Abstract P2-08-03: Real-World Treatment Challenges in HR+/HER2- mBC: Results From the RETRACT Survey of 150 US Oncologists

Abstract Background: There are few published studies that evaluate the real-world barriers to the optimal management of patients with breast cancer, especially patients with metastatic disease (mBC). Clinical oncologists have a unique insight into barriers that exist both at the patient level and at the level of the health care system. The RETRACT (REal-world TReatment patterns And Considerations of Toxicity in HR+/HER2- mBC) survey was developed to explore real-world treatment patterns in patients with HR+/HER2- mBC by surveying a relatively large sample of oncologists working in academic and community centers. Topics included challenges to optimal patient treatment, providing a unique insight into this question from the provider perspective. Methods: A survey was distributed to clinical oncologists using an internal database. The survey was accessible via an online digital platform using an invitation link and individualized credentials. Responses were collected from December 2023 through April 2024. The results were analyzed using descriptive statistics. This sub-analysis concerns the responses to the following survey question: “What are the key challenges that hinder optimal management of patients with mBC?" Respondents could choose any number of 6 pre-filled options, and an optional free text response was also available. Results: The survey was sent to approximately 1000 oncologists working at academic or community medical centers, 187 registered on the digital platform, and 150 completed the survey, including 145 respondents who completed the item regarding key challenges to optimal patient treatment. The highest number of respondents, 118 (81%), chose treatment toxicity as a key challenge to optimal patient management. In addition, 25 (17%) respondents cited treatment efficacy and/or a lack of enough treatment options in the free-text responses. Most respondents, 84 (58%), chose financial barriers, and 12 (8%) cited insurance barriers in the free text responses: “high copays for targeted therapies such as CDK4/6 inhibitors that require significant work on the part of pharmacy staff in order to secure financial assistance for patients, which can sometimes result in delayed start of medication.” There were also 5 (3%) respondents who cited socioeconomic barriers in the free text including “transportation” and “patients need home care for themselves, other family members, or children.” Minorities of respondents identified low health literacy among patients (32; 22%) and poor treatment adherence (30; 21%). Other free text responses included difficulty in enrolling patients onto clinical trials due to lack of availability or accessibility (5; 3%), symptoms of progression and metastasis (4; 3%), comorbid conditions (4; 3%), lack of biomarkers for treatment decisions (4; 3%), patients diagnosed at an advanced stage (2; 1%), difficulty in coordinating complex care (2; 1%), and 1 (1%) each for medical misinformation and lack of enough oncologists. Conclusions: Oncologists who participated in the RETRACT survey identified several challenges to optimal care of patients with mBC. A large majority chose treatment toxicity, highlighting an urgent need for more tolerable treatments. In addition, education for providers can help to improve toxicity management. Financial and insurance-related challenges were frequently cited and can reduce access to existing medications due to high patient costs, increased burdens on providers’ time, and delays in treatment. These challenges are difficult to address through medical practice and are of particular concern among patient populations with fewer resources and other socioeconomic burdens such as needing childcare, lacking transportation, or lacking social support. These results show there are opportunities to improve care of patients with mBC throughout the health care pipeline. Citation Format: Hope S. Rugo, Aditya Bardia, William Gradishar, Erika Hamilton, Sara Tolaney, Komal Jhaveri, Reshma Mahtani, Sarah Hurvitz. Real-World Treatment Challenges in HR+/HER2- mBC: Results From the RETRACT Survey of 150 US Oncologists [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-08-03.