Identifying barriers to immunotherapy access for triple-negative breast cancer: A qualitative analysis of interviews with medical oncologists

PURPOSE: Immune checkpoint inhibitors, a type of immunotherapy, show promise in treating triple-negative breast cancer (TNBC). Although TNBC is more prevalent among Black and Hispanic women, they are less likely than non-Hispanic White women to be treated with immunotherapy. To date, no studies have explored the reasons underlying these disparities in the use of immunotherapy. This information is crucial for the development of targeted interventions that mitigate these disparities and accordingly address TNBC-related inequities among Black and Hispanic women. The aim of this study is to qualitatively identify medical oncologists' perspectives of barriers to immunotherapy access among patients with TNBC. METHODS: Using the Consolidated Framework for Implementation Research, between May 29, 2020 and September 23, 2022, we conducted semi-structured interviews until thematic saturation with 15 medical oncologists treating New York City metropolitan area patients with breast cancer. We used inductive content analysis to examine the interviews and identify themes corresponding to barriers to access to TNBC immunotherapy. RESULTS: The following five overarching themes emerged: (1) Mixed public perceptions about immunotherapy safety and efficacy, (2) Two-tier systems of care, (3) Timely initiation of immunotherapy, (4) Lack of dissemination of best practice guidelines leads to lack of adoption of standard of care, and (5) Side effect profile impacts use and continuation of immunotherapy. CONCLUSION: Large-scale studies quantifying the effect of these barriers on access to TNBC immunotherapy are needed to determine cause and inform effective interventions promoting equal access to all patients with TNBC.