Prashant Poddar co-wrote this blog post with David Kriesman.
Oncologists are precisionists, relying on every tool at their disposal and a well-connected network of practitioners to make the best choices for their patients. But that approach is nearly impossible during the COVID-19 crisis which is disproportionately affecting cancer care. Oncologists are struggling with a newfound loss of control over the consistency of their business and lack the confidence they once had to make optimal treatment decisions and keep their patients safe.
For community physicians, the uncertainty is magnified, as they confront short-term financial challenges and limited resources. The picture looks a little different for hospital-based oncologists who are navigating new risk mitigation policies that are deprioritizing cancer treatment for many. By understanding the issues that oncologists are facing and how they are slowly adapting, oncology drug manufacturers can determine the role they need to play in supporting their primary customer.
Making difficult decisions with a ‘blindfold’ on
Oncologists are struggling to find the right balance between fighting cancer and limiting risk of infection for some of their most vulnerable patients. A recent study presented at AACR shows that cancer patients are three times more likely to die from the new coronavirus. In some diseases like lung cancer, patients with a cough (a tell-tale sign of lung cancer) are being actively dissuaded from coming into the office. That might limit risk in the short-term, but it could lead to a trip to the emergency room a few weeks later and the loss of precious treatment time.
Oncologists also face hurdles in day-to-day management. They are being forced to deviate from their standard of care, focusing on alternative strategies such as increasing the use of neoadjuvant hormone therapy for HR+ breast cancer patients, shifting to less invasive procedures (liquid biopsy instead of tissue, systemic therapy instead of TACE for HCC), and less frequent dosing for PD-1/PDL-1 checkpoint inhibitors are commonplace.
Telemedicine has dramatically increased (about 40% of cancer patients have shifted or will soon), but it has its limitations. Oncologists feel inadequately prepared to advise patients without labs or current diagnostic work-ups in hand. Certain side effects are difficult to monitor remotely: imagine, for example, trying to inspect a rash over a Zoom video conference. Most oncology practices have shifted to virtual tumor boards to discuss cases, but the level of peer discussion and engagement isn’t quite the same (at least for now).
Dealing with a sudden decline in referrals
According to a recent ZS study about how healthcare entities are emerging from COVID-19, community and academic oncology practices stated seeing a decline of about 20% to 40% in new patient referrals. Many smaller community practices rely on referrals from local primary care physicians, many of whom have closed themselves. In some cases, PCPs may not even be aware that cancer practices in the community are still open. In response, some community practices like the Cancer Treatment Centers of America (CTCA) have released DTC advertisements to get the message across.
Empathizing with patients
Meanwhile, oncologists are struggling to maintain the human element of medicine. How do you deliver the news of a cancer diagnosis over a webcam with the same level of empathy? In many cases, patients are alone for their appointments. Caregivers have been forced to stay at home themselves and cannot sit side-by-side with them during video calls or join them in-person due to building access restrictions.
It’s early, but with COVID-19 cases flattening, oncologists are beginning to see a glimmer of hope. According to a recent ZS study, oncologists, on average, believe that business will return to “normal” in the next four months.
As a result, some practices are starting to regain a sense of normalcy and put measures in place. Early on, a few national organizations produced high-level guidelines governing treatment. Now, practices are anxious for more specifics, and some societies have started to publish tumor-specific guidance for treatment, surgeries, radiation and transplantation. A few cancer centers including Moffitt Cancer Center have ramped up in-house COVID-19 testing capabilities to identify suspected cases and triage patients for chemotherapy treatment. Smaller practices are collaborating with local hospitals overloaded by the virus to offer capacity, leading to a potential network of “reverse referrals.”
While practices continue to adjust to the current climate, pharma faces its own dilemma: how to continue to provide adequate support for its products and services, while respecting their customers’ precious time during the crisis. Here are four ways that manufacturers can help:
- Adapt to digital engagement: Virtual/video calls may not be ideal for reps who are used to interacting live, but they can still be effective. But, simply switching mediums isn’t enough. Oncologists report frustration with reps who don’t adapt their approach (like reading a product insert over the phone instead of engaging in a dialogue). Sales organizations must train their teams to use digital tools in a way that elevates the content and engages the customer. Virtual calls are here to stay, so the companies that invest in digital call training and optimize marketing materials for digital will gain more access, not less.
- Tailor to your customers: Each practice is facing a unique set of challenges. A small, community practice will need significantly more patient access and financial support from pharma in the short-term. Even dropping off lunch for the care team can be greatly appreciated. In academic institutions and hospitals, oncologists suspect pent-up demand is looming, with a backlog of postponed surgeries and new patients presenting in tumor types with less conspicuous cancer symptoms. When the doors open, how will this flood of patients get prioritized? Manufacturers should consider forming a coalition to enable “where to go” tools that can help with patient allocation and local capacity management.
- Offer “pull” support on demand: Make it easy for customers to quickly find you when they need you, on their terms. Product or company websites should provide front-page access to online FAQs, a one-click button to request follow-up, or implement AI-driven chatbots to help triage or address common inquiries. These digital “pull” mechanisms exist today but aren’t as widespread or easy to find as oncologists want them to be.
- Tap into virtual speaker programs, webinars and forums. These events are often the best way right now for oncologists to regain some comradery and interaction with their peers and pharma needs to play an active role in sponsoring these events.
At this time of great uncertainty, what oncologists need most is pharma’s trust and reassurance. Customers want to know that manufacturers are in this with them together. By “disappearing off the face of the earth,” pharma companies might create an unintended negative perception of their commitment to oncology practices and cancer care overall—even if the intention was to respect oncologists’ time. As oncology practices adjust their procedures to regain some sense of normalcy over the coming months, pharma will need to fit into this picture by adjusting its engagement, or risk being ignored.