Untapped Opportunities for Oncology Medical Affairs

Striving for better access and more equitable cancer care in communities nationwide

Introduction

Pharmaceutical companies’ traditional medical education model relies on prominent researchers and publishers in the oncology space, otherwise known as Key Opinion Leaders (KOLs), to spread information about the newest therapies. There remain, however, significant untapped opportunities for oncology medical affairs to penetrate communities and reach more practitioners nationwide. Medical Science Liaisons that currently focus their efforts on traditional KOLs may be able to expand their reach by also targeting newly rising Digital Opinion Leaders, who spread information to many through new online channels. Further, increasing Community Science Liaison utilization to reach and educate community oncologists will allow manufacturers to tap into the patient-centric space where 85% of cancer care actually occurs. Following these routes to bolster oncological medical affairs will not only increase the uptake of novel and life-extending cancer therapies but address current inequities in the oncology space.

Background: Cancer Disparities

Health disparities are prevalent in the United States along many dimensions, including gender, socioeconomic status, race, and geographic location. Often stemming from systemic health and health care inequities, these disparities are avoidable and unjust differences in the treatment and health outcomes of different population groups. Many disparities exist in the cancer space in particular, and can be measured by differences in disease occurrence, frequency, treatment, and mortality. For example, Black and Indigenous Americans suffer the greatest rates of cancer and the poorest outcomes for each of the most common types. Many structural issues are to blame: historical and present-day discrimination has worsened these communities’ social and economic well-being. Socioeconomic status directly affects health security, and many with unstable incomes or job statuses lack health insurance and appropriate access to care.
Inequities are further embedded in the caregiver side of the cancer space. People of color and lower socioeconomic status are deeply underrepresented in clinical trials -- only 12 states allow Medicaid to cover routine costs of clinical trial participation. This lack of coverage systematically excludes many minorities from groundbreaking research therapies and limits the true generalizability of clinical trial findings. Further, patients of lower socioeconomic status are significantly less likely to receive care that adheres to the clinical practice guidelines from the National Comprehensive Cancer Network, decreasing their likelihood of successful treatment and survival.

Examining The Traditional Model

The traditional oncology therapeutic educational model does not address these inequities in cancer research and care. Clinical research, concentrated in the hands of a few elite research institutions and “key opinion leaders,” excludes most cancer providers and patients. Key Opinion Leaders (KOLs) are oncologists who are thought to be the most influential experts in their area, and typically conduct and publish high volumes of research. The pharmaceutical and biotechnology companies behind much oncology research focus clinical partnership with KOLs because of their influence, which has been a largely successful educational model. In a survey of 156 community oncologists in 2015, 60% of them indicated that national KOLs impact their treatment behavior.

Driven by research interests, this traditional model leaves a gap at the actual delivery of cancer care by skipping direct communication with community practitioners and researchers. Medical Science Liaisons (MSLs) talk mainly to KOLs that are identified from scientific activities, and engagement occurs through traditional scientific communication channels such as medical congresses. This model could be more inclusive to community oncologists, especially because 85% of cancer care happens in the community at a local level, rather than at high-powered research institutions. Local health practitioners administer cancer therapies to patients and make a majority of treatment and care decisions. Given that they hold the most power regarding the ultimate use of therapeutics to treat patients, the traditional model should be expanded so that the information they learn about new therapies and care practices isn’t diluted and delayed.

Two Routes of Action

Increasing community practitioner awareness of novel therapies will not only improve population cancer outcomes but increase the equity of cancer care. Taking a broader, more community-based approach to medical affairs will improve diverse and rural communities’ access to the highest standard of cancer care.

1. Traditional Meets Digital
The rapid digitization of medical affairs means that expanding beyond traditional KOLs to Multichannel or Digital Opinion Leaders (MOLs, DOLs) will drive more impactful conversations to improve medical education. The recent rise of social media channels, such as Twitter, and other online communication platforms such as electronic Continuing Medical Education have opened untapped routes for communication with healthcare practitioners. MOLs and DOLs exert influence through tweets, YouTube video views, blog posts, and other channels. These experts don’t necessarily conduct high volumes of research themselves, but rather serve the important role of editorializing new information in a digestible and compelling way. Professional and patient education in the digital space is not merely an emerging trend, but already has real impact. Twitter mentions drive citations of scientific knowledge.

COVID has further accelerated the digitization trend. Once in the digital space, it is easy for practitioners and patients seeking medical information to find and engage DOLs. Social network algorithms allow for rapid organic growth, as feed and content suggestions are tailored based on an initial signal of interest. Leveraging this expansive new platform will significantly expand pharma’s reach in the oncology community and bolster medical affairs efforts.

2. Including the Community
The shifting landscape of oncology research, education, and care has also seen recent emphasis on inclusion at a local community level. Clinical trials are being conducted more in community cancer centers, signaling a shift away from high-powered institutions as the sole home of information generation. The education and outreach model must shift accordingly, identifying and involving the best community doctors. Engaging these doctors in clinical trial design and expanded access programs is critical for both initial therapeutic uptake and broader influence. Those who have spoken with medical representatives or been involved in trials are often the first adopters of oncology drugs, and the community practitioners who care for 85% of patients nationwide have control over most treatment decisions.

Conclusion

Cognizant of these trends, Amplity has helped clients achieve a well-rounded targeting focus mix of traditional KOLs and community accounts. We initially targeted key accounts, traditional elite research institutions, but began targeting a larger breadth of community doctors over time. Messaging was received very well in the community, and it was easier to change practitioner behavior. As trends move further toward digitization and including the community, we expect that this new and adaptive medical affairs strategy will allow pharma and biotech companies to reach more practitioners and more patients, in a more equitable way. If you’d like to learn more about our experience and discuss how we can partner to achieve similar results, click here to contact us.