The Practice of Oncology in Translational Medicine


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The Practice of Oncology in Translational Medicine

  1. 1. The Practice of Oncology in Translational Medicine MedTrust Online September 2008 Brandon Goldman Chris Yoo
  2. 2. Introduction How do oncologists determine which drugs and what dose is appropriate for their patients? How do they keep up with the latest recommendations and indications of chemotherapy? The diagnoses they arrive at, and the treatments they select have to measure up to conventional wisdom while their care for a patient has to be individualized. Oncologists are increasingly pressed for time, with the busiest oncologists in the United States seeing on average 100 patients weekly. 1 In addition to their busy schedule, oncologists have greater information needs than ever before. There are currently over 150 FDA approved cancer drugs on the market today and 750 medicines and vaccines in development.2,3 This represents almost 30% of all new drug development and is resulting in a more sophisticated arsenal of treatment options for physicians to use. The rapid advancement in Oncology drug development has spurred an increase in the relevance of genomic data resulting from the use of molecular diagnostics (MDx) tests. In general, this has created the need for oncologists to research multiple types of content, including the latest research findings to interpret the relevance of new information in treatment options for their patients. Oncologists’ needs for information in analyzing the results of these tests will compound – in 2006, the MDx market was $250 million and growing rapidly at a CAGR of 30%.4 As Oncologists’ needs for new types of research and clinical information continue to expand, the Internet can play and increasingly useful role in helping oncologists find useful information. Oncologists are already using the Internet as one of their routine sources for information retrieval, with 98% of physicians stating that they use the Internet in their daily practice, according to one recent study.5 The Internet represents a growing opportunity for pharmaceutical companies to create a more relevant marketing approach to communicate with oncologists. The new advances in understanding molecular mechanisms of cancer and the subsequent actions of therapeutic agents developed to combat disease represent new arenas for the pharmaceutical industry to deliver timely and clinically useful content for physicians as they migrate to an electronic source for knowledge.
  3. 3. Figure 1: Use of the Internet is Pervasive How MedTrust Online Addresses the Needs of Oncologists Seeking Information While many experts and industry leaders in healthcare have noted the apparently slow pace of adoption of information technology, there are now several examples of IT solutions that have become more widely accepted, including Electronic Medical Records (EMRs) and Personal Digital Assistants (PDAs). Currently, 25% of office-based physicians are using EMRs on a daily basis, and the current overall adoption rate for professional use of PDAs among physicians is over 45%.8,9 This indicates that physicians are willing to shift to electronic tools when they fit well with established workflows and practices. To date, many efforts to determine what parameters are important for this shift have traditionally focused on technology platforms like the personal computer or the PDA. MedTrust Online has taken a different approach, partnering early on with one of the premier oncology centers in the southwestern United States, South Texas Oncology and Hematology (STOH) to understand how oncologists work and where established technologies to manage information can be clinically useful. STOH has been an integral partner in the design and development of solutions for MedTrust Online. Dr. Ronald Drengler, an oncologist at STOH working with MedTrust Online, says, “The access to timely and relevant information is a great need for all oncologists, especially those difficult and rare cases. We need best-in-class systems that can rapidly make information relevant for clinical decisions. We therefore see tremendous promise in how MedTrust Online will address this critical need in the oncology community.”
  4. 4. MedTrust Online recognizes that computing and the Internet have already revolutionized the use of information in other industries. Our focus is on identifying the information sources and processes necessary for clinical decision making and develop solutions built upon those existing technologies that accelerate the availability of integrated information for physicians within the context of their workflows as they provide optimal care for their patients. Challenges for Healthcare Information Technology Solutions While there is great promise in the use of information technology in healthcare, there are still important hurdles for oncologists in the widespread use of new electronic solutions in their practice. Tight regulations in the healthcare industry have created additional complexity for providers of technology solutions. Privacy laws like the Health Insurance Portability and Accountability Act (HIPAA) are designed to protect patients and require physicians to be even more vigilant than they already are in handling information about their patients. Some physicians may avoid technology solutions altogether due to the complexities of implementing electronic systems that handle patient data. Important business challenges to technology adoption exist as well. The largest market for software solutions consists of doctors residing in small physician practices (5 or fewer physicians). Many of these practices do not have the financial resources and staff to leverage technology solutions. For example, the average cost of an (EMR) Electronic Medical Record system is $20,000 per physician. While there is a proven benefit of using EMRs, the risk-reward proposition at this cost can be too high for many physicians.10 Not all technology solutions are alike; however, poor experiences with either cost or implementation have a tendency to establish negative connotations that affect all solutions viewed from the physician’s perspective. Challenges and Opportunities for the Pharmaceutical Industry The pharmaceutical industry has its own set of technology, regulatory, and business hurdles that make adoption of new solutions for interaction in the healthcare ecosystem complex. Communication of information to physicians is subject to strict government regulations despite the potentially clinically useful research information that may be in silos within companies and unavailable or undisclosed. Email is the top activity for users on the Internet, and these messages often are not searchable by others aside from the individuals sending or receiving them11 . Although email is often thought of as personal communication, the sheer volume suggests the size of information unavailable to the rest of an organization. Other business challenges, such as the need to protect intellectual property have promoted a more cautionary approach towards newer technologies that open up more communication and connections in the ecosystem. In addition to these hurdles, pharmaceutical companies are developing new agents and/or collaborating with biotechnology companies to produce more specialized drugs that require more information for proper usage. About 75% of the current drugs in development are specialty medications. 12 As drug therapies become more specialized, the large blockbuster drugs and marketing strategies associated with them will need to evolve into a more targeted approach.
  5. 5. As “face time” for pharmaceutical companies has steadily decreased and new limitations on how pharmaceutical companies markets to doctors increase, the pharmaceutical industry needs new avenues to provide the physicians with unbiased, evidence-based information about their products. 13 “Ten years ago, you were able to get up to six minutes to talk with a doctor," SK&A President and COO Dave Escalante told Pharm Exec. "Now you're lucky to get 90 seconds, and that's not happening by chance. That's happening because of the pressure on practitioners to manage much larger patient populations and offices."14 Advances in Pharmaceutical Company Marketing Approaches As the landscape of the drug development business changes, pharmaceutical companies are beginning to explore new alternatives to more effectively market their new products. Pharmaceutical companies have prioritized Internet-based services according to oncologist demands by continuing to improve their product drug websites, for example, creating blogs, and collaborating with physician social networking sites. eMarketer, has projected pharmaceutical companies will increase their Internet spending by about 25% this year, to $780 million, as marketers shift from mass marketing to consumers to more targeted opportunities on the Internet. By 2008, online spending will rise to $1.3 billion, according to eMarketer’s new report, “Pharmaceutical Online: Direct-to-Patient Becomes a reality.”15 Glaxo Smith Kline, PLC has joined the healthcare “blogosphere” by creating a blog for their popular weight loss product Alliweight™, and Johnson & Johnson Companies Inc., has also created a corporate blog to connect with consumers and with physicians. Pfizer Inc. has entered into an agreement with a social networking site that allows physicians to communicate and post questions both individually and to the entire community.16 In Oncology, product websites are steadily changing from placeholders of traditional paper content into tools that are specifically made for the Internet. Physicians now have access to drug indications, new prescribing information, and studies with the click of a button.
  6. 6. Table 1: Selected Pharmaceutical Companies and Their Websites for Oncology Drugs Company Name Products Websites Features of Site Roche/Genentech MabThera, Herceptin, Tarceva, Avastin Allows oncologists to take online surveys and provides them with video presentations. Amgen Neulasta, Aranesp Oncologists can sign up for newsletters and use “search box” to retrieve information Sanofi-Aventis Taxotere and Eloxatin Provides oncologists with interactive visuals and email options to send information. AstraZeneca Arimedex, Casodex Oncologists can listen to Podcasts, sign up for RSS feeds, and easily order product information. Novartis Gleevec, Femara Provides interactive visuals and allows oncologists to use “search box” to retrieve information. Pfizer Aromasin, Camptosar PfizerPro account allows oncologists to tailor information needs with account registration. Schering-Plough Intron-A, Viraferon-peg, Temodar Provides interactive learning materials and video presentations as well as tools such as dosage calculators Lilly Gemzar, Alimta Provides oncologists with interactive video options, newsletters subscriptions, and email options. Biogen-Idec MabThera, Avonex, Zevalin Provides oncologists with interactive visuals and has “search box” to retrieve information In response to physicians reducing the amount of scheduled visits and allowing less frequent “stop-ins”, pharmaceutical companies have turned to e-detailing programs to help increase engagement and retention of a company’s message. E-detailing, which uses digital technology in the detailing processes, has nearly doubled over the last 3 years, used by companies to reach 246,000 physicians. 17
  7. 7. With the current detailing process, a representative will schedule visits when they stop-in to see a physician. It is unlikely that at the exact moment the representative visits the office the doctor will be thinking about a specific patient case involving that representative’s product. Although the information provided may be valuable, it might not be relevant at that point and time. If there is a question beyond the scope of the representative’s knowledge during the conversation, it is the representative’s job to triage the question appropriately. The process and time to respond varies greatly depending on the resources of each company. Ideally, a pharmaceutical representative would be able to provide an immediate response. In MedTrust Online’s model, pharmaceutical companies may have the opportunity to leverage a tool that will be the default Internet-based portal that oncologists will use as they see patients everyday. Reminiscent of judiciously placed advertising found on search engine websites such as Google and Microsoft Live, MedTrust Online provides an avenue for pharmaceutical companies to deliver relevant information when a physician is looking up specific knowledge. Based on simple prototyping with our physicians at STOH, we have found that physicians prefer communicating with each other when seeking information to help them with difficult cases. Knowing any and all scientifically- supported options available for them as they formulate treatment plans is tremendously valuable for patient care. It is also likely that enhancing access to quality data quickly can result in patients receiving the best care. New Methods for Informing Physicians Seeking Better Care for Their Patients As MedTrust Online continues to create and deploy tools through its Portal for oncologists, conveying growing volumes of clinically useful information will become possible. Physicians will use electronic systems to provide the best treatment options available for their patients and more effectively seek out help for the cases where they need it. Pharmaceutical and diagnostic test companies will provide knowledge that will be important in this evolution of care. With greater adoption of information-based solutions to help these companies and the physicians they service, patients will receive timely, tailored care, and this will enable the entire healthcare ecosystem to operate more efficiently. Acknowledgements We would like to thank the MedTrust team for their helpful feedback and input.
  8. 8. REFERENCES 1. Forecasting the Supply of and Demand for Oncologists: A Report to the American Society of Clinical Oncology (ASCO) from the AAMC Center for Workforce Studies (2007). 2. Taken from the National Cancer Institute’s Website (July 2008): 783D1B210AE3 3. PHRMA Cancer Report 2008: 4. Diagnostics marketing research July 2008 re 5. Where the Doctors Are, ePharmaceuticals, July2005 6. Nielsen Online Research Division July 2008: 7. Universal McCann March Report: 8. Centers for Disease Control August 2008: 9. Journal of Medical Internet Research July 2008: 10. EMR deadline does not compute: Falling short of 2014 goals 11. Fallows, Debra. Pew Internet & Research Project: “Search Engine Use” August 2008 12. Deloitte & Touche: Bolstering Pipelines: “Why Big Pharma and Biotechs Need Each Other”,1002,sid%253D109091%2526cid%253D125231, 00.html 13. Iovino, Lou (2008) Oncology Business Review: “Cutting through the noise: Gaining and maintaining voice in today’s oncology marketplace.” 14. SK&A Physician Access Study July 2008 15. Pharma Marketing News: “Is Pharma eMarketing at a Tipping Point?”. ePharma Marketing Supplement: Volume 2, Section 1, 2008. 16. Johnson, Avery. (July 2007) Wall Street Journal: “Pfizer Doctor Web Pact May Get Looks.” 17. Paullin, Devin; Thierer Mark. Product Management Today April 2006. Marketing Automation Can Optimize On-Line Pharmaceutical Marketing Investments.