UCLA CENTER FOR
HEALTH POLICY RESEARCH .

 

 

Health Policy Fact Sheet

April 2021

 

Better Access to Palliative Care
Can Improve the Experience for
Metastatic Breast Cancer Patients

AJ Scheitler, Susan H. Babey, Riti Shimkhada, Beth Glenn, and Ninez A. Ponce

 

SUMMARY

® Palliative care is an important part of care
for patients with metastatic breast cancer
(MBC), yet it is widely misunderstood.

e Palliative care is too often perceived solely
as end-of-life care rather than as a way to
manage pain and improve quality of life.

© Investment in clinician training can help
promote palliative care as an important part
of care for MBC patients.

In 2019, 30,650 individuals were diagnosed
with breast cancer in California, and 4,620 died
from the disease.' Metastatic breast cancer,
also called stage 4 or advanced breast cancer,
was the cause of nearly all of these deaths.

An estimated 30% of women diagnosed
with early-stage breast cancer will go on to
develop MBC. The five-year survival rate

for MBC is only 27%, compared to 91%

for breast cancer that has spread to lymph
nodes and 99% for cancer that is confined to
the breast.'

In this fact sheet, we present findings from
interviews, discussions, and studies (see
boxed section) on barriers to accessing
palliative care, and we recommend policy
solutions that could improve survivors'
understanding of and access to care for
breast cancer that has metastasized.

 

ain management, psychological and

social support, assistance with nutrition,
functional rehabilitation, and end-of-life care
are all part of palliative care, which addresses
many of the needs of MBC patients and can
help improve their quality of life.?* The
National Cancer Institute notes that the
goal of palliative care is to prevent or treat,
as early as possible, the symptoms and side
effects of the disease, in addition to any
related psychological, social, and spiritual
problems. However, palliative care is an area
in which there appears to be considerable

misunderstanding and lack of awareness
among providers, potentially making
them less likely to recommend this cate to
patients.*

Misconceptions around palliative care
were also discussed extensively at the
7th Annual Metastatic Breast Cancer
Conference (September 2020) and
revealed in the key informant interviews.
Conference attendees felt that education
programs were needed to promote
palliative care among providers, insurers,

 

 
 

 

and patients as a valuable part of treatment
that helps with the management of pain
and symptoms associated with MBC.
Interview participants also expressed a lack
of understanding about what palliative care
entails. Several respondents either equated
it to hospice or end-of-life care or noted that
providers and insurers treated it as such. As
one support service provider said:

Again, it goes back to lack of knowledge
and fear. People, when they hear palliative
or even hospice care, {are} freaking out
already. Your brain automatically goes to
end of life, and that's scary for people.

MBC patients who understood that
palliative care is intended to help manage
symptoms had inconsistent experiences

in being connected to such services. One
respondent noted that while she was on
private insurance, the company contacted her
about receiving coordinated palliative care.
However, when she transitioned to Medicare,
she did not receive any such outreach.
Patients for whom palliative care was
integrated into the treatment plan reported
positive experiences.

Policy Recommendations

The need for better integration of MBC
treatment with palliative care and support
services was a common theme across all
sources of information for this study. Some
legislation has been passed in California to
improve support services:

In 2018, the state legislature enacted SB
1004, which required Medi-Cal managed
care providers to offer home-based
palliative care to seriously ill patients.
However, participation in the managed
cate program was lower than expected,
likely due in part to lack of physician
awareness, challenges in providing

UCLA CENTER FOR HEALTH POLICY RESEARCH

education about palliative care to
patients, cultural and language barriers,
lack of time, competing demands of
physicians, patient mistrust of the
health care system, and limited services
for meeting basic needs.'

In 2019, the legislature enacted

AB 1287 to help give older adults,
caregivers, and people with disabilities
greater access to community services
and support.

Health officials could improve access to
palliative care by acting on the following
recommendations:

© Provide training on palliative care to
providers (to address lack of referral) and
educate patients about the scope and
benefits of palliative care.

e Improve awareness among providers
and patients of Medi-Cal's home-based
palliative care program.

Author Information

AJ Scheitler, EdD, is the director of stakeholder
relations at the UCLA Center for Health Policy
Research (UCLA CHPR). Susan H. Babey, PhD,
is a senior research scientist and co-director of

the Chronic Disease Program at UCLA CHPR.
Riti Shimkhada, MPH, PhD, is a public
administration analyst at UCLA CHPR. Beth
Glenn, PbD, is a professor in the Department of
Health Policy and Management at the UCLA
Fielding School of Public Health. Ninez A. Ponce,
MPP, PhD, is a professor at the UCLA Fielding
School of Public Health and director of the UCLA
CHPR.

Suggested Citation

Scheitler A, Babey SH, Shimkhada R, Glenn B,
Ponce NA. 2021. Better Access to Palliative Care
Can Improve the Experience for Metastatic Breast
Cancer Patients. Los Angeles, Calif.: UCLA Center
for Health Policy Research.

 

 
 

 

Endnotes

1

American Cancer Society. 2020. Cancer Facts & Figures
2020. Atlanta, Ga.: American Cancer Society.

Bergqvist J, Strang P. 2017. The Will to Live-Breast
Cancer Patients Perceptions' of Palliative Chemotherapy.
Acta Oncologica 56(9):1168-1174.

Cherny NI, Paluch-Shimon S, Berner-Wygoda Y. 2018.
Palliative Care: Needs of Advanced Breast Cancer
Patients. Breast Cancer (Dove Medical Press) 10:231-243.
Enguidanos S, Rahman A, Hoe D, Meyers K. 2019.
Provider-Identified Barriers to Palliative Care for
Medicaid Patients. Innovation in Aging 3:S689.
MacDonald T, Krishnan V, Wilson WA. 2019. Palliative
Care Access in the Elderly Metastatic Breast Cancer
Population: Obstacles and Opportunities. Translational
Cancer Research: $110-S115.

Thrift-Perry M, Cabanes A, Cardoso F, Hunt KM, Cruz
TA, Faircloth K. 2018. Global Analysis of Metastatic
Breast Cancer Policy Gaps and Advocacy Efforts Across
the Patient Journey. Breast 41:93-106.

UCLA CENTER FOR HEALTH POLICY RESEARCH

Addressing Barriers to
Metastatic Breast Cancer
Care in California: Levers
for Policy Change

Metastatic breast cancer occurs
all across the United States,

but differences in health care
systems, health insurance
products, and population
characteristics create state-level
differences in the experiences of
patients. While there are national
standards and laws governing
different aspects of care for MBC
patients, state-level policies still
have significant impact.

The findings contained in this
fact sheet are drawn from a study
by the UCLA Center for Health
Policy Research and the UCLA
Center for Cancer Prevention and
Control Research on the barriers
to metastatic breast cancer care
in California. The study report
synthesized information collected
by listening to patients and to
both clinical and nonclinical
caregivers, as well as by
accessing published research, the
grey literature, and Twitter chat.

Read the full report:
httos://healthpolicy.ucla.edu/
publications/search/pages/
detail.aspx?PubID=2101

 

Read this publication
online

FS2021-3