International Journal of Community Medicine and Public Health | January 2021 | Vol 8 | Issue 1 Page 279 International Journal of Community Medicine and Public Health Singh P et al. Int J Community Med Public Health. 2021 Jan;8(1):279-285 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040 Original Research Article Socioeconomic factors affecting trastuzumab usage in patients with breast cancer in a resource constrained setting in North India Pragya Singh 1 , Rajesh Pasricha 1 *, Laxman Pandey 1 , Deepa Joseph 1 , Ajas Ibrahim 1 , Ajeet S. Bhadoria 2 , Manoj Gupta 1 , Bina Ravi 3 INTRODUCTION Breast cancer (BC) is the most frequent malignancy in women worldwide. Its incidence continues to soar in low- and middle-income countries. 1 Based on the cancer registry data, BC is the most prevalent cancer among women in Indian cities. 2 Though BC related mortality is showing a declining trend in developed countries, the survival rates of the patients with BC residing in developing countries continues to remain low. This paradox may be attributed to the paucity of health care facilities and financial constraints to accessing the newer cancer therapies. 3,4 Trastuzumab is currently the standard of care in patients with Her-2 (Human epidermal growth factor receptor-2) positive BC. It is a recombinant humanized monoclonal antibody against Her-2 receptor and is approved for both non-metastatic (either in the neoadjuvant or adjuvant setting) and metastatic Her-2 positive BC. 5 Considering the plethora of data supporting the role of trastuzumab in Her-2 positive BC, the World Health Organization ABSTRACT Background: Trastuzumab is now the standard of care in patients with Her-2 positive breast cancer. Despite its availability, high cost of treatment of trastuzumab makes it out of reach for many patients. This study analyses access to trastuzumab and identified potential barriers to its use in a large tertiary care hospital in northern India. Methods: This is a cross- sectional study of all the Her-2 positive breast cancer patients diagnosed and treated in our institute in 2018. These patients were investigated to look into various socio-economic factors for acceptance or non- acceptance of trastuzumab by using a predesigned questionnaire. Chi square test or Fishers exact test was applied. Results: Out of 310 diagnosed cases of carcinoma breast 52 (16%) patients were Her-2 positive. The majority of the trastuzumab recipients belonged to upper/middle socioeconomic status as compared to the non-recipient group (75% vs. 34.4%, P=0.004). Most of the receiver were well-educated (75% vs. 28.2%, P= 0.0009) and belonged to the high- income strata (55% vs. 37.5%, P= 0.22). It was found that the treatment of maximum (84.6%) Her-2 positive patients were met by out- of- pocket expenditure (OOPE) and 71.9% of the patients cited financial issues as the main cause of not taking the drug. Conclusions: The patient’s socioeconomic class and their education level significantly influenced the usage of the drug. Improving patient education as well as the implementation of the government health scheme can improve the availability and usage of this drug. Keywords: India, Socioeconomic, Trastuzumab 1 Department of Radiation Oncology, 2 Department of Commnity & Family Medicine, 3 Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India Received: 05 October 2020 Accepted: 12 November 2020 *Correspondence: Dr. Rajesh Pasricha, E-mail: drrajesh_pasricha@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20205708