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

By Claire Gillis

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?

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.

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. In most countries in Europe, approval for priority anticancer drugs takes 180 days, but in Spain it’s delayed by 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.

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’.

Claire Gillis is CEO at VMLY&R Health