Despite significant scientific achievements, cancer remains a tough opponent in the healthcare industry. Traditionally, efforts to combat the disease focused on episodic medical interventions, where ‘successful’ outcomes were determined by assessing the efficacy and safety of a drug or treatment against the standard of care.
While this approach has unlocked a myriad of therapeutic options for patients, a growing body of evidence shows that exogenous factors, such as genomics, behaviour, and social and environmental influences also play a key role in improving the effectiveness of cancer treatments.
Fuelled by technological advancements, patient support programmes (PSPs) – also known as patient assistant programmes – are gaining attention as a potential way to deliver continual care for oncology patients.
In contrast to the episodic approach to treatment, PSPs recognise that, for the millions of patients living with cancer across the UK, their conditions, symptoms, and treatments do not cease between appointments. In fact, there is a wealth of knowledge to be found in the day-to-day experiences of cancer patients. Yet, until relatively recently, capturing and collecting this data was challenging for HCPs and drugmakers.
As Rayna Patel, CEO and co-founder of Vinehealth, explains, “There is a complete dearth of data around how patients are experiencing their care, and that has a massive knock-on impact on patient quality of life, clinician day-to-day work burden, and the understanding by pharma companies and drug developers as to how they can deliver drugs with the greatest impact and maximise revenues that are associated with that, given the huge amounts that we spend on drug development.”
Although cancer treatment is most commonly depicted within the clinical environment, in reality, most patients living with cancer will spend the majority of their time outside of a hospital. Having only brief and intermittent interactions with their doctors to discuss what they need to do to self-manage their health at home, these individuals and their loved ones face the prospect of navigating the complex landscape of cancer treatment on their own.
For Patel, this disconnect between the clinical setting and self-management at home became apparent through her work as a doctor and neuroscientist. Leveraging her interest in behaviours and psychology, she began to explore how behavioural science could be applied in supporting patients and clinicians in the real-world environment.
“There’s a real gap there, between all the things the patients are having to do in their own home and in the community, that really impacts their outcomes that are happening outside of that traditional care model,” she explains. “A lot of deterioration or development of toxicity happens away from the care team. Often, there is a real advantage both from a survival and outcome perspective, but also from a quality-of-life perspective, to be dealing with those deteriorations and to be responding in a really rapid, but also individualised way, to what a patient is going through.”
Having identified an area of unmet need in cancer care, Patel set about finding a solution to bridge the gap between clinic and home, joining forces with Vinehealth co-founder and CTO, Georgina Kirby, to explore the potential of using PSPs to help support cancer patients and care teams.
With PSPs, patients can actively play a role in monitoring and reporting changes in their condition. Using AI and behavioural science, these tools can help HCPs deliver more personalised support. For example, providing prompts to take medications, and allowing patients the opportunity to log symptoms and medication side effects as they experience them. As Patel highlights, this can have a substantial impact on a patient’s behaviour.
Beyond expanding our understanding of cancer care, evidence shows that when cancer patients track and share their lived disease experience with their clinician, median overall survival can increase by five to seven months.
“We often term this patient activation,” she says. “It does really change how a patient feels about their disease, how well they manage it, and their outcomes. There is a real benefit and real evidence to improving that level of patient activation.”
When exploring the value of PSPs in cancer care, it is important to keep in mind that doctors can only act on the information provided to them. However, what may be an important symptom or detail to an oncologist may get lost in the ether between appointments if the patient doesn’t understand what to look out for or prioritises other concerns during their allocated appointment time.
“It’s one of the biggest difficulties as a clinician, that you don’t necessarily have all the information that you need to understand who needs your help and when,” says Patel. “Often your appointments are short, they might be 20 minutes, 30 minutes, and in that time, you have to gather a full history of what a patient has experienced. Then create a management plan, and most importantly, communicate that management plan and make sure the patient understands it, will follow it, has bought into it, and wants to follow it.”
For resource and time-limited HCPs, this traditional pen-and-paper approach to collecting patient information is inefficient, particularly when compared to the capabilities offered through data-driven digital PSPs, which collate patient information into a comprehensive overview of that individual’s experience and symptoms. This personalised patient data removes potential communication barriers that can hamper cancer care, as doctors can make more informed decisions about care and identify potential concerns early on.
“Rather than having a default appointment schedule of being seen every six weeks and having to come in and say, ‘Actually, I’m fine’, and being sent home again, and other times coming in and saying, ‘I was really unwell three weeks ago and I ended up in A&E’, which is often not the right place for people with complex chronic conditions, [PSPs allow patients to say], ‘I’m unwell this minute and this is when I need an appointment’,” explains Patel.
Beyond advancing everyday cancer care, PSPs can also offer significant benefits for the broader healthcare landscape, notably pharmaceutical companies. Pharma companies spend millions researching and developing new cancer therapies, the success of which will likely be impacted by the same insights that can be collected through these patient platforms.
In previous years, technological and resource limitations meant that accessing this information was a challenging task for pharma companies. Similar to the situation experienced by HCPs, information gaps between home care and clinical care obscured key behavioural and treatment insights from drugmakers. However, thanks to recent drives towards greater digital adoption and patient centricity in healthcare, pharma companies can now partner with PSPs to remove the blinders of traditional cancer care outcome measurement.
Speaking on the benefits that PSPs offer pharma companies, Patel says: “Patient support programmes can be really bespoke around their drug. For example, through a self-serve configuration and through drug-specific information and patient-specific support. Using those programmes to accompany newly launched drugs could really change patient engagement and medication uptake and adherence, closing the gap between what we see in clinical trials and in the real world.”
Adherence is a particular area where pharma companies can leverage PSP data. It’s a costly concern, with €125 billion lost each year across Europe due to non-adherence to medication. For Patel, this is where partnering with a PSP can help drugmakers to better understand why patients choose not to take their medications and address areas of unmet need in future developments.
She spotlights a study that Vinehealth conducted with The Royal Marsden, which showed that patients dramatically improve their medication adherence and that they experience a better quality of life whilst using the tool.
“We had a 52% increase in medication adherence, which was really stunning, and 87% of patients reporting that they had a better quality of life whilst using the tool,” she says. “Really importantly, we had something like 98% of patients engaging really well with using it across the age spectrum, across the geographic and demographic spectrum.”
For Patel, seeing PSPs’ impact on HCPs and patients is a rewarding sign that the combination of behavioural science and technology can have tangible benefits in oncology; not only in improving survival rates, but in the quality of life for those living with the disease.
“We had a 90-year-old lady in one of our studies who had never used a smartphone before, never used an app before, but she borrowed her daughter’s for the purpose of a small study,” Patel notes. “She said that it was an absolute revelation to be able to remember her medications with ease, be able to communicate with her clinician without getting stressed by those appointments, and being able to loop in her daughter and her loved ones into her care and feel like she was being taken care of.”
Taking care of individual patients is a critical piece of the PSP puzzle in oncology, particularly as the industry pursues personalised treatment. Using PSP data, HCPs can identify where patients may need more support, which can, in turn, lead to more appropriate allocation of resources, such as developing long-term plans for patient follow-up interactions.
Cancer can be scary and confusing for both those living with the condition and their loved ones. PSPs empower patients to take an active role in their treatment, which, as Patel highlights, can be the spark that drives behavioural change.
Looking to the future, Patel notes that the opportunity to collaborate with pharma companies and patients is only growing as more evidence around the benefits of PSPs emerges.
“The fact that we can deliver such massive benefits across these three stakeholders [patients, HCPs and pharma companies] who all have aligned intentions in many ways, is really important,” she says. “I think if you can capture that data and that information in a robust, continuous way, it will enable patient-centric, individualised care and transform healthcare in the future.”
Dr Rayna Patel is a medical doctor & neuroscientist with an MPhil in Translational Medicine. She has extensive experience in academia (Cambridge, Harvard, MIT, Columbia) and was a Post-Doctoral Fellow of Clare Hall College, Cambridge. Rayna has subsequently held strategic & commercial roles in government policy, tech start-ups & the Cabinet Office’s Nudge Unit, where she used behavioural science to rewire patient behaviours through digital products.
She is currently CEO and co-founder of Vinehealth, a digital platform using a combination of behavioural science and AI to improve the quality of life and survival of cancer patients, whilst generating crucial real-world data to better inform healthcare delivery and drug development.
Vinehealth’s platform uses behavioural science and AI to increase the quality of life and survival of cancer patients. The Vinehealth mobile app allows patients to track, understand, and optimise their care, supporting them to feel in control and better self-manage. Patients can track data on symptoms, side effects, medications, and appointments.
This information is seamlessly integrated with lifestyle data from smartphones and wearable devices, and machine learning delivers highly personalised behavioural nudges to support self-management. Through this, the platform generates highly valuable patient-reported outcome data and real-world data to inform healthcare delivery and drug development.