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Transcription:

Lilian: Hello, and welcome to another episode of the Avalere Health Essential Voice Disease Education Series. My name is Lilian Buch, and I’m an Associate Principal here at Avalere on the Market Access team. I am joined today by Ted Okon, Executive Director of the Community Oncology Alliance, better known as COA, and Dr. Debra Patt, Executive Vice President of Texas Oncology and a COA board member.

In today’s episode, we will discuss the state of oncology care from a provider and patient perspective as we continue to look at the impact of COVID-19 and prepare for post-pandemic realities. As many of our listeners know, Avalere and COA have collaborated for months on a project that continually assesses the impact of COVID-19 on oncology care.

We also just saw a report from the CDC that states cancer is still the number 2 leading cause of death, even in 2020. In recent years, the number of deaths had plateaued just short of 600,000 per year, but given the care disruptions and the delays that were observed in 2020 and into 2021, we do expect that some of the progress in cancer prevention and treatment might be rolled back.

So, we’ll start with Dr. Patt. What is your direct experience in the field and what are you most concerned about?

Dr. Patt: Thank you, Lilian. Thanks so much for having me. I greatly appreciate the partnership between COA and Avalere. It has been incredibly fruitful.

So, what I’m seeing in the clinic is much of what I expect to see from the data that we looked at together. As we appreciate a decrease in utilization of cancer screening, cancer biopsies, new cancer diagnosis, and treatment among Medicare beneficiaries, I’m seeing delayed presentations of cancer in my clinic.

I will say that it was not until recently that I’ve been appreciating them because they’re just now starting to come in. Yesterday in clinic, I had 6 new breast cancer patients, and 5 of them had advanced breast cancer. In the United States, we diagnose around 265,000 new breast cancers every year. About 5% of those patients present with metastatic disease.

So, seeing such a high proportion of patients with advanced cancer is unusual and I think a clear reflection of the fact that people are presenting after having delayed diagnoses, and then are at a more advanced stage.

Lilian: That’s interesting, thank you. I mentioned the CDC report earlier, and it also highlights that mortality rates are high among Black and Native American populations. Given the growing focus on and the collective will to address health disparities, what are your thoughts on what we can do to improve equity in cancer care and outcomes?

Dr. Patt: It’s a great question, Lilian, and what I would say is that vulnerable patient populations and patient populations that have been disproportionately affected by the pandemic are clearly going to be worse hit by some of the challenges in health outcomes as well. I was just looking at a report from the Kaiser Family Foundation that examined how women more often delayed seeking medical care in comparison to men. We looked at a report from the Medicare Beneficiary Survey characterizing so many Medicare beneficiaries that weren’t seeking routine care. I also saw another report from the Kaiser Family Foundation looking at different racial and ethnic disparities in regular healthcare use during the pandemic.

All of that supports what you’re seeing in the CDC report. This burden during COVID to get care, be it cancer care, cancer screening, or primary healthcare, is borne disproportionately by vulnerable patient populations. The bigger question is, what do we do about it? We need to proactively encourage people to get the screening that they need and reduce medical distancing. Doctor’s offices are safe places to go, but I think to hit those vulnerable patient populations, particularly women, and also racial and ethnic minorities, you need to heighten awareness of the importance of screening in a friendly way to get those folks in for appropriate screens. We don’t want to alarm them, though, because we’ve all just seen too much alarm this year.

Lilian: Thank you for that insight. That’s a nice segue to the topic of, how we do this. So, we’ll turn a little bit to policy. Ted, your organization, COA, is holding this annual meeting and your motto is “Resilient. Resourceful. Innovative.” It refers to the agility that oncology practices have shown in the face of this pandemic.

Given the challenges that Dr. Patt just described, what do you think stakeholders should be continuing to focus on to mitigate last year’s impact and to move forward to close some of those disparities and improve outcomes in certain populations?

Ted: Well, first of all, ditto to what Dr. Patt said. Thanks for having me. We love our collaboration with Avalere. I think we’re bringing a lot of good data and information to the forefront, which will help shape policy.

I was actually meeting with a member of Congress about 2 hours ago talking about this and talking about how practices like Dr. Patt’s have had to reinvent themselves to keep their doors open. You have to keep your providers and facilities COVID-19-free to be able to see patients in a safe environment.

The screening data is very disconcerting. The policy and the politics are focused on COVID-19, obviously where they should be, but no one’s really looking at the underlying problem that we have with cancer. What will the impact be down the road in terms of mortality and morbidity?

One of the things that we’re doing at COA is spending a lot of time with members of Congress to educate them, open their eyes to what is happening out there with cancer. I think it’s really important for practices, oncologists, practice administrators, nurses, advocates, everybody else to educate their members of Congress, as well.

Along with our conference, we’re also going to be launching a PSA campaign. Unlike some of the other PSA campaigns, which have great messages, we’re going to provide solutions. So, when a person doesn’t know where to get screened because the hospital is overrun with COVID-19 cases, they’re going to pick up the phone and dial an 800 number to CancerCare. CancerCare is an organization that has trained social workers who are going to walk the person through where to get screened.

When you look at mammograms and see that as of November of last year, they were down over 200%, it’s scary in terms of what the repercussions are on Dr. Patt’s practice, when you have 5 out of 6 women coming in with metastatic disease that might have been caught if they were screened earlier.

Another good thing is that we’ve worked with The New York Times, CBS This Morning, and others on stories about what’s happening in terms of the shortfalls in screenings. That not only helps people, but also policymakers because it’s important they understand that we have to help community practices, hospital systems, and others out there. We can’t hurt them in the time of a still-raging pandemic.

Lilian: That’s great insight. Thank you so much, Ted. And thank you for outlining some of your plans and where policy can impact this crisis going forward.

I think the next step would be talking about how a manufacturer or life sciences company would engage a patient to close those gaps. From an Avalere perspective, as we work with life sciences companies, there are several things that come up.

First, there’s going to be this influx of patients, as we discussed. There is a huge decrease in the number of patients who are coming in for their screenings and eventual treatment. So as vaccination rates increase and people are more comfortable coming to see their physician and enter the healthcare system, there is going to be more reliance on the manufacturer in terms of reaching out to patients and making sure that patient support programs are up and running.

To your point, Ted, how do you engage a lot of stakeholders? It’s not just the patient and the provider, but it’s perhaps advocacy, education across the stakeholders that are involved in that patient journey and making sure that the patient has access. It’s no longer just about having insurance, though we have seen shifts in insurance and increases in job loss causing a lot of out-of-pocket issues.

The other thing that’s really interesting that we are continuing to work on, and my colleagues here at Avalere are experts in this, is looking at social determinants of health and the role of the manufacturer in utilizing some of that information to look at access to a drug or a therapeutic area and making sure that you are meeting patients where they are, catering to what is needed to reduce those healthcare disparities.

Dr. Patt: Let me just jump in and say I can’t stress enough how important that is. One of the things we didn’t talk about is how the environment today is so challenging. With decreased cancer screenings, we know there are decreases in new cancer diagnoses, and that’s going to result in cancer morbidity and mortality for years to come. We need to fix that problem.

But even in our clinics, patients frequently don’t have their caregivers with them and there is heightened anxiety and depression. Cancer is already incredibly stressful, but cancer during a pandemic without your loved ones around you is very challenging.

If there are any barriers to access to care beyond insurance, such as network adequacy, reasonable reimbursement, and the complexity of getting the right drugs to the right patient at the right time—those are critical problems to solve to help patients have cancer managed appropriately.

Lilian: Thank you for pulling that through. Beautifully said. Ted, anything to add?

Ted: I think Dr. Patt hit it spot on. So often, we’re fighting with Pharmacy Benefit Managers (PBMs) that get in the way of people like Dr. Patt providing optimal care even during a pandemic. We get in the way of policymakers. We had a big push to get the sequester, that mandatory Medicare cut, removed for the rest of the year. Why is that important? Because practices are under financial stress. They’re under operational stress. They’re under emotional stress. The more we support our providers, the better position they’re in to keep their doors open and treat patients.

Because the politics and policy have been so focused on COVID-19, it’s important for policymakers to realize there’s an underlying crisis in cancer care after we’ve done so well for so many years. We have a real problem. If you can’t get people screened, you can’t get them treated. If you can’t get them treated, then they’re going to be worse off. They’re going to show up in the emergency room and end up hospitalized. What does that do? It costs employers more. It costs Medicare more. It costs taxpayers more. Awareness is very important in this area.

Dr. Patt: I want to emphasize how important our collaboration with Avalere has been. We really appreciate that, Lilian, because I do think that especially with Medicare beneficiaries not seeking regular care, it is going to be harder for them.

If we didn’t have a way to systematically evaluate the data and understand what some of those impacts would be, it would be hard for us to educate policymakers, manufacturers, and others on how to support these patient populations to get the care they need. Only through systems that look at large populations are we able to understand these trends. I think that increases in cancer mortality will be something that we continue to appreciate for years to come.

Ted: To add to that, what we’re going to be doing with Avalere is look at how health disparities have been impacted and exacerbated. We’re going to be comparing mammograms pre-COVID-19 and during the pandemic. Our hypothesis going in is that if you look along racial and ethnic lines, you will see disparities, and during the pandemic, our hypothesis is you’re going to see more disparity.

So, when you hear policymakers talk about solving the problem of health disparities, you have to isolate where the problem is by looking at the data and then put sound policy to decrease or, preferably eliminate, disparities.

Lilian: Absolutely. Thank you both so much for your insights. We appreciate your partnership and all you do for patients across the globe. And thanks to our audience for joining us today on Avalere Health Essential Voice. Please stay tuned for more episodes in our Disease Education Series. If you would like to learn more, please visit our website at www.avalare.com.