Cancer drugs: setting the record straight

Earlier this year, the subhead to an article in the The Economist read: ‘New cancer drugs are technically impressive. But must they cost so much?’ The question frames a debate that has generated increasing heat but little light over the past several years.

Almost 12 million Americans live with cancer according to the AACR Cancer Progress Report 2011 and around 150 people are diagnosed with cancer every hour in the United States. The good news is that decades of investment in drug development have changed the lives of people with cancer, allowing many to live longer and have a better quality of life. In fact, the Centers for Disease Control and Prevention reported a 20 percent increase in the number of cancer survivors over the past six years, largely due to earlier diagnosis and treatment.

Cancer drugs have become victims of their own success. Combination approaches to treatment have transformed what used to be a death sentence into survivorship for many people. With the introduction of an increasing number of medicines that attack specific cancer-causing mutations, progress will continue, as will new discoveries.

A recent editorial in the New York Times (November 8, 2011) says that: “If more patients get access to life-saving drugs, cancer patients will benefit greatly. Of the 35 approvals in the last fiscal year, seven provided major advances in cancer treatment, including two that were approved with a diagnostic test that helps to identify which patients are most likely to be helped.” But hope comes at a price.

Many complex factors impact the cost of cancer drugs, including:

• New personalized approaches to treatment, which limit the market size for many products
• The high cost – and high risk – of preclinical and clinical research.

Only one in 10,000 substances screened for anticancer activity will ever become a drug, and the cost of bringing a new drug to market is estimated to be $1 billion, according to Business Week (November 7, 2011, article by Carol Eisenberg). Of those cancer drugs that make it through the 10- to 15-year development and regulatory process, most are initially approved for relatively low-value indications (eg, rare or advanced cancers).

In the ongoing debate on the cost of cancer drugs, it is rare to hear a balanced discussion that takes into account the complexities, risk and rewards for all parties involved.

Critics often take a one-sided view
Critics of the pharmaceutical industry are quick to point out that “these new drugs sell well.” Cancer drugs, they claim, “could rescue big drug-makers from a tricky situation: more than $50 billion worth of wares will lose patent protection in the next three years.” This one-sided view defines the value of cancer medicines solely in terms of revenue and profit.

The Pharmaceutical Research Manufacturers Association (PhRMA) has shined a light on the investment required to develop breakthrough medicines – and potentially cures. But a broader coalition is needed to raise the volume and introduce more balance into the debate. The current polarization surrounding cancer drugs misinforms the public about the real value of medicine.

Extraordinary progress has occurred in the ‘War on Cancer’. Steve Jobs’ battle with pancreatic cancer, after some initial reluctance to adopt an aggressive treatment strategy, is a powerful example of the impact and value of treatment. Diagnosed with an incurable cancer in 2004, Jobs was able to keep death at bay for seven years.

Accessing the best healthcare options, including experts’ advice, was not a problem for Steve Jobs. But patients with more modest goals and aspirations also want to be allowed the chance to reach important milestones: a graduation, a wedding or an anniversary.

Oscar Wilde famously defined a cynic as a person “who knows the price of everything and the value of nothing.” It is all too easy to lose sight of the value of cancer medicines amid the often cynical rhetoric on price.

Unfortunately, bio-pharmaceutical companies’ reputation is not the only casualty of such rhetoric. Access to care is also in the crosshairs.

A global crisis
The challenge for healthcare communicators is to help drug development companies set the record straight about the value of their products. These discussions will impact the future of cancer care.

All over the world, proposed government initiatives aim at curbing the availability of costly cancer treatments. In Britain for example, the government is planning to introduce ‘value-based pricing’ by 2014, with a system to price drugs not just for their efficacy, but also for their ‘wider societal benefits’.

In America, the pressures have been on passing part of the cost of treatment to individual patients privately insured.

But clearly, the time has come for critics to stop ‘picking on’ cancer drugs and for the pharmaceutical and biotechnology industry to help restore their image as industry leaders who are altering the course of disease and delivering valuable solutions. Mobilizing cancer advocates to enter the debate should also be on the agenda.

Expanding the focus and delivering a powerful message
As healthcare communicators, we play a major role in shaping and delivering messages about the cost of drug development and the value of treatments. Traditionally, our efforts have focused on promoting new drugs. Most companies start to think of public relations support when a product is near regulatory approval. Rarely do drug development companies promote the huge investment of time, resources and talent required to translate basic scientific insights into a viable medicine. Early stage promotion is often limited to the investment community.

Our relative silence on research and development (R&D) is a reflection of how communications resources are typically prioritized. Since drug discovery and early-stage development are not supported by product marketing budgets, communications programs for R&D are often underfunded or non-existent. This is problematic for an industry that stakes its reputation in large part on scientific innovation.

Giving short shrift to R&D communications also misses a critical opportunity to demonstrate how companies – in partnership with academia, government research organizations, and regulators – are working to reduce the time and cost of drug development and improve the value of marketed medicines. For example, new cancer drugs are increasingly being developed with companion diagnostics to identify who is most likely to benefit from treatment.

Our approach to communicating the true value of new medicines also tends to be limited in its scope. Diverse perspectives and critical dimensions, including the impact of new treatments on quality of life and quality of care, are often lacking.

To move the debate forward in a productive way, communications must make a great effort to:

• Increase awareness of discovery science and pipeline research to highlight the investment required to deliver breakthroughs in cancer treatment
• Create programs that highlight the value of a product to payers and government
• Mobilize potential advocates early on – they will be invaluable in the future
• Engage in the debate about the high cost of healthcare with good will and respect
• Demonstrate our commitment to find ways to address the financial challenges faced by the healthcare system worldwide
• Stay away from promotional programs that may look frivolous or extravagant.

There must be more focus on messages that are:

• Compelling, and encourage healthcare stakeholders to see the value of the expense against research
• Differentiating – pointing out the exclusive efforts the industry makes to find drugs that address major health conditions like cancer that affect so many people
• Relevant to each audience, highlighting the impact of the money spent on research for each audience
• Credible – and defensible – underlining the rationale for drug costs to fund research, with proof of success that has both rational and emotional impact.

More than ever it is critical to involve and inform patients, healthcare professionals and the general public to ensure an intelligent and constructive debate.
For the oncology community, including patients and advocates, the time is now.

The Author
Laura Schoen is President, Global Healthcare at Weber Shandwick.
She can be contacted at lschoen@webershandwick.com