Regional differences in experiences of patients with metastatic breast cancer in the Republic of Ireland and Northern Ireland: a comparative analysis (CTRIAL-IE 23-05)

Abstract

Introduction: Metastatic breast cancer (MBC) presents significant psychological, social and financial challenges. Differences in the healthcare systems of the Republic of Ireland (ROI) and Northern Ireland (NI) may impact patient care experiences. This study aimed to explore regional differences in the experiences of patients with MBC between ROI and NI.

Methods: A patient-developed cross-sectional survey titled 'Patient-led Metastatic Breast Cancer Survey' was administered online to patients with MBC in ROI and NI from July to October 2023. The survey included 76 questions addressing demographics, understanding of diagnosis, mental health, financial burden, time spent managing cancer care (time toxicity), palliative care, sexual health, exercise and access to information. These topics were selected by patients with MBC as being most impactful. Responses from 246 patients (196 ROI, 50 NI) were analysed using descriptive and comparative statistics.

Results: Psychological distress was highly prevalent in both regions; however, NI patients were more likely to receive medications for psychological distress (51% NI vs 23.7% ROI, p=0.0008). Financial strain was more pronounced in ROI, with 77.5% feeling they had no control over their medical care spending, compared with 56% of NI patients (p=0.0124). Time toxicity was also higher in ROI, where patients reported more frequent visits to oncology day wards and acute oncology service units (p=0.0012) and spent more time in these settings (p=0.038). Participation in exercise programmes was significantly higher in NI compared with ROI (p<0.0001). Additionally, palliative care referrals were more commonly accepted or considered in NI than in ROI.

Conclusions: This study, the first of its kind, highlights important disparities observed in this cohort of patients with MBC across ROI and NI. Bidirectional learning could enhance patient care experiences, with NI potentially focusing on psycho-oncology integration and ROI expanding strategies to reduce time toxicity and financial burden for patients.

Keywords: Chronic disease management; Comparative effectiveness research; Health policy; Healthcare quality improvement; Patient-centred care.

Figure 1. Proportions of patients with MBC in ROI (n=196) and NI (n=50) reporting mental health impacts and prescriptions for mental health conditions. MBC, metastatic breast cancer; NI, Northern Ireland; ROI, Republic of Ireland.

Figure 2. Financial burden: agreement with “I feel I have no choice about the money I spend on medical care” in ROI (n=196) and NI (n=50). NI, Northern Ireland; ROI, Republic of Ireland.

Figure 3. Frequency of visits to oncology day wards or AOS units and time spent in these settings among patients with MBC in ROI (n=196) and NI (n=50). AOS, acute oncology service; MBC, metastatic breast cancer; NI, Northern Ireland; ROI, Republic of Ireland.

Figure 4. Comparison of travel times to hospital appointments for patients with MBC in ROI (n=196) and NI (n=50). MBC, metastatic breast cancer; NI, Northern Ireland; ROI, Republic of Ireland.