trials as a potential treatment option. This provided important insights and contributed to ongoing debate.