"Enhancing patient-centred approaches to optimise early-breast cancer care: a review of current practice and opportunities for improvement in Thailand" is a research report by Economist Impact examining the existing breast cancer care pathway in Thailand and the factors that help or hinder the goal of achieving optimal patient-centred care.
We have explored how Thailand can improve patient-centred care and build awareness, promote screening, early detection, diagnosis and prognosis, and ensure access to high-quality treatment, including supportive and palliative care. The research aims to improve long-term outcomes for women with breast cancer in Thailand.
The key findings:
Awareness: In Thailand, awareness gaps exist among people living in urban and rural areas. Many people use social media platforms to gain cancer information without knowing the source's credibility. Patient advisory plays a significant role in Thailand in spreading awareness of the disease and encouraging women to perform regular breast self-examinations (BSE) and clinical breast examinations (CBE). However, the lack of knowledge of the risk factors associated with breast cancer among Thai women is a challenge that must be tackled to optimise patient-centred early breast cancer care.
Screening and Diagnosis: The screening programme recommended in Thailand focuses on breast self-examination and clinical breast examination. Mammographic and ultrasound screening, though recommended, is not covered under universal health coverage schemes, leading to its lower uptake. In addition, the uneven distribution of diagnostic setups in urban areas also adds to the access challenges for people in rural regions. While some positive attempts, such as the introduction of mobile screening units, have been made to overcome the access barriers, this has yet to achieve the desired results. However, attempts to improve genetic testing have been successful in optimising early breast cancer care.
Treatment: Universal health coverage and multidisciplinary teams providing integrated care in big hospitals drive better patient-centred early breast cancer care in Thailand. As the treatment plans are often based on benefits provided to the beneficiaries of public reimbursement schemes, the clinical practice guidelines have a limited impact on optimising patient-centred care. The variable access to precision medicine under different public reimbursement schemes and lack of patient involvement in decision-making hinder patient-centred care for early breast cancer patients. Thailand's healthcare workforce shortage is another substantial challenge to achieving patient-centred early breast cancer care.
Survivorship: Support groups for early breast cancer survivors in Thailand play an important role in enhancing patient-centred care. However, poor survival rates highlight several challenges from screening to treatment that can lead to poor outcomes requiring attention.
We have identified the following opportunities to optimise early breast cancer care and improve outcomes for people living with breast cancer in Thailand:
- Data, data, data: Improving the availability of data from cancer registries would help develop better evidence-based strategies to improve the quality of cancer care and develop targeted screening and treatment protocols for high-risk populations.
- Rethink reimbursement: The reimbursement system in Thailand is complex and fragmented. While it provides comprehensive coverage of essential drugs and treatments, only a minority of patients can access novel, high-cost, innovative therapies. Establishing equal access, performance-based reimbursement and more affordable drug prices for newer, more efficient treatments and drugs could help reduce disparities and improve Thailand's breast cancer outcomes.
- Improve distribution and access: The lack of workforce, infrastructure support, and equipment at Thailand's district and provincial hospitals can be a significant barrier to early breast cancer management that should be addressed. The concentration of breast cancer clinics in Bangkok and other larger cities also means access issues for people in rural areas.
- Improve collaboration and information sharing: To provide improved patient-centred care pathways, the policymakers, patients, and healthcare workers need to work together. Transparency and information sharing among all stakeholders are necessary for collaboration.
