Clinician's Role in Breast Cancer Care, Access: Lakshminarayanan Nandagopal, MD

Access to breast cancer care for patients can often cause financial burdens. Lakshminarayanan Nandagopal, MD, a physician of medical oncology at Hematology Oncology Associates of Fredericksburg, discussed the current state of breast cancer care innovations and spoke with The American Journal of Managed Care® about common barriers patients face when navigating treatment costs and what health care providers, payers, and policy makers can do to help alleviate some of these burdens.

Nandagopal recently spoke at the Institute for Value-Based Medicine® event in Richmond, Virginia, on September 8, where he discussed current and progressive real-world strategies and policy considerations to improve financial toxicity, equitable access to advanced diagnostics, targeted therapies, and supportive care innovations in breast cancer. Nandagopal specializes in cancers of the reproductive system, urinary system, and precision medicine, where he is involved with a high-level of customization for treatments and care

Financial toxicity varies in the negative effects that medical costs can sometimes have on patients. Patients who experience high rates of financial toxicity have been associated with decreased quality of life and lower adherence to treatment. Often patients with breast cancer who are younger, in marginalized racial/ethnic groups, and who have metastatic disease disproportionately experience financial toxicity. Many patients with breast cancer reported that their physicians don’t discuss financial implications of the treatment despite their expressed desire for said conversations.¹

“Our insurance system is still incredibly complex. Actually, making sure the patients are aware of what those different options mean and making sure that they're aware of what the copay could be in situations like this so that they make the right choices when they pick up an insurance plan, I think, could be helpful,” Nandagopal said.

Nandagopal also believes that providing “backup” resources for patients that don’t have access to financial resources and making them available for women in communities that would benefit from it is important for getting them the care they need.

Furthermore, Nandagopal said it is imperative for health care providers, clinicians, and physicians to show up to where it matters to encourage and inform policy makers of the life-changing treatments available and why policy implementation for coverage is crucial for improving patients with breast cancer outcomes and quality of life.

“I think that's where the government and policy makers also need to step in and try to make sure that we have some resources available to patients who need them,” he said.

Financial toxicity does not only encompass the costs of treatment but also time commitments, transportation costs and difficulties, and childcare.

“Sometimes the insurance picks that up—they're able to cover transport costs—but having more robust community supports for that [is needed], and that comes from community investment too,” he said. “I think all of these should be resources available to patients so that they don't feel left out or like they are having to fight things on their own. But again, I think it comes from involving policy makers, community partners [and] other organizations in the community that work with patients.”

On the other hand, Nandagopal also encourages younger oncologists and clinicians-in-training to take advantage of the progressive tools used today, so many of which are effective “with a high chance of cure.” Understanding the fundamentals of cases helps to make better decisions for patients’ treatments.

“I think that's the skill that every oncologist needs. You cannot rely on just UpToDate telling you what to do at the bedside, unless you have that basic knowledge of what this trial is trying to accomplish,” he said.

References

1. Lee K, Enju A, Booth C, MacDonald M, Chino F. Financial toxicity and breast cancer: why does it matter, who is at risk, and how do we intervene? Am Soc Clin Oncol Educ Book. 45, e473450 (2025). doi:10.1200/EDBK-25-473450