World Cancer Day 2023 – closing the gaps in cancer care to give more patients access to life-changing medicines

green and yellow painting

The following article by Claire Gillis, CEO of VMLY&R Health was originally published by PMLive. Click here to read the article on PMLive’s website.

Great Expectations – exploring the counterpoint between advances in oncology and the challenges of ensuring life-changing medicines reach patients

It might be 2023 but the current cancer landscape feels almost Dickensian. It’s the best of times, and it’s the worst of times.

Remarkable advances in oncology technologies continue to provide hope that we may one day manage all cancers as chronic diseases. However, while science keeps giving us ‘Great Expectations’, the reality on the ground is markedly different. For all the amazing progress we’re making, gaps in cancer care – all over the world – are significantly holding us back.

Global disparities in access to cancer services – from prevention, diagnosis, treatment and management, all the way through to end-of-life care – silently shape who gets to benefit from breakthrough innovations. The biggest gaps are often found in disadvantaged populations with the least timely access to cancer care. Some of those, remarkably, are right on our doorstep. Others, inevitably, are hidden further afield. With smarter thinking – and better communication – we can help close them all.

Hard times
According to WHO, fewer than 15% of low-income countries provide comprehensive treatment services for cancer through their public health systems. The result? 70% of all cancer deaths in 2020 were in low- and middle-income countries.

But disparities in cancer aren’t just geographical and socio-economic, they span race and gender too. In the US for example, five-year survival for cervical cancer is lower in black women (58%) than it is in white women (71%), while people living in segregated African-American communities have higher odds of later-stage diagnoses of breast and lung cancers. The implications are stark. Late diagnosis typically leads to poorer prognosis, fewer treatment options and lower survival rates.  A four-week delay in treatment can increase mortality by as much as 13% in solid cancers, with further increases every extra day.

These trends – exacerbated by unprecedented wait times for cancer services in the aftermath of COVID – underline why inequity of access to cancer care, in all its forms, remains one of our biggest challenges. It’s a sobering – even Dickensian – message that, in 2023, who you are or where you live can still mean the difference between life and death. In a world of rapid scientific advancement, cancer care must not be determined by area and luck. We must close the care gap. The question is: how?

Life-changing science
First, let’s look how far we’ve come and what’s at stake. Arguably, there’s no better example of progress than recent advances in metastatic breast cancer (MBC) – an incurable disease responsible for most breast cancer-related deaths. On average, women with MBC survive just three years from diagnosis, with just 29% surviving up to five years. Last year, data from two separate studies provided renewed hope for MBC patients:

  • Phase 3 data from the DESTINY-Breast04 study showed Enhertu reduced the risk of disease progression or death by 50% versus chemotherapy in patients with HER2-low MBC with HR-positive and HR-negative disease. It also showed a 36% reduction in the risk of death compared to chemotherapy in patients with HR-positive disease.
  • Phase 3 data from the TROPiCS-02 study showed Trodelvy improved progression-free survival by 34% in heavily pre-treated HR+/HER2- MBC patients. After one year, three times as many patients were progression-free compared to physicians’ choice of chemotherapy, with patient-reported outcomes data also indicating Trodelvy improves quality of life

These interventions, which target large and specific subsets of patients previously treated suboptimally, constitute life-changing science. And there’s plenty more of it in a golden era for oncology innovation.

The past 12 months have seen a glut of game-changing breakthroughs in the fight against cancer. For example, studies suggest that neoadjuvant immuno-oncology (I-O) could become the standard of care for patients with hard-to-treat cancers and metastatic disease, leading to more cures and less surgery. In colorectal cancer, neoadjuvant I-O resulted in major pathologic responses in 95% of patients, and it led to improved event-free survival in patients with stage III-IV melanoma. It’s advancing in lung and breast cancer too.

Elsewhere, new modalities of immunotherapy are being used to signal the immune system to challenge haematological tumours, with positive outcomes in acute myeloid leukaemia and potential application in other disease states. In mantle cell lymphoma – where patients often require unpleasant stem cell transplantation procedures – TKI growth-blocker technology is increasing failure-free survival rates in younger patients. Finally, in multiple myeloma, a first-in-class bispecific T-cell engager antibody – talquetamab – is showing promise in heavily pre-treated patients. Data shows that 70% of patients previously treated with other lines of therapy – without response – responded to talquetamab, with their cancer diminishing significantly or entirely.

These advances, and many more like them, can transform lives. However, breakthrough innovations only make a difference if they reach patients in clinical practice. Research consistently shows that a sizeable proportion of European citizens, just like those in low- and middle-income countries, have inadequate access to cancer therapies that have demonstrated meaningful therapeutic benefits.

An IHE report published by the European Society for Medical Oncology in 2020 highlighted wide disparities in access to new cancer medicines, with patients in poorer countries significantly missing out. The biggest gaps were in immuno-oncology medicines where uptake in poorer countries was 10-20% of that observed in wealthier nations. With the analysis carried out pre-COVID-19, those disparities are unlikely to have improved. With cancer forecast to become the leading cause of death in Europe by 2035, the need to improve access to all components of cancer care is urgent.

Communications and transformation
In January, a new White Paper, commissioned by the EFPIA, set out a blueprint for redesigning cancer care in Europe. The authors make these recommendations to transform care: long-term cancer care policies and funding programmes, robust data on patient needs and experiences, long-term focus on value, and best practice sharing through innovation networks. These recommendations demand greater collaboration across the entire cancer community, including patients. It’s the only way we’ll win.

The secret ingredient, commonly overlooked in transformation road maps but always essential in connecting the dots, is creative communications. The most impactful communications are rooted in deep patient insight, captured through early and sustained engagement that highlights unmet needs, lived experiences and the things that constitute value to patients. These interactions inform everything that matters – from drug discovery targets and clinical trial design to value strategy, stakeholder communications, experience design, and patient education and support. At each touch point there’s a communication need. By liberating the patient voice and allowing it to influence every component of end-to-end strategy, we can strengthen those communications and uncover meaningful ideas that close the gaps in cancer care and empower everyone to demand better outcomes.

A good example of this is Gilead’s ‘Paintings of Hope’ campaign for metastatic triple-negative breast cancer (mTNBC). The campaign from our teams in Spain, designed to show society that there’s still plenty of life in patients with mTNBC, tackled one of the biggest challenges in cancer care: achieving faster patient access to breakthrough treatments. While in Europe, approval for priority anticancer drugs takes 180 days, in Spain it’s delayed up to 500 days. In mTNBC, where the majority of patients die within a year, every day counts.

Paintings of Hope shows real patients describing the realities of life with mTNBC; their emotions, their experiences, their hopes. Through a combination of voice analytics, AI and robotics, their feelings are translated into art as they speak – creating nine canvasses that journey through the three most important emotional stages of mTNBC. They are Paintings of Hope. The collection has been exhibited across Europe to raise awareness of the unmet needs of mTNBC patients. Significantly, the campaign made it to the Spanish Parliament, helping to prompt a legislative change that expedites funding for metastatic cancer drugs within 180 days.

It's a powerful example of how creative comms – rooted in an authentic patient voice – can help to eliminate unwarranted variation in cancer care.

Hope for the future
Fundamentally, despite huge advances in oncology innovation, inequities in cancer will never be solved by medicines alone. A cancer journey is like a complex novel, with a storyline that involves an ensemble of characters across a variety of settings, encountering barriers and plot twists every step of the way. Communications – good, bad and indifferent – feature on every page. If we can get them right, we can start to close the gaps in cancer care. And, in the words of Charles Dickens, find the ‘spring of hope’ from the ‘winter of despair’.

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