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Review
. 2025 Jun 30:2025:2461234.
doi: 10.1155/tbj/2461234. eCollection 2025.

Underserved Patient Populations With Metastatic Breast Cancer: A Review of Progress and Remaining Challenges

Fatima Cardoso  1 , Rachel Wuerstlein  2 , Tomoyuki Aruga  3 , Renate Haidinger  1   4 , Matteo Lambertini  5   6 , Christine Benjamin  7 , Elisenda Llabrés Valentí  8 , Carmen Criscitiello  9   10 , Matti Aapro  11 , Generosa Grana  12 , Sharon S Gentry  13 , Eduard Vrdoljak  14
Affiliations
Review

Underserved Patient Populations With Metastatic Breast Cancer: A Review of Progress and Remaining Challenges

Fatima Cardoso et al. Breast J. .

Abstract

Breast cancer presents a significant risk to public health and is the primary cause of cancer-related death in women. Awareness of metastatic breast cancer (mBC) continues to increase, and advances have been made; however, challenges remain for many patient populations that do not receive equal opportunities along the treatment pathway. The Underserved Patient Population (UPP) Coalition Task Force, a group of international experts in mBC, held meetings between 2022 and 2023 to prioritise the needs of UPPs and propose solutions. The key unmet needs identified included the following: delayed diagnosis of mBC due to difficulties in the presentation of patients to the healthcare system and a lack of primary care physician and non-breast cancer specialist understanding of the signs and symptoms of mBC; difficulty navigating the mBC patient pathway due to suboptimal use of multidisciplinary care and limited communication between HCPs; unequal access to the most appropriate mBC treatment options and supportive therapy due to the unconscious bias of HCPs, and direct and indirect financial toxicity for patients; and negative impact on QoL resulting from the limited uptake of shared decision-making, low prioritisation of patient preferences and a lack of personalised care. This paper aims to shine light on initiatives supporting underserved patients with mBC, illustrate the remaining gaps in care and call upon the global community to change how care is delivered to UPPs.

Keywords: advanced breast cancer; health disparities; health inequity; metastatic breast cancer; unmet needs.

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Conflict of interest statement

Fatima Cardoso was in a consultancy role for Amgen, Astellas/Medivation, AstraZeneca, Celgene, Daiichi-Sankyo, Eisai, GE Oncology, Genentech, Gilead, GlaxoSmithKline, Iqvia, Macrogenics, Medscape, Merck-Sharp, Merus BV, Mylan, Mundipharma, Novartis, Pfizer, Pierre-Fabre, prIME Oncology, Roche, Sanofi, Samsung Bioepis, Seagen, Teva and Touchime. Rachel Wuerstlein was an advisor, consultant or speaker, or received travel grants from Agendia, Amgen, APOGHEVA, Aristo, Astra Zeneca, Aurikamed, Celgene, Clinsol, Clovis Oncology, Daiichi-Sankyo, Eisai, Eli Lilly, Esteve, Exact Sciences, FOMF, Gilead, GlaxoSmithKline, Hexal, MCI, MedConcept, MediSeminar, Medstrom Medical, MSD, Mundipharma, Mylan, Nanostring, Novartis, Odonate, Paxman, Palleos, Pfizer, Pierre-Fabre, PINK, Pomme Med, Puma Biotechnology, Riemser, Roche, Sandoz/Hexal, Sanofi Genzyme, Seattle Genetics/Seagen, Sidekick, Stemline, Tesaro Bio, Teva, Veracyte, Viatris and Wiley. Tomoyuki Aruga received lecture fees, honoraria or other fees from AstraZeneca, Chugai, Daiichi-Sankyo, Eli Lilly, Kyowa Kirin, MSD and Pfizer. Matteo Lambertini was in an advisory role for Roche, Eli Lilly, Novartis, AstraZeneca, Pfizer, Seagen, Gilead, MSD, Exact Sciences and Menarini; received speaker honorarium from Roche, Lilly, Novartis, Pfizer, Sandoz, Libbs, Daiichi-Sankyo, AstraZeneca, Takeda and Menarini; received travel grants from Gilead, Daiichi-Sankyo and Roche; provided research support to the Institution Gilead—outside the submitted work. Christine Benjamin was a paid participant of the Breast Cancer Steering Committee (Pfizer). Elisenda Llabrés Valentí was in a consultant or advisory role in Daiichi-Sankyo, Seagen; received research funding from AstraZeneca, Pfizer, Novartis and Roche; received speaker fees from AstraZeneca, Daiichi-Sankyo, Eli Lilly, Gilead, MSD, Novartis, Pfizer and Roche. Matti Aapro was the Past-President of the European Cancer Organisation, President of Sharing Progress in Cancer Care and President of All.Can. Generosa Grana was involved in the advisory board of Eli Lilly Oncology and Pfizer Oncology. Eduard Vrdoljak supported the clinical trials and scientific projects of AstraZeneca, BMS, Pfizer and Roche; received speaker fees and provided consulting for Amgen, Astellas, AstraZeneca, Boehringer Ingelheim, Johnson and Johnson, MSD, Merck, Novartis, Pharmaswiss, Pfizer, Roche, Sanofi and Servier. The remaining authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Prevalence of key UPP characteristics amongst patients with HR+ HER2− mBC in six countries [19, 20]. Abbreviations: N/A: not applicable and UK: United Kingdom. Proportion of patients with HR+ HER2− mBC with UPP characteristics based on Pfizer-funded survey results collected from oncology physicians by Ipsos in 2020. Ethnic minority background was not studied in Japan. This figure was produced by the authors for the purpose of this publication.
Figure 2
Figure 2
Key unmet need areas for UPPs with mBC prioritised by the UPP Coalition Task Force between 2022 and 2023. Abbreviations: HCP: healthcare professional, mBC: metastatic breast cancer, QoL: quality of life and UPP: underserved patient population. This figure was produced by the authors for the purpose of this publication.
Figure 3
Figure 3
Example page of the educational toolkit for primary care physicians and non–breast cancer specialists: signs and symptoms of mBC. Reproduction of the educational toolkit for primary care physicians and non–breast cancer specialists, with permission from the UPP Coalition Task Force, ABC Global Alliance and Pfizer.
Figure 4
Figure 4
Example page of the Patient Barrier Assessment Tool: identifying patients at risk due to age, comorbidities or demographics. Reproduction of the Patient Barrier Assessment Tool, with permission from the UPP Coalition Task Force, ABC Global Alliance and Pfizer.
Figure 5
Figure 5
Example page of the Visual Treatment Pathway: making a treatment decision. Reproduction of the Visual Treatment Pathway, with permission from the UPP Coalition Task Force, ABC Global Alliance and Pfizer.
Figure 6
Figure 6
Example page of the Wellness Chart: recording side effects. Reproduction of the Wellness Chart, with permission from the UPP Coalition Task Force, ABC Global Alliance and Pfizer.
See this image and copyright information in PMC

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