152P Inflammatory breast cancer (IBC) in low and middle-income countries (LMICs): Knowledge, and practice patterns - The BRIDGES study

The standard treatment for patients with non-metastatic IBC is trimodal therapy (TMT), which includes neoadjuvant chemotherapy (NAC), modified radical mastectomy (MRM), and post-mastectomy radiation therapy (PMRT). In the US, 29% of patients receive TMT. The management of patients with IBC in LMICs is unknown. A questionnaire in English and Spanish was constructed to assess the IBC knowledge and practice of providers in LMICs. It was emailed to the ONCOLLEGE group and other oncology providers in LMICs using snowball sampling. 574 providers were emailed the survey. Between June and December of 2023, 145 participants completed the questionnaire, of which 114 from 36 LMICs were included in this analysis (described in the table). The response rate was 25%. 47.2% and 26.8% were very comfortable in treating BC, and IBC, respectively. 74.1% noted that IBC is a clinical diagnosis, though 51.8% stated that pathologic evidence of lymphatic emboli was required for IBC diagnosis. All the providers reported that standard chemotherapy and MRM were available in their practice; 4.5% responded that radiation therapy was not available. 30.7% of the providers responded that more than 90% of their patients undergo all three parts of TMT. 76% reported they would offer TMT in a case-based question in this IBC-specific questionnaire. Patient-level data to confirm these numbers are unavailable.Table: 152Pn=114 – n (%)CountriesEast Asia and the PacificEurope and Central AsiaLatin America and the CaribbeanMiddle East and North AfricaSouth AsiaSub-Saharan Africa7 (6.1)6 (5.3)38 (33.3) 30 (26.3)24 (21)9 (7.9)GroupsLow incomeLower-Middle incomeUpper-Middle incomeUnclassifiable4 (3.5)47 (41.2)47 (41.2)16 (14)Provider Medical oncologySurgical oncologyRadiation oncologyGynecologist Other82 (71.9)17 (14.9)19 (16.8)2 (1.8)3 (2.6)PracticeGeneral oncologistBreast cancer Breast cancer and 1-2 other cancersOther82 (71.9)13 (11.6)16 (14)1 (0.9)Tumor boardYes77 (68.8) Open table in a new tab Many patients with IBC in LMICs are not receiving TMT, similar to what has been reported in the US. Most participants had access to TMT, and barriers to diagnosis and treatment were primarily related to lower provider comfort and knowledge; cost and logistical barriers may also have an impact. The next steps will be to create educational material in various languages to improve the knowledge and comfort levels of providers in LMICs as well as in high-income countries.