Purpose: Trimodal therapy (TMT) is the standard treatment for patients with nonmetastatic inflammatory breast cancer (IBC). TMT consists of neoadjuvant systemic therapy, modified radical mastectomy (MRM), and postmastectomy radiation therapy. Although broadly considered the best approach for IBC, in the United States, only a third of patients receive TMT. The rate is unknown in low- and middle-income countries (LMICs).
Methods: A questionnaire in English and Spanish was constructed to assess the awareness, knowledge, and treatment patterns of IBC among providers in LMICs. It was emailed to the ONCOLLEGE global oncology collaborative group (a network of cancer care providers practicing in LMICs) and through other oncology network providers in LMICs, enhancing the sample size through a snowball sampling approach.
Results: Between June and December of 2023, 145 participants completed the questionnaire, of whom 112 respondents were from 36 LMICs. All the providers reported that standard chemotherapy and MRM were available in their practice; 99.5% responded that radiation therapy was available. A total of 74.1% appropriately reported that IBC is a clinical diagnosis, although 51.8% stated that pathologic evidence of lymphatic emboli was required for IBC diagnosis. A third of the providers responded that >90% of their patients undergo all three parts of TMT.
Conclusion: Many patients with IBC in LMICs are not receiving TMT. Barriers to diagnosis and treatment were at least partially related to limited providers' comfort level and knowledge, suggesting that educational approaches can be impact-oriented interventions. On the basis of our findings, we created educational material, which will be translated into various languages and disseminated broadly to improve providers' awareness and knowledge of IBC.