How to bring game-changing cancer care to all
Advances in diagnosis and treatment can give people with cancer more time and better quality of life. Our challenge now is to bring these innovations to every patient, every day, everywhere.
Science is having a moment. Rarely have we seen such public focus on epidemiology, testing, vaccine development, and the role of innovation in solving the certainly biggest acute health challenge of our time.
Of course, the COVID-19 pandemic is far from over, even if the ingenuity of researchers and physicians has begun to sketch out an exit strategy. But as we begin to refocus on the significant chronic issues that predated the crisis, including cancer, we find another science success story: game-changing advances in precision medicine with the power to redefine how we think about oncological diseases that impose a heavy burden on the lives of patients. This is also an opportunity to engage with patients, their physicians and society overall about what they want from medical innovation more broadly.
However, there are qualitative differences in the brief history of taming the pandemic and long-running efforts to advance cancer care. The obvious one is the timeframe: the battle against cancer has been a marathon rather than a sprint. Just as important and potentially linked to the more long-term timeframe are the policy, regulatory and reimbursement barriers to converting innovation in oncology into widely enjoyed benefits.
Quite rightly, politicians and health authorities moved heaven and earth to ensure COVID-19 tests were rapidly developed and deployed, while funding, approval and infrastructure were reimagined to minimise hurdles that might have slowed the progress of vaccine makers. Public and private actors worked shoulder to shoulder to solve a shared problem. For the spirit of partnership and common sense that prevailed at key moments over the past 15 months, we can all be grateful.
The fight against COVID-19 demonstrates what we can accomplish when all stakeholders work together with urgency. With the advances in science that are taking place, I strongly believe that same mindset is needed – and possible – to accelerate new treatments to cancer patients.
The barriers to better care have less to do with science than with the systems that connect patients with innovation. Indeed, recent years have been marked by great strides forward in oncology: innovative therapies that allow patients to live well in addition to extending survival rates, and genomically targeted treatments that require availability of genomic testing which promises to make treatment more precise than ever before.
Overcoming barriers – together
The latest innovations in cancer care are not reaching all patients for a variety of reasons, including Health Technology Assessment (HTA) procedures not keeping up with scientific developments, resulting in delays in reimbursement, and lack of awareness among physicians, patients, and other key stakeholders. The result is inequity: some patients in some countries have access to optimal treatment – while others do not. This translates into variations in outcomes which we can only tackle together.
One of the central reasons for these differences is the varying pace at which health systems have adapted to science and innovation. While science has delivered ground-breaking new tools, many of the systems we use to regulate and reimburse them were designed for another era.
Take certain childhood cancers which are driven by a rare genomic alteration. Precision medicine can deliver a paradigm shift in patient expectations and outcomes, turning a life-threatening condition into a chronic disease. Aiming for radical cure while preserving quality of life, new approaches to treatment can allow patients to live full and long lives.
Key to this approach is the genomic testing that helps to more precisely identify those patients most likely to benefit from a specific treatment. It is built on decades of research that has delivered a deeper understanding of the genomic basis of cancer.
Today, rather than treating all patients with non-targeted regimens, clinicians can prescribe medicines tailored to the specific oncogenic driver of the tumor. This opens the door to choosing the right drug for the right patient based on testing a tissue sample. However, without testing, there is no prospect of precision treatments.
Lack of access to comprehensive molecular testing is a major barrier to unlocking the potential of new therapies . Availability of testing and the access to it can vary widely, meaning those in areas with limited access to comprehensive testing are often locked out of optimal care. Physicians and professional societies are already taking the lead in connecting the right patients with the right diagnostics so that those patients get the right treatment. In concert with this, I am confident that clear reimbursement frameworks will play an important part in tackling global disparities in access to precision medicine.
Empowered patients
Even where the newest testing methods and treatments are technically available, patients and caregivers are not always aware of the benefits of these new approaches. We must address this together. The task of fostering health literacy and empowering patients to make informed treatment decisions falls to all who share an interest in advancing cancer care.
Take prostate cancer, for example, which is the second most common type of cancer in men worldwide. Patients with non-metastatic castration-resistant prostate cancer can reasonably expect to thrive rather than simply survive. Their care can seek to maintain quality of life in ways that were either not possible in the past or simply not prioritized. Today’s patient is focused not only on survival rates, but also on quality of life – on urinary and sexual function, for example. They are focusing on living and living well.
In guiding patients to a thorough understanding of their condition, physicians can equip their patient to better express their individual preferences. This is the path to shared decision-making and, ultimately, greater patient satisfaction. Here, the burden of side effects that can arise from some surgical and medical interventions comes to the fore.
The informed views of patients should be a feature not only in physician-patient conversations, but in wider decision-making processes that can profoundly affect cancer outcomes. For example, access to therapies and to NGS may be determined by HTA reviews that could take account of patient perspectives. If we are serious about offering patient-centered care, it is vital that patients have a seat at the table.
Some regulators and HTA bodies are taking steps to bring the patient voice into the conversation – a practice which needs to be accelerate and become universal. Clinical and economic factors are important considerations, but so too are patient preferences. While no two patients are the same, it remains important to hear how a typical patient feels about risks, benefits and the value of improved quality of life.
To make this work, authorities charged with making key decisions on the approval and reimbursement of innovative health technologies should develop formal structures for patient engagement, if they have not already done so. On the other side of the equation, capacity building among the patient and caregiver community is needed to ensure patient experts are equipped to shape decisions that affect them.
Physicians can play a key role in engaging all of their patients in these complex conversations, providing information and helping to identify those who have potential to work with regulators, HTA bodies and others. Individual physicians and scientific societies should also continue to consider key issues regarding quality of life and product safety profiles when feeding into assessments.
Conclusion
Removing the barriers to better cancer care is a significant challenge. However, our response to the pandemic demonstrates what we can accomplish if science and policy go hand in hand. It offers a classic example of how significant improvements in the outcomes that matter to patients can be delivered in the near term, if we build partnerships to quickly capitalize on the rapid innovation delivered by decades of science.
For our team at Bayer, highlighting these challenges demonstrates our commitment beyond research and development. The growing appreciation of multi-disciplinary stakeholder approaches across the cancer community will help turn innovation into patient benefit. While it may be complex, progress is tantalizingly close. With a concerted effort, I believe our combined efforts can change lives around the world.
