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InnomarLive 2023: Part Three

By Innomar Strategies

Caring for Canadian oncology patients – the physician’s perspective

Dr. Gerald Batist, Director, Dept. of Oncology, Sir Mortimer B. Davis-Jewish General Hospital; Director, McGill University Centre for Translational Research in Cancer; Professor, Department of Oncology, McGill University

Following the lively interactive panel discussion, Dr. Gerald Batist took to the stage to deliver insights on the physician’s perspective on delivering quality care to oncology patients. Covid-19 has certainly been a disruptor in the treatment approach for cancer patients. While many challenges arose during the pandemic, what we face today may be more alarming wherein there are larger numbers of patients presenting with more advanced disease than before, thwarted by a shortage of healthcare professionals – what Dr. Batist referred to as the “post-covid cancer tsunami.” However, today’s technological advances and innovations are bringing real promise in managing cancer care with precision medicine. More effective and targeted treatments can lower overall treatment costs by optimizing patient-treatment matching, thereby avoiding predictably ineffective, toxic, and costly treatments while improving overall clinical outcomes. In just the past few years, there has been a surge of New Active Substance approvals in oncology, most of which are targeted therapies. In oncology, innovative approaches like Exactis Innovation and the Oncology Interactive Navigator can improve personalized treatments and successful person-centered care. 

Gaining access to diagnosis, treatment, and care – the patient’s perspective

Claire Edmonds, Registered Psychotherapist, affiliated with Wellspring 

In her own compelling patient narrative, entitled ‘Blind Sided’, Claire portrayed the deep anguish, thoughts, feelings, and determination she experienced dealing with ocular melanoma as she walked us through her journey of challenges and successes as a cancer patient, and an allied health care professional. 

In her research, Claire has looked at a lot of Kaplan-Meier Curves assessing survival of patients or groups, trying to understand good prognostic indicators. Now, she sees these curves with the data points as people, people trying hard to survive, trying hard to live…some of them will make it, some of them won’t. And so, in your work, when you look at these datapoints, know that each datapoint is a patient, and that each patient has a story, and there are possibilities for skillful interactions and possibilities for unskillful interactions.

With this ‘tsunami’ of patients entering hospitals and cancer care, there has been tremendous stress on hospitals, staff, and psycho-social services. To relieve this stress, hospitals are looking to download the psycho-social needs onto community cancer centers, such as Wellspring and other resources. 
Wellspring is a cancer support organization that provides a variety of programs and services to people affected by cancer, including patients, survivors, and caregivers. Patient expression through medical narratives (such as Claire’s ‘Blind Sided’ narrative) is one of Wellspring’s support offerings. They offer emotional, psychological, and practical support, such as counseling, educational workshops, and fitness classes.
Nurse and businessman

The role of the Oncology Drug Access Navigator

Nurse and businessman

Shirley Chen, Medication Reimbursement Specialist, Princess Margaret Cancer Centre

Drug Access Navigators (DANs) are patient advocates who are subject matter experts on medication coverage, eligibility criteria and resources, helping patients explore and understand their drug coverage and funding, and facilitating medication access in a timely manner. Challenges faced by DANs include navigating through a complex medication coverage system; access and funding gaps for new medicines which are not listed; long turnaround times; high out of pocket costs for patients; the nuances around PPNs (Preferred Provider Networks); private clinics that present safety concerns; treatment delays and inconveniences. 

In addition, DANs have a heavy workload, with limited resources. They need to keep up with emerging changes in the complex funding landscape, as well as to frequently deliver bad news to patients. Although pharmaceutical companies may provide financial support, in many cases, patients are still out of pocket for healthcare expenses. Patient Support Programs offer helpful general access solutions by providing generous financial support, compassionate and bridging support, nursing care, home injection and other home care services. It would be helpful if industry would engage the DANs in the early planning stages of programs, as they can offer valuable insights.

Nurse and businessman

Hope and Challenges for Cell and Gene Therapies, Turning today’s challenges into opportunities for patient care and access

Dale Hanna, Director, Cell and Gene Therapy Solutions, AmerisourceBergen

Cell and Gene Therapy Solutions is a new and unique group within the AmerisourceBergen organization. They sit at the enterprise level looking globally across all business units to understand the needs of all stakeholders. This enables them to help solve the hurdles they face related to the complexities of cell and gene therapies.

Dale highlighted three hopeful promises from the patient’s perspective: 1) Scientific innovations are leading to greater health outcomes for the sickest patients; 2) inclusion of patient and caregiver voices is coming to the forefront of development and commercialization efforts; 3) Biopharma is pushing the health industry into the 21st century across many different workstreams and perspectives.

There are many challenges within “the reality of the cell and gene complexity experience.” From a manufacturer’s perspective, the key challenges are that in an increasingly competitive and complex environment, unlocking commercial success requires speed to market. They face a war on talent, complexity of process, and miscues during clinical operations for commercial handoff. To successfully scale up volume, an integrated strategy involving service providers is essential. Providers also face challenges when it comes to securing access to treatments for their patients, and not to mention the funding and reimbursement struggles from a financial perspective.

RWE continues to be significant, as it holds the promise of representing real-world practice and behaviors of patients throughout their treatment experience. A patient-driven outcome that is aligned with their daily lives should be included.
Patient support services are often in place to address unmet needs beyond the clinical setting. Designing services around the patient and caregiver to address pre- and post - treatment needs will improve both health and commercial outcomes.

Get ahead of many unknowns and design flexibility in your access pathways when coming to market. You can never partner early enough with industry, regulators, patients, caregivers, and providers to ensure your product has optimal reach and success.

Real-World Evidence: Moving from Engagement to Implementation

Brent Fraser, on behalf of Nicole Mittman, Vice-President, Scientific Evidence, Methodologies, and Resources 

Brent provided an update on the Real-World Evidence Guidance initiative and its next steps. Stakeholder consultations for the guidance were completed on January 6, 2023. Based on the HTAi’s Global Policy Forum after 3 rounds, key principles that surfaced were Transparency, Impartiality, and Inclusivity, with Transparency being at the top of all three rounds. 

The goal is to develop, in collaboration with Health Canada, a guidance document for reporting RWE as a supplement to submissions. This will improve reporting standards, the quality of submitted data and better inform decision making. Fifty-four different stakeholders provided comments, constructing some general themes and learnings. CADTH and Health Canada will respond to the comments by organizing the themes, providing a response to the comments and then determine whether the Guidance Document will be updated. The RWE Guidance Document will be launched at the CADTH Symposium on May 16th to 18th, 2023.

It is particularly important to look at the evidence, and the quality of the evidence. RWE will not lead to automatic approvals but will help fill the gaps of uncertainty. It is necessary to determine what are the appropriate outcomes that need to be measured before we can discuss Outcomes Based Agreements (OBAs). Pharmaceutical manufacturers can prepare by consulting with CADTH and the right stakeholders, patient groups, to understand what the right outcomes are, to ensure the best data comes forward. 
Man sitting at a computer

Role of Patient Support Programs (PSPs) in enhancing the oncology patient’s journey

Man sitting at a computer
Sandra Anderson, SVP International Commercialization, AmerisourceBergen 

PSPs for oncology are different from specialty medications, as oncology patients’ needs are different. Quality of life and personal support for these patients, and caregivers, are paramount. As new cancer therapies and new treatment paradigms surge, there is a further shift in the oncology patient journey and payer mindset. 
The oncology PSP is one component of an individual’s treatment journey. It requires simplified and compassionate enrollment, reimbursement and financial support, quality administration coordination, caring support, education, and proper adherence to the program. Partnerships with advocacy groups for peer-to-peer live, and virtual, mix of support for oncology patients can provide a seamless patient experience. Patient support programs are designed to meet the emotional, social, practical, and restorative needs of cancer patients, with access to bilingual peer support from volunteers that assists patients/caregivers with the tools to help manage their disease and reduce burdens, allowing them to focus on their health and well-being. 

Data collected through PSPs can provide reliable and credible data sources for generating real world evidence which can play a significant role in evaluating new oncology medicines.
Man sitting at a computer

Key Learnings and takeaways

Key messages from this exchange of information by regulatory, HTAs, payers, HCPs, manufacturers, and patient stakeholders focused on how HTA systems (payers, evaluators, HCPs, and industry) can evolve together so that Canadian patients may benefit from scientific breakthroughs. Involving the voices of patients and all stakeholders earlier in the process is necessary in bringing these innovative technologies into Canada and making them accessible. This must be done at the ‘speed of cancer’. Applying learnings from regulatory collaborative initiatives such as ORBIS and ACCESS in the HTA system can help achieve improvements. While the expanding use of RWE to monitor patient outcomes may be useful to overcome the challenges of assessing the long-term impact of innovative technologies, data must be robust and of high-quality. RWE can also offer solutions for OBAs. The importance of addressing the issue of companion diagnostics was discussed, particularly in the context of cancer care. The need for a comprehensive plan and proactive approach to this issue was emphasized, as well as the importance of redefining cancer as a collection of uncommon and rare sub-groups looking at specific molecular profiles. Drug Access Navigators (DANs) help patients navigate through the complex medication coverage system and can provide valuable insights during the early development phase of access programs. In addition, Patient Support Programs offer general access solutions by providing financial support, nursing care, home injection and other home care services. Finally, there is an urgent call for more collaboration among stakeholders and more engagement with clinical experts to address the challenges facing the HTA system.


At the InnomarLive 2023 Conference, distinguished experts from regulatory bodies, health technology assessment organizations, payers, healthcare providers, manufacturers, and patient advocates convened to address pertinent issues within the current oncology landscape in Canada. The speakers acknowledged that all stakeholders encounter comparable difficulties in keeping pace with the rapid proliferation of innovative technologies. Thus, it is crucial for them to collaborate and devise comprehensive strategies to meet the growing demand for efficient and prompt patient access to innovative treatments and technologies.

InnomarLive 2023: Part One 
Emerging Trends in the oncology ecosystem. Turning today’s challenges into opportunities for patient care and access
Read more

InnomarLive 2023: Part Two
Panel Discussion Summary: “How can we turn these challenges into opportunities which will benefit patient care and access?”
Read more

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