Cancer science has evolved fast over the past decade. Better knowledge of basic cancer biology based on increased understanding of cell signalling and mechanism of disease, and greater access to genomics and other 'omics' data has led to the rapid development of precision medicine and the growth of immuno-therapeutics.
The challenge of innovation: Spoiled for choice?
New drugs with their new targets and new mechanisms of action, and their greater specificity, safety and efficacy, combined with earlier and more accurate diagnoses, have led to improvements in patient’s outcomes and survival. This has benefits not only for the patients and their families, but to society as a whole.
These innovative therapies add extra layers of complexity to diagnosing and treating cancer. For example, in lung cancer in the 1990s, classification was relatively simple. Over two-thirds of lung cancers were described as adenocarcinomas, and the remaining third were large cell or squamous cell lung cancers, and the treatment choices were limited and often empirically based on physician experience and patient responses. Just a quarter of a century later, around three-fifths of lung cancers can be defined by eight or more different mutations, and treatment choices are driven by cancer genetics and tumour cell receptors.
Access problems at the point of delivery
Treating patients with immunotherapeutics or other drugs targeted to their specific mutations improves an individual's outcomes, but comes with additional testing requirements and higher-cost drugs compared with standard chemotherapeutics. Other issues increasing the burden on the UK's already finite resources include:
- Increasing levels of cancer
- An aging population, with rising numbers of age- and lifestyle-related cancers
- Cancer survivors who are living longer, and so require support for longer periods
- Better informed patients
- People who are more willing to talk about 'the big C', and so are more likely to visit doctors
- An increasingly vocal and well-informed patient population
- Lack of access to diagnosis or treatment
- Primary care physicians reticent to refer patients, or simply not recognising cancer symptoms early enough
- Lack of access to drugs not endorsed by health technology assessment (HTA) bodies such as NICE
- Tightening budgets
- Expert cancer centres already at capacity
- Lack of reporting systems or integrated testing pathways, and insufficient communication between departments in hospitals and clinics, so delays in test results, or wrong test results requested
All of these can delay or prevent access to treatment for patients who become anxious, and where immediate initiation of the right treatment is crucial.
Finding a route to access
There are a number of possibilities for improving access to cancer treatment, and improving the patient experience. By working more closely with HTA bodies prior to approval, biopharma companies could increase the chance of recommendation and reimbursement. Once drugs are on the market, greater consideration needs to be given to outcome-based, risk-sharing schemes and other variable pricing approaches that could also help individual patients access drugs.
Improving clinical pathways could also make a significant difference, by ensuring that the best possible use is made of all resources. Take the story of one of the UK’s largest centralized gynaecological cancer clinics as an example: patients had to travel lengthy distances and wait for long periods to see clinicians who were under severe time pressures, for appointments that often overran. This left both patients and physicians unsatisfied.
Creating new treatment and referral pathways tailored to different cancer types and alternative patient follow-up approaches, including clinics led by clinical nurse specialists rather than doctors, and nurse-led telephone follow up, cut waiting and travel times. It made better use of the clinic's healthcare professionals and other resources, increased patient satisfaction ratings, and reduced the overall number of patient follow-up appointments.
By creating robust diagnostic and clinical pathways, and ensuring that reporting and recording systems are integrated, patients should be able to access the best care that the NHS can provide.
To learn more about improving innovative oncology treatment and access in the UK, you can view our on demand webinar recording
discussing this topic in more detail which includes myself and Dr Jason Lester, a Consultant Clinical Oncologist specializing in lung cancer and urological cancers at Velindre Cancer Centre here in the UK.
View the webinar recording here: http://bit.ly/1J3znh2
Download the case study highlighting how Quintiles improved patient pathways for a gynecological cancer clinic in the UK here: http://bit.ly/1HNhx5d