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An effective commercial model for cancer care

Patient-centric cancer care

Oncology commercial models

Each year, over 8 million new patients are diagnosed with cancer globally. Roughly 50% die of the disease.

Aligning the practice, delivery of and access to commercial cancer care is a challenge that is widely recognised but yet to be ingrained in traditional commercial paradigms. Here are five elements of a cancer care model that can infuse patient-centricity into the process of commercialising and marketing cancer drugs.

1. Improve patient access
Treatments for cancer are among the most expensive of all, regardless of disease. According to one estimate, 90% of recently approved cancer drugs cost $20,000 or more for a 12-week course of therapy. As a result, patient ability to receive appropriate cancer care is severely tempered by healthcare systems' tendencies to limit access to only those significantly impacted. Such tendencies are manifest in public and private payer restrictions on use, hospital formulary guidelines and physician propensity to follow such norms to ensure adequate reimbursement.

Severe limits on the use of cancer treatments currently in place hardly serve the interests of patient-centricity in cancer care. Oncologists are restricted to fewer options and patients and their caregivers often feel deprived of opportunities for receiving adequate treatment.

It behoves manufacturers and marketers of cancer treatments to work with payers to ease such restrictions and increase access to what are often perceived as life-extending treatments. Documenting retrospective use of a cancer product and its outcomes in tandem with direct and indirect costs incurred for such use as documented in reimbursement claims and electronic medical records (EMRs) can form the basis for analyses that establish its cost-effectiveness. Rather than a disproportionate focus on cost, establishing proof that the cost is well spent as seen through evidence of effective use is a convincing way to reduce restrictions on access. Data for such analyses is typically hard to compile, but recent partnerships between some cancer manufacturers and large pharmaceutical database providers, clinics and hospital chains are fast making it possible for large, integrated databases to be constructed for such purposes.

2. Improve patient-provider communications
Evidence exists that shows a strong association between poor patient-provider communications in cancer care and reduced patient satisfaction. Poor communication skill reduces the clinician's capacity to recognise psychiatric morbidity, increases patient anger toward healthcare professionals and makes them prone to litigation. Poor communication exerts significant burden upon the patient, the clinician and the service delivery system. Patients suffer heightened psychosocial distress, physicians undergo abnormal stress and burnout, and their healthcare system faces unnecessary treatment, administrative and hospitalisation costs associated with the use of needless, alternative treatment paths. 

Designing cancer product marketing programmes that emphasise the use of effective patient-provider communication can benefit cancer patients, their care providers and the manufacturers of cancer-treating medications. There is considerable social and business value in reducing avoidable uncertainty about information patients care about, identifying and explicating the worth of a course of treatment over available alternatives, justifying product and regimen choices and emphasising the importance of receiving continual patient and caregiver feedback.

Treatments for cancer are among the most expensive of all, regardless of disease

Emphasising patient-provider communication in cancer care reduces healthcare costs incurred by payers and other key accounts in the healthcare environment. For example, a Canadian study has demonstrated health plan billings reduction of over 20% at a two-year follow-up for those breast cancer patients who were offered a cognitive behavioural psychosocial group as compared to those who were not. Other studies have consistently proven the value of psychosocial support for cancer patients in offsetting medical costs and freeing up resources in terms of reduced office visits, medical procedures, diagnostic tests and hospital admissions. Such savings can conceivably be better allocated for the purchase and utilisation of proven, safe and effective medications in the oncology portfolios of leading biotechnology firms - often perceived to be expensive in the larger context of healthcare costs for cancer care.

3. Leverage patient-centric technology
The potential exists for leading cancer treatment manufacturers to adopt technology in building a viable patient-centred commercial model for their oncology businesses. There are two ways technology can be leveraged.

1. Allowing cancer patients easy access to their electronic medical records 
In an online survey of 8,411 cancer patients administered by LIVESTRONG (the Lance Armstrong Foundation) and the National Cancer Institute's Health Information National Trends Survey (HINTS), 80%-87% of respondents indicated it was very important for patients to be able to obtain their own medical records electronically, since it would improve their care. Respondents who were survivors (on or post-treatment) comprised the greatest proportion of those who believed this was important. In another survey, data indicated that approximately 75% of respondents wanted to engage in their care by having access to their medical records and by reading education materials

2. Developing and encouraging the use of cancer patient portals 
A demo patient engagement portal designed by Navigating Cancer includes a health tracking tool for patients to record psychosocial measures such as anxiety, energy and stress. Patients can easily share this information with their healthcare team, which allows clinic staff to be alerted sooner to potential issues so they may intervene when necessary, even if it's between appointments. Over time this data can be used to measure performance to see if patients are experiencing less psychosocial distress as practices implement initiatives to address specific issues. As patients identify specific issues, the portal has a robust library of expert resources that can be shared with them via private messages to help them cope. If a practice has outside providers who refer patients for palliative care or genetic counselling, this information can be stored in their clinic resource library, ready to send to patients and/or their caregivers when appropriate. When patients see outside specialists during treatment, the portal can be used to generate and send a treatment care summary. This can also be used when patients complete their cancer journey and transition back to their primary care physician.

Devising creative branded and unbranded tools that use technology to facilitate patient engagement and involvement specific to their condition, treatment and ongoing care in light of such demand can only better serve the needs of cancer patients and firms that provide medications for their care.

4. Invest in oncology medical homes
The medical home concept envisions patients receiving accessible, comprehensive, longitudinal and coordinated care in the context of their own families and community. Ostensibly meant to streamline patient care, introduce efficiencies and control costs, the medical home concept is clearly suited to the development of a patient-centred commercial model in oncology. Cancer product commercial strategists should actively explore opportunities to build and/or encourage investments in oncology medical homes as a way to deliver the benefits of new and emerging cancer treatments and cost-effective clinical pathways to patients in need.

A successful oncology medical home can: 

  • Allow a one-stop coordination of all aspects of patient cancer care related to evaluations and services beyond the medical oncology office
  • Proactively promote a seamless, interdisciplinary approach to cancer management
  • Illustrate the importance of patient education, engagement and compliance
  • Enable constant collaboration between clinical treatment and support teams
  • Enhance patient access to allow proactive management of symptoms via extended hours, telephone triage services and physicians on call, and
  • Increase autonomy and accountability for appropriate cancer care delivery with care providers, patients and their caregivers.
The oncology medical home concept is meant to streamline patient care, introduce efficiencies and control costs

One pilot scheme increased the number of cancer patients treated by 29% with the same number of physicians and a decrease in office staff, reduced ER admissions by 51% and reduced inpatient admissions by 68%, while also reducing the number of incoming clinic calls, resulting in a drop in ER referrals by more than 50% over a five-year period.

5. Expand care focus to include palliative care
Providing cancer care for the whole patient - rather than focusing on halting disease progression alone - is an important and under-recognised opportunity to better serve cancer patients. The treatment of cancer presents unique challenges in that requirements for patient care stretch far beyond relieving symptoms and achieving control or remission. Even when treatment is completed and no cancer remains, serious residual effects such as depression, anxiety and post-traumatic stress disorder impair patients' abilities to perform activities of daily living, limiting capacities to function as responsible family members and adversely impacting adherence to necessary medications.

Beyond the obvious, altruistic goal of better patient care, building a palliative care component into a patient-centric commercial model holds potential economic benefits. According to studies, adding palliative care consultation to the standard of care for patients avoids unnecessary tests or treatment and reduces costs associated with ICU and hospital stays. Cost savings in the study attributed to palliative care range from $1,696 to $4,908 per patient.

Large sample surveys of cancer survivors outline a host of physical (eg loss of energy, lack of concentration, impaired sexual functioning), emotional (eg fear of recurrence, sadness, depression) and practical (eg employment, debt, insurance, education) effects that linger well after treatment ends. The surveys further emphasise the fact that such physical, emotional or practical concerns receive little or no attention from their care providers.

A patient-centric commercial model that explicitly incorporates mechanisms to address the palliative care needs of cancer patients is likely to succeed both for its champions within the oncology commercial organisation at a manufacturer as well as with the customers of its products.

Article by
Sanjay K. Rao, Ph.D.

is vice president in the Life Sciences practice at CRA

26th May 2016

Article by
Sanjay K. Rao, Ph.D.

is vice president in the Life Sciences practice at CRA

26th May 2016

From: Sales

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