Earlier this year, I had the privilege of convening stakeholders from different parts of the oncology world to discuss precision medicine. The goal was to better understand issues, challenges and opportunities in the oncology market from the perspective of its key stakeholders. A mix of 45 clinicians and executives from various types of organizations took part in this session, including payers, academic medical centers, oncology clinics, National Cancer Institute Designated Cancer Centers, and pharmaceutical, biotech, medical device, diagnostic and data companies.
For years, the industry has been clamoring for solutions around improving patient outcomes through evidence-based care and precision medicine. The only path forward to addressing this need is through an open dialogue with the various players involved. Coming out of our session, we boiled down our key takeaways into nine buckets.
Clinical trial design needs to be informed by stakeholders early in the process. Research needs to extend beyond genetic mutations and take a more holistic view of the patient’s full profile and environmental factors.
Stakeholders articulated an inability to extract data from its primary source to share with others who would benefit from it. There is a thirst for information on the successes and failures of on-label and off-label (e.g., using a therapy for a condition other than what it has been officially indicated for) use of targeted therapies.
We all realized that an aggregator of data that can be integrated into the clinical practice for oncologists is necessary for fostering better care. With an increasing amount of data available faster than ever before, providers are challenged with constantly staying up to date with the latest information. The electronic health records (EHRs) that have become ubiquitous were described as part of the problem – not the solution – with respect to data management and use.
Standardization of Treatment
The lack of data standardization is a universal source of consternation for all stakeholders. There is a clear need to standardize clinical data, measures and practices so that oncologists are better informed on how to treat their patients.
Guidelines and Pathways
The standards of care that are already in place need to be developed into more formal guidelines and pathways that are relevant, practical and derived from real-world evidence. There need to be reliable and consistent strategies to drive and implement this evidence-based care.
There is too much variation in what are considered best practices when it comes to the “who,” “what,” “when,” “where” and “why” of testing. Everyone is searching for clarity. At this point, practices vary widely when it comes to timing and, interestingly, between primary cancer centers and their affiliated community oncology practices.
Organizational Constraints for Providers
The provider stakeholders pointed out that they have internal organizational constraints associated with resources — including staffing shortages and high turnover in pathology, pharmacy and nursing — along with the fiscal challenges of high medication and procedure costs and falling reimbursement.
Need for Access to Resources
There is a need to revisit the resources available to all parties, such as pharmaceutical manufacturers’ reimbursement support programs, care coordination programs and others. These could be leveraged as a means of addressing staffing and cost constraints and potentially eliminate some communication barriers.
Focus on System-Level Integration
All stakeholders are looking for solutions that will enable them to integrate on an enterprise level. Health systems need to track and manage patients across the continuum of care – from inpatient (e.g., hospital) to outpatient (e.g., doctor’s office) settings. This requires having the proper technology solutions in place to allow visibility across the entire patient journey.
Additionally, communication between providers is often lacking. Working together collaboratively will allow the organizations to provide high-quality, evidence-based care with greater coordination throughout the entire process. At the end of the day, the seamless integration of technology and communication best serves patients as they receive care from infusion clinics, doctor’s offices, hospitals or any other sites of care.
Across all stakeholder groups – including patients – there is a need for education on precision medicine and testing to ensure that patients receive the right care (e.g., lab tests, therapies, etc.) at the appropriate point in their treatment plan.
This session we hosted is proof that interdisciplinary collaborations can work when it comes to navigating complex issues. It supports the notion that advancements in this space, including data aggregation, clinical decision support tools, order sets, clinical program development and industry-derived oncology guidelines and pathways are critical to realizing the full potential of precision medicine in oncology.
When it comes to cancer care, innovation can’t happen in a vacuum. There are too many moving parts and considerations to work in silos.