PME talks to Joanne Kanaan from Omini about the potential role of precision medicine in chronic diseases and the challenges patients face in managing their conditions

PME: The number of patients with chronic diseases has risen globally over recent years. What portion of the UK population is affected by one or more chronic conditions and how is this impacting healthcare systems?

Joanne Kanaan (JK): It is estimated that six out of ten people over the age of 60 suffers from at least one chronic condition, and four out of ten suffer from two or more. In England particularly, approximately 15 million people have a long-term condition including diseases like diabetes, heart failure, chronic obstructive pulmonary disease, arthritis and hypertension.

People with long-term conditions account for a substantial portion of healthcare utilisation, including GP appointments, outpatient appointments and inpatient bed days. The treatment and care for these conditions are a major part of health and social care expenditure, taking up about £7 in every £10 of total health and social care expenditure in the UK.

PME: What are some of the key challenges that chronic disease patients face in managing their condition?

JK: Chronic conditions have physical, social, psychological and financial impacts on patients. These include adhering to complex treatment regimens, dealing with physical symptoms like pain and fatigue, and the psychological toll of ongoing illness, such as anxiety and depression. Financial burdens due to healthcare costs, lifestyle adjustments and potential disruptions in employment and education are also significant. Social challenges, such as maintaining relationships and avoiding isolation, coupled with the difficulty of navigating healthcare systems and managing comorbidities, further complicate their experience. Access to care also remains a critical issue for many of these patients.

In heart failure for instance, patients regularly suffer from shortness of breath, persistent coughing and wheezing, oedemas, fatigue, nausea and confusion. It also requires adhering to a strict medication regimen and diet and fluid restrictions. The disease is also responsible for the highest rate of hospital readmissions, thus patients live with the anxiety of going back to the hospital.

‘With better outpatient management, healthcare systems can expect fewer hospital admissions, reduced overall costs and improved health outcomes for patients’

PME: Which factors can contribute to an increased risk of developing a chronic disease and do you feel that the general public is well educated about these factors?

JK: While some are linked to lifestyle choices such as an unhealthy diet, physical inactivity, tobacco use and alcohol consumption, others are out of the patients’ hands such as environmental factors, genetic predisposition and socio-economic conditions.
Public awareness varies widely. Many developed countries provide a significant amount of information about risk factors through public health campaigns, education systems and media. However public awareness is impacted by education, socio-economic status and access to healthcare.

There is also a disparity in awareness between different types of chronic disease. There are numerous chronic diseases – in fact, thousands – but public awareness often centres on a relatively small number of these, particularly the more common or high-profile ones.

Common chronic diseases like diabetes, heart disease and asthma are frequently the focus of major public health campaigns and receive substantial media coverage, leading to greater public awareness. In contrast, rare diseases, such as Huntington’s disease, cystic fibrosis or scleroderma, receive less public attention and awareness despite their collective impact.

This difference can have significant implications. Diseases that are less known face challenges in funding for research, difficulties in diagnosis and a lack of support and resources for patients and their families. Additionally, healthcare providers may be less familiar with them, which can lead to delays in diagnosis and appropriate treatment.

PME: Precision medicine is considered to have helped revolutionise the treatment of some genetic diseases and cancers. What role could it play in improving chronic disease management?

JK: Precision medicine brings a much-needed focus on the complexities and comorbidities that many patients face. Chronic diseases often don’t exist in isolation; they come with a web of interrelated health issues, making management intricate. It’s not just about treating one disease; it’s about understanding how different conditions interact with each other and tailoring the treatment to address all aspects of a patient’s health.

A significant part of this approach is the use of monitoring devices to regularly gather data about various health parameters such as a patient’s history, symptoms, heart parameters, respiratory function and blood biomarkers. This real-time data provides a more dynamic and comprehensive picture of a patient’s health status, leading to timely adjustments in treatment plans and better managing the comorbidities.

Artificial intelligence (AI) will also play a pivotal role in chronic disease management within the next few years, identifying complex patterns and helping make more accurate predictions about disease progression, response to treatment and potential complications.

Precision medicine also bridges gaps in care that often exist due to differences in ethnic backgrounds, socio-economic status and other factors, thereby working towards more equitable health outcomes across diverse patient populations.

PME: What role would a multiplexed blood testing platform play in delivering personalised care to chronic disease patients and how could it help to relieve the current burden chronic diseases have on healthcare systems?

JK: Multiplexed blood testing offers more nuanced and effective approach to patient care. For instance, consider diseases like diabetes, heart disease and kidney disorders.  Managing these conditions often requires monitoring different organ systems, which is where multiplexed blood testing becomes invaluable. It allows clinicians to monitor specific sets of blood biomarkers related to each of these organs simultaneously, providing a holistic view of patients’ health status.

For a diabetic patient, along with blood sugar levels, it’s crucial to keep an eye on kidney functions and cardiovascular health, as diabetes can affect multiple organ systems.  Multiplexed testing can track biomarkers related to kidney function, heart health and glucose levels all at once, enabling a more comprehensive management strategy. Similarly, in heart disease, it’s not just about monitoring cholesterol levels, but also looking at markers of inflammation, kidney function and other factors that might influence heart health.

Such data enables better tailoring of treatment plans and leads to more effective management of diseases, reducing the likelihood of complications and the need for emergency interventions. In the long run, this approach is not only cost-effective – by reducing the need for multiple, separate tests – but also improves the overall quality of life for patients by proactively managing their conditions.

Additionally, better management means fewer hospital admissions and a lower overall demand for intensive healthcare services, which is especially important given the increasing prevalence of chronic diseases worldwide.

Another interesting example is in cancer management. For instance, in the case of breast cancer, a multiplexed test could measure markers that indicate the presence of cancer cells, hormone levels that influence tumour growth, and markers of liver and kidney function to monitor the effects of chemotherapy. A patient undergoing chemotherapy could get the test at each clinic visit, indicating how well the treatment is working and also whether there is liver or kidney stress, side effects of the chemotherapy. By getting these results promptly, the oncologist can make immediate decisions, such as adjusting the chemotherapy dosage or addressing any emerging side effects.

PME: How do you see the role of precision medicine in chronic diseases evolving over the next five years?

JK: Over the next five years, a key focus in the evolution of precision medicine in chronic disease management will be the need for improved outpatient management. This shift is crucial for both cost reduction and enhancing the quality of care. Efficient outpatient management means providing more proactive and continuous care for chronic conditions outside of hospital settings. This approach is not only more cost-effective by reducing the need for expensive inpatient care, but also supports patient-centred care, improving the quality of life for individuals with chronic diseases. With better outpatient management, healthcare systems can expect fewer hospital admissions, reduced overall costs and improved health outcomes for patients.

Following this, the discovery of new biomarkers and advancements in multiomics will further revolutionise chronic disease management.

The identification of new biomarkers will enable earlier and more accurate detection and diagnosis of chronic diseases, leading to more effective treatment strategies. For instance, new tumour markers could revolutionise the early detection of cancers, while markers for disease progression in conditions like Alzheimer’s could vastly improve monitoring and treatment adjustment.

In parallel, multiomics – the integrated study of genomics, proteomics, metabolomics and other biological data – will provide a comprehensive view of an individual’s health.  This holistic approach will deepen our understanding of the molecular mechanisms of diseases, paving the way for more personalised and predictive treatment strategies. By integrating these scientific advancements with a focus on enhanced outpatient care, precision medicine is set to transform the landscape of chronic disease management, offering more tailored, efficient and patient-centric care solutions.

Joanne Kanaan is CEO and Co-Founder of Omini