By Matt Lashey, MBA, & Alex Whitehead, BS

— Originally posted in NCODA’s Inspire Magazine (Spring 2023) —

It takes a village to overcome cancer. While oncology patients have always relied on networks of caregivers, oncologists, nurses, pharmacists, and the manufacturers of their medications, how these groups work together to improve outcomes is becoming increasingly complex.

The National Comprehensive Cancer Network’s Clinical Practice Guidelines in Oncology have established a ballooning number of clinical decision pathways a 370% absolute increase — between 1996 and 2019.¹

To cohesively navigate this evolving landscape, care networks require high-quality patient-level clinical data and the technologies to sufficiently capture it. Efficient and reliable capture of patient data is needed to inform value-based care, quality initiatives, and to ultimately benefit oncological care.²

The Roles and Expectations of Oncology Pharmacists

Oncology pharmacists play a critical role in patient education during the early days of a cancer diagnosis. Patients are often overwhelmed by the amount of new information being provided by their oncologists at the time of diagnosis. It is typically a few days later, when patients receive or pick-up their medication, that patients are reminded of persisting questions regarding their treatment and their disease. A specialty pharmacy touchpoint is one of the few instances in U.S. healthcare where a licensed healthcare professional with this specialized knowledge is both free and accessible to patients when they need it most.

Being “on the frontlines” of patient care, oncology pharmacists are also uniquely positioned to use technology to improve outcomes and to collect important data. Studies have shown that pharmacists are integral to improving care, reducing costs and limiting drug complications for patients with cancer.³

With an increasing number of new cancer treatments launching each year,⁴ rising expectations of oncology pharmacists will continue from all sides of the healthcare matrix.

FROM PATIENTS: Patients will look to oncology pharmacists for clinical support with 1. side effect education as they start onboard to their new, complex medications, and 2. guidance on when to contact their oncologist regarding their medication. This assistance will help patients and their care teams understand whether to adjust dosing, treatment schedules or switch medications entirely.

FROM CARE PROVIDERS: Oncologists will look to oncology pharmacists for support with 1. improving patient engagement and care plan adherence, and 2. summarizing patient health outcomes between provider visits (e.g., nonadherence treatment-resistance, adverse events. This assistance will help facilitate harmonious patient care across the care network, and ultimately optimize outcomes.

FROM PAYERS AND MANUFACTURERS: Pavers and manufacturers will look to oncology pharmacists for support with facilitating patient access to medication through all stages of the treatment journey for .1 medication approval and initiation, 2. adherence over time, and 3. prescription renewal reporting or reporting for downstream business purposes (e.g., value-based contracting). Assistance here will ensure the right patients are receiving the right medication at the right time.

Oncology pharmacists are well-positioned to meet the expectations — if equipped with the required data and the technology to collect it.

Mail-Order Pharmacies & Challenges of Meeting Expectation

Given vertical integration across the industry’s largest Pharmacy Benefit Managers, health plans and specialty pharmacies, many patients currently receive their oral oncology medications through mail-order pharmacies.⁵ These entities extend off-the-shelf materials and one-on-one clinical support, but often require patients to navigate busy websites in order to find and utilize these resources. This creates an opportunity for oncology pharmacists to take a more active role in patient care, but there are gaps in information and capabilities.

INCOMPLETE PICTURE OF PATIENTS AND THEIR EXPERIENCES: When a mail-order pharmacy receives a prescription, there is little that is known about the patient. Since prescriptions do not come with visibility into the patient’s electronic medical record, their diagnostic and demographic information is largely unknown. Pharmacists collect some of this information during scheduled touchpoints, but several factors make it challenging to get complete data (e.g., language barriers, patients not picking up phone).

Patient outcomes data is also incomplete. Pharmacists understand whether a patient has refilled a prescription, but outside of what is collected via scheduled touchpoints, or what is collected via text or call-based patient-reported outcomes (ePRO) instruments, not much is known about the patient’s experiences — the critical missing context for the patient outcomes.

LIMITED VARIETY IN WORKFLOWS AND CARE PLANS: After receiving their initial. prescription, patients are typically put onto similar care plans and are provided standard educational resources.

For example, many oral oncolytic patients follow identical touchpoint schedules (e.g., phone calls at days 14, 30, 90, 180) where pharmacists ask a set of standard questions. Pharmacists then refer patients to the same off-the shelf content to help with medication and disease management. Care plans are not often set or adjusted based on individualized patient needs.

CHALLENGES IN MONITORING AND PREDICTING NEGATIVE OUTCOMES: Monitoring the evolution of a patient’s symptoms and side effects is also a challenge. Even for patients who consistently
update their pharmacists or complete PRO instruments, there is no single resource that succinctly. summarizes data across sources to inform quick care decisions.

Lesser so, there is little being done to predict negative outcomes based on a patients treatment and disease progression.

How a Patient’s Experience of These Gaps Led to the Solution

These gaps were experienced from the patient perspective by Treatment Technologies &Insights (TTI) cofounders Matt Lashey and Ric Grenell. Following a non-Hodgkin lymphoma diagnosis, Grenell leaned on his pharmacists’ deep disease and treatment knowledge for help with managing side effects and with updating his oncologist. As Grenell’s partner and primary caregiver, Lashey had an appreciation of the support of pharmacists, but grew frustrated by gaps in care exacerbated by an absence of technology.

Born out of that experience, Wave Health was created. This ePRO smartphone app uses data science to educate patients and their care networks about their response to treatment and disease. Based on patient logs, data analysis finds statistically significant correlations between what patients are doing (e.g., medications, activities) and how they are feeling (e.g., condition, mood, and side effects).

TTI was founded to help deliver this technology to care organizations and their patients. Since then, to meet the needs of today’s mail-order pharmacies, TTI has evolved Wave Health from a stand-alone app to a three-component platform:

• An industry-leading patient app⁶ for comprehensive logging, ePRO short form completion, and delivery of correlation insights and relevant content.
• A care portal for pharmacists to review and act on succinct patient-level summaries of symptom evolution and ePRO short-form responses.
• Comprehensive and standardized data reporting, visualization, and predictive modeling to inform oncological care and downstream organization strategy.

How Wave Health is Filling These Gaps Today

Today, oncology pharmacists are using the Wave Health Platform to close gaps in patient care, to meet the growing expectations of care networks, and to drive better health outcomes.

PROVIDING A COMPLETE PICTURE OF PATIENTS & THEIR EXPERIENCES: The Wave Health App collects an abundance of meaningful data given its distinctive ability to keep patients engaged. Patients find that providing the app with more data leads to more relevant correlation insights and content back to them.

The outputs of this engagement are presented in the Wave Health Care Portal, where pharmacists access patients’ demographic and diagnostic profiles and multi-leveled views of experiences to augment care decisions.

PROVIDING MORE VARIETY IN CARE PLANS: To help oncology pharmacists, Wave Health’s Care Portal automates patient segmentations based on how patients are logging and responding to ePRO instruments. This enables oncology pharmacists to design and implement segment-specific or individual-specific workflow, and ultimately, provide stronger, more relevant care.

To help patients, the Wave Health App delivers insights and individualized care management content based on that individual’s specific logging behavior. This way, patients avoid navigating through cookie-cutter content, and instead, receive the right information at the right time.

PROVIDING AN ABILITY TO MONITOR & PREDICT NEGATIVE OUTCOMES: The Wave Health Care Portal allows pharmacists to easily monitor the evolution of patients throughout their treatment journey. This facilitates higher-quality patient conversations and individualized care decisions.

However, given busy schedules, oncology pharmacists are unable to monitor all patients all of the time for risks of negative outcomes (e.g., medication nonadherence). To address this, TTI is developing predictive algorithms that identify patients at-risk of nonadherence, allowing pharmacists to enable relevant care services to patients when needed.

With the right tools, oncology pharmacists will close critical gaps in patient care and will collect the patient data needed for care networks to navigate an increasingly complex oncology care landscape.

We would like to thank Yasmin Saafan, PharmD, BCPS, for her contributions to this article.

Matt Lashey, MBA, is the creator of Wave Health and is cofounder & CEO of TTI. In his free time, Lashey likes to go hiking and to cook for friends and family. Alex Whitehead, BS, previously led Strategy & Product for Treatment Technologies & Insights (TTI). In his free time, Whitehead enjoys being active outdoors, traveling and attending concerts in his home city of Los Angeles.

REFERENCES

1. Kann BH. Changes in Length and Complexity of Clinical Practice Guidelines in Oncology, 1996-2019. Jama Network. http://jamanetwork.com/journals/jamanetworkopen/fullarticle/2762702. Published 2020. Accessed January. 5, 2023.

2. Hernandez-Boussard T, Blayney DW, Brooks JD. Leveraging Digital Data to inform and improve quality cancer care. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195903/. Published April 2020. Accessed January. 5, 2023.

3. Justin G. Impact of clinical pharmacists in outpatient oncology practice: A Review. American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists. http://pubmed.ncbi.nlm.nih.gov/28947527/. Published 2017. Accessed January 5, 2023.

4. Raper, A Beardsley HJ, Christie M, Team E. Specialty medications: Hope for patients, Hurdle for Healthcare. CoverMyMeds Insights. http://insights.covermymeds.com/healthcare-technology/specialty-therapy/specialty-medications-hope-for-patients-hurdle-for-healthcare. Published 2021. Accessed January 5, 2023.

5. Fein AJ. The top 15 U.S. pharmacies of 2021: Market shares and revenues at the biggest companies. Drug Channels. http://www.drugchannels.net/2022/03/the-top-15-us-pharmacies-of-2021-market.html. Published March 8, 2022. Accessed January 5, 2023.

6. Lu DJ, Girgis M, David JM, Chung EM, Atkins KM, Kamrava M. Evaluation of Mobile Health applications to track patient-reported outcomes for oncology patients: A systematic review. Advances in PMC7547022/. Published 2021. Accessed January 5, 2023.

— Treatment Technologies & Insights’ (TTI) ePRO app solution, Wave Health, enabled innovative approach to capture real-world symptoms and side effects —

SEATTLE, WA and EL SEGUNDO, CA, May 31, 2023 – The Wave Health digital health platform, used to collect patient symptom and quality of life information in an innovative research study, comprises two abstracts accepted to the 2023 ASCO Annual Meeting. The study used TTI’s electronic patient reported outcomes (ePRO) platform to measure a variety of symptoms and aspects of health-related quality of life (HRQoL) in the “ImmunoWave” study, conducted at Fred Hutchinson Cancer Center. 

Dr. Hall, Assistant Professor at Fred Hutchinson Cancer Center and University of Washington School of Medicine, who led the study said, “Immune checkpoint inhibitors (ICI) have transformed the care of many cancers and are among the most commonly prescribed cancer medications in the United States. Relatively little is known about the symptom and life experience of patients who have received this type of treatment in the past. The use of a patient-friendly ePRO system in this study enabled us to frequently and conveniently assess symptoms and quality of life in a group of patients who are not frequently coming in for infusions and visits.”

The study assessed for the presence of eleven symptoms and overall quality of life in a group of participants with prior exposure to ICI therapy or ongoing long-term ICI treatment. Participants in the study completed weekly symptom and HRQoL assessments using Wave Health. The two abstracts submitted to the 2023 ASCO Annual Meeting include:

• Understanding the late immune checkpoint inhibitor (ICI) symptom experience using an electronic patient reported outcomes (ePRO) app-based platform: The Immunowave study.

• Association between symptoms and health-related quality of life in patients with cancer with prior or ongoing immune checkpoint inhibitor therapy exposure.

Study participants completed the majority of the assessments, providing crucial evidence of the feasibility of this technology to measure symptoms and HRQoL in this population. Participants reported frequent, persistent, and often severe symptoms, most notably fatigue, mental health symptoms and musculoskeletal symptoms. The study also identified which symptoms appeared to correlate most with diminished quality of life. For example, symptoms of depression, joint pains, and shortness of breath were associated with decreased physical functions on HRQoL measures.

“This study demonstrated that ePRO assessment is feasible in the population of cancer patients who are receiving or have completed ICI therapy. We have been able to collect much richer data using this approach than if we had relied on patients completing pen-and-paper questionnaires when they presented for clinic visits. This study lays the groundwork for future important studies of patient experience during and after ICI treatment,” said Dr. Hall.

TTI CEO and Wave Health creator, Matt Lashey, added: “These early learnings have already informed multiple new projects underway in Europe centered on both early and later stage cancer patients. In addition to the app, we now have a connected ePRO portal, Wave Health Connect, to elevate shared decision making and drive the ability to triage emerging adverse events.”

For the “ImmunoWave” study, in addition to weekly ePRO monitoring resulting in high questionnaire completion rates, study participant feedback on the Wave Health app tool was very positive.  Specifically, of those patients who completed the study off-boarding survey: 90% said they would “recommend the app to a friend going through similar circumstances;” and 80% said using the Wave Health app “helped them understand better how to live with their condition.”  Correspondingly, less than 5% of participants who completed the study off-boarding questionnaire, did not find the app “easy to use.” 

Treatment Technologies & Insights/Wave Health

TTI is a digital health insights and real world data (RWD) company, powered by the best-in-class electronic patient reported outcome (ePRO) ecosystem, Wave Health.  Born from a personal cancer experience, Wave Health transforms the understanding and management of chronic conditions – outside the clinical setting.  Wave Health App empowers patients to become more active partners with their care teams by helping them track and communicate their symptoms and experiences; the Wave Connect PRO Portal enables care teams to digitally augment care, with a lens into the patient journey at home; and Wave Health RWD supplements clinical data with critical context and individual variables.