Source : 'Scrip Intelligence'
Susanne Schaffert, president of oncology at Novartis AG, has been reflecting on the catastrophic gaps in cancer care that are resulting from the coronavirus pandemic and the challenges of getting treatment to patients in a lockdown world.
Speaking to Scrip, Schaffert said that a number of countries, "and the UK is unfortunately one of them," have adopted guidance that prioritized COVID-19 and led to the postponement of appointments for cancer treatment and surgery. That was a very worrying stance, she said, and "we all know that this is impacting survival and mortality."
Schaffert cited figures from a report published earlier this month by US electronic medical records vendor Epic which showed that appointments for screenings for cancers of the cervix, colon and breast were down between 86% and 94% in March, compared with average volumes in the three years before the first coronavirus case was confirmed in the country. Her comments came as the Institute of Cancer Research in London issued a report claiming that delays to cancer surgery and other treatment caused by the coronavirus crisis could result in thousands of additional deaths in the UK linked to the pandemic.
Analyzing Public Health England data, the ICR team found that a delay of three months across all 94,912 patients who would have had surgery to remove their cancer over the course of a year would lead to an additional 4,755 deaths. Taking into account the length of time that patients are expected to live after their surgery, the delay would amount to 92,214 years of life lost.
Schaffert said Novartis had a duty to patients and physicians "and really help them to navigate this challenge." She added that "we are engaging a lot in education" and highlighted a series of videos published on the Swiss major's social media channels involving discussions with the likes of Pat Garcia-Gonzalez, CEO of The Max Foundation, which channels over a million daily doses of cancer treatment in 66 low- and middle-income countries.
Another video features a chat with Fatima Cardoso, director of the breast cancer unit at the Champalimaud Cancer Center in Lisbon, Portugal. "She had a quote that really stuck with me," Schaffert said, that "while COVID-19 may be very frightening, it still has a relatively low mortality rate. Metastatic breast cancer has a 100% mortality rate."
On the operational front, the pandemic has provided supply challenges for Novartis "and for our, let's say, normal products, thanks to our global footprint, we have organized production and delivery well. It requires a great effort but can be done fairly easily," she said.
However, "we have some cutting-edge novel therapies for cancer in my unit that are produced on demand for individual patients." Schaffert said, such as the radiopharmaceutical Lutathera (lutetium Lu 177 dotatate) and the CAR-T therapy Kymriah (tisagenlecleucel). The process for producing Kymriah involves blood collected from a patient which is then cryopreserved, shipped to a facility for genetic reprogramming into CAR-T cells then shipped back for infusion into the patient. Time is of the essence in this process and the COVID-19 crisis, with its resulting travel bans, has posed considerable logistical problems.
Schaffert said that Novartis had used passenger aircraft to transport Kymriah, "the normal carriers like British Airways and Lufthansa" and had not missed one shipment. "My colleagues get into their cars and drive to the hospital to deliver it; I'm so impressed with their dedication," she added.
Being able to make decisions quickly, helped by the 'unbossed' environment cultivated by Novartis CEO Vas Narasimhan, has been a major factor in preventing supply disruptions of these complex cancer therapies, Schaffert said. "The concept of unbossed is something that some people still don't get right, they think it is about no leaders. What it really means is leadership providing direction and giving a vision, but then you empower your individuals and your associates to really find the solution, like getting people into the car to make sure that the patient gets Kymriah, for example." ("How Novartis Is Helping Staff Through COVID19 Crisis" "Scrip" )
COVID-19 has also affected the way the company's oncology sales reps work, she noted. "They have seen a complete change in their jobs of visiting hospitals and physicians as this was not possible. Also I saw that oncologists were being put onto COVID treatment and I said, 'We cannot bombard them with marketing messages.' We need to understand what they need and what we can provide as the basis for dialogue."
No longer being able to speak face-to-face with physicians means that virtual marketing is the norm and Novartis was well prepared to make the adjustment quickly, Schaffert said. "Our executive committee committed to go very bold on digital, and we have trained our reps to do multi-channel engagement. They already knew how to use these tools which are now of course default."
By Kevin Grogan