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Moscow, March 19th, 2015
Future Vision in Oncology
Wieland Voigt, MD Ass. Professor
Answers for life.
Page 1
March 2015
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Aging population and addictions in Russia as driver for growing incidence of diseases such as
cancer
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Increased life expectancy
Growing incidence of diseases which
come with age such as
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Cancer # 2 cause of death in
Russia 2014
Ratio of the 65+ to the 15 to 64 population (%)
4/8/15
Cardiovascular disease
Cancer
Dementia
Joint diseases
……
4/8/15
4/8/15
Sources: United Nations, 2010 Revision of the World Population Prospects;
„Cancer will become the leading cause of death
in the United States by 2030“
Clifford A. Hudis, MD, FACP 2014
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March 2015
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4%
4/8/15
4/8/15
Source: Goss P. et al. Lancet15: 489-37,2014
Russia is world leader in smoking with 43.9 Mio smokers (31% of
population) in 2010
52 % of death in ages 15-54 are attributed to alcohol
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Cancer incidence and mortality in Russia
Cancer incidence prediction 2012 →
Cancer Type
20122035
Breast Cancer
57502 →
60891
Colorectal Cancer
59928 →
67643
Prostate Cancer
26885 →
31072
Lung Cancer
55805 →
61127
Stomach Cancer
38417 →
42973
Cervix Cancer
15342 →
14700
Uterus Cancer
20972 →
22325
2035
Cancer incidence and mortality in Russia
Source: Globocan 2012
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March 2015
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Performance indicators of the Russian healthcare system
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Mortality to incidence ratio in Russia ~ 0.64 compared to
0.44 in Germany
Life expectancy over time (men)
79
74
64
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Stagnating life expectancy over time compared to significant
increases in other major countries
Lacking availability of quality healthcare even in metropolitan
areas with often outdated medical facilities and equipment
Low number of clinical trials in progress for cancer indicating
low innovative capacity
Poor access to healthcare for general population due to
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Underfinancing of healthcare and growing percentage of private
expenditures
Understaffing in several areas
Increasing inefficiency of health care operations
Lack of access to affordable drugs
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64 63
68
76
67
47
Life expectancy 1965 (years)
Life expectancy 2011(years)
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Survey result amongst Moscow citizens
Percentage of respondents answering „good“
Availability of quality healthcare
Having areas to go at night that
are safe and fun
Moscow as a tourist destination
Beauty or physical setting
Availability of cultural opportunities
such as theater, museum and music
Source: gallup.com “Soul of the City survey in Moscow”
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March 2015
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Screening programs – an opportunity to impact on cancer related mortality in Russia
Screening in Germany1 and the USA2
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Screening in the Russian Federation3
Screening for 5 cancer types is paid for by the
insurances:
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Breast cancer (Physical exam and Mammography)
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Cervical cancer (PAP-Test)
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Prostate cancer (Physical exam)
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Skin cancer (Skin inspection)
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Colon cancer (Colonoscopy)
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No nationwide screening programs in place,
recommendation to screen for Breast and Prostate cancer
A few local projects on Breast cancer screening,
participation in rural areas is low
National Priority Project Health focuses on disease
prevention with an aim to reduce cancer mortality,
individual cancer screening at regular physical check ups
In the USA screening for Lung cancer (Low-dose CT) is
recommended for high-risk patients > 55 years old
Recommendations and Reasons
Breast cancer stage distribution3
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Implementing local (Moscow) or national screening programs for
major cancer types such as Breast Cancer, Colon Cancer, Lung
Cancer etc.
Screening helps detecting the cancer in early stages where curative
treatment is possible and costs for treatment are lower
Screening programs lower the mortality rate of cancer patients
4/8/15
1 Deutsche Krebshilfe
2 U.S. Preventive Services Task Force
3 Challenges to eff ective cancer control in China, India and Russia, Lancet Oncol. 2014 Apr;15(5):489-538. doi: 10.1016/S1470-2045(14)70029-4
Page 5
March 2015
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Improved outcomes due to innovations in cancer care
Cancer survival trends by cancer type in UK
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Improved overall 5 year survival in several major
cancer types such as breast cancer or prostate
cancer – cancer as a chronic disease ?
Improvements can be attributed to implementation
of
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early detection/Screening
Introduction of new classes of anticancer drugs
such as TKIs or Immunotherapies
advances in applications of radiation oncology
minimal invasive therapies
advanced imaging and molecular diagnostics
modern supportive therapy to control side
effects of therapy
centralization and specialization e.g. therapy in
cancer centers/multidisciplinary care
improved access to therapy
Education programs e.g. by Cancer Societies
March 2015
Source: cruk.org/cancerstrats 2014
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Economical burden of cancer care is rising dramatically
Mean Cost of Primary Radiation Therapy
Main cost drivers
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Growing cancer incidence and increased
cancer survival
Increased number of highly expensive targeted
drugs
Introduction of new treatment technologies
Growing usage of advanced diagnostics
Source: Nguyen P. et al. JCO 29: 1517-24, 2011
Increase in Healthcare spending in the US
Cost change, chemotherapy regimen for mCRC*
Immunotherapy
MABs
TKIs
* mCRC: metastatic colorectal cancer
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March 2015
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Certification and standardization to improve care quality and efficiency
As of today ….
Inappropriate deviations from
standards of care for cancer
cost more than $ 25,000 per patient
1 in 4 cancer patients have
treatment plans that do not conform to
evidence-based cancer care
Source: Poster presented at 2013 ASCO annual meeting, Chicago, 2013
…. need for
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Certification
Standardization and process optimization
Improved care quality and efficiency
Standardization & Benchmarking
Value based care approaches
Benchmarking
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Source: Voigt et al. PlosOne, 2014
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March 2015
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Molecular diagnostic & imaging as companion for modern targeted therapy
Lung Cancer CS IIIB
Therapy A
Therapy B
Therapy C
Conventional
Chemotherapy
Detailed tumor characterization
on anatomical, functional and molecular level
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Advanced imaging
Molecular tests
Targeted drug A
Targeted drug B
Increased therapeutical efficiency
Less side effects→ more quality of life
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Avoidance of unnecessary therapies→ increase quality
of life and reduce healthcare costs
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Targeted drug C
Targeted drug D
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March 2015
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Minimal invasive procedures shaping future therapy landscape
RFA
TACE
Potentials of Interventional therapy as
drivers
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Enabling therapy for less fit and elderly
patients
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Treatment on outpatient basis
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Reduction of mortality rates
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Shortening length of hospital stays
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Facilitating speedy recovery
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Reduction of healthcare cost for patients
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Opening new areas for therapy
Ablation procedural growth by organ
Source: MedMarket Dilligence Report
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March 2015
Vertebroplasty
Source: Radiologie Klinikum Koblenz
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Oncology services have to develop along the care continuum – erase existing boundaries
Hospital-centric model today
Drivers of model transformation
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Medical practice changes to focus on coordinated,
collaborative care across the continuum
Standardized care approaches to reduce care
variation
Care process redesign to reduce unnecessary work
in all care settings
Optimized service distribution to ensure the right
care at the right site
Financial incentives of the new value-based
payment models
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Inefficient, fee for service
Lack of coordination of services
Lack of integration of services
Hospital services
Population-centric model tomorrow
Physician and clinical services
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Prescription services
Value based driven payments
Integration of services to be patient
centered
Improved transition of care by IT
solutions
Home Health and Nursing home care
Other services
Source: http://healthaffairs.org
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March 2015
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Shift to outpatient care – enabling the continuum of care
Need for better transition of care from inpatient
to outpatient in value based payment systems
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Care coordination
Information exchange based on IT
solutions/electronic health records
Strengthening the role of general practitioners
and auxiliary services
Remote monitoring of patients to prevent
hospitalization
Standardized clinical care protocols
Preventive care
Outcome
Cost
Source: Medical Pharmacy & Oncology Trend report, 2012
Page 12
March 2015
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Cancer centers to increase care quality and outcomes
Growing demand for high quality cancer centers (drivers)
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Consolidation of services in well defined cancer centers
massive increase of complexity of oncological care with increasing
need for specialization
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patients expectation of well organized, high quality and efficient services which
requires centralization
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emerging need for multidisciplinary treatment and disease orientated integration
are
of disciplines
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increased focus on outcomes of therapy which tend to be better in specialized
Growing number oncology centers
centers, e.g. in breast cancer centers
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Patients desire to select centers for their therapy based on performance and
benchmarks (transparency of performance) “patient as consumer”
“One of the most important aspects of health care delivery for cancer
patients involves the need for centralization of treatment to high quality
centers.”
Beller, U. Int J Gynecol Cancer. 2012 Feb;22(2):177
Page 13
March 2015
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Value based care and risk/savings models to achieve cost control and cost effectiveness
From profitable procedures to well-managed patients
Strategic growth levers across payment models
Fee-for-service world
Value-based fee-for-service
world
Shared savings/
risk-based world
Profitable
procedures
Efficiently managed
care episodes
Engaged
patients
Procedural
specialists
Multidisciplinary
care teams
Cross-continuum
care management
infrastructure
Payer price
escalation
Episodic payment
margin expansion
Total cost of
care reduction
Source: Advisory Board
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March 2015
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Patient centered medical home (PCMH)
Patient centered medical home
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Comprehensive care: prevention/wellness, acute care, chronic care.
Requires a team of providers (physician, nurses, pharmacists,
nutritionalists, social worker educationers and care coordinators)
Patient centered: partnering with patients and families, respecting
patients needs, culture etc. Enable patients to manage their own care
Coordinated care: coordination across all elements of health care
system including specialists care, hospitals, home health care,
community services; critical for transition from inpatient to outpatient care
Source: parkwaymedicalgroup.com
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Accessible services: shorter waiting times, enhanced in person hours,
24/7 access to the care team, email and telephone
Quality/safety: commitment to quality improvement, evidence based
medicine & decision support tools, performance measurement &
improvement, measurement of patient experience & satisfaction
Sharing quality & safety data with public to create transparency as
commitment to quality
March 2015
Economic benefits of PCMH
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Reduced hospital care
Reduced need for emergency care
Reduced overuse of advanced diagnostic
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Molecular guidance for therapy selection and safe application
Current situation
Increasing complexity of oncological therapy with changes from
single to multiple drug regimens
Growing risk of toxicities due to drug interactions and differences in
patients metabolism
Rapidly evolving new knowledge can‘t be handled anymore by
individuals
Etc…
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Decision support tools - potentials
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Help physicians to optimize and plan cancer treatment
Increase safety of therapy application
Will enable less experienced to apply oncological therapies and will
help to mitigate shortages of oncologists
Could reduce cost of care
Increase productivity of hospitals by time savings
Could help to improve compliance to treatment guidelines and care
quality
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March 2015
Source: http://http://www.google.de/imgres?imgurl=http%3A%2F%2Fimg.medicalxpress.com
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Access to cancer care in Russia
Access to cancer care has been recognized as important variable to
determine outcome in cancer patients
Cooperating cancer center network
Russian situation
Decreased public funding of healthcare expenditures from 73.9% (1995) to 59.7
(2011) → increased burden of out of the pocket expenses
Lack of trained workforce in several areas central to cancer care
High discrepancies in quality between large metropolitan areas and rural areas
leading to delay of diagnosis and lack of timely intervention
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How to improve it ?
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Build more specialized cancer centers and treatment facilities to improve coverage
Strengthen the outpatient sector/departments primary care
Foster the building of care networks between cancer centers and surrounding care facilities
Implementation of telemedicine approaches/decision support tools
Optimize operational processes to increase efficiency of centers and reduce costs
Education of healthcare providers, adapt payment to increase motivation of professionals
Support international collaborations, clinical trials etc. to stimulate knowledge exchange
March 2015
Source: R. Hazin et al. Lancet 11:204-210, 2010
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Integrational components of Cancer Centers to consider (not exhaustive)
Clinical concept
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Clinical Catchment Area
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Clinical Solutions
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Patients
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Patient demand
Collaboration and education
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Regional collaboration within
core area
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Number of patients
Near Home concept
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Inpatient capacities
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Surrounding Hospitals
Best in class diagnostic & treatments
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Outpatient facilities
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Outpatient centers/offices
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Epidemiological trends
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Patient compliance
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Screening programs/ early detection
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Patient communication
Palliative Care/ Rehabilitation Program
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Patient centered care & access to therapy
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Sustainable clinical facility concept
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Department specific systems
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End to end workflows
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Hospital and Clinical Information
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System
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Integration of departments and services
Financial sustainability
(i.e. upcoming reimbursements)
March 2015
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Clinical research concept
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Education & training
Logistics
IT - Infrastructure
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Center strategy and
development
Collaboration with leading national and
international institutes on
Patient friendly infrastructure
Center Management
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Archive and Document
Management Solutions
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Patient Administration Systems
Consumable Consumption
Management
Fully automated supply systems
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Automated transport systems
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RFID tracking
Patient readiness concept
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Conclusions for the Russian Oncology Market
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Russia is facing a growing incidence of all major types of cancer with at present comparatively high mortality rate
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Further drive and manage cancer screening and preventive programs to impact on cancer incidence and mortality –
these could be allocated and executed by cancer centers
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Increase coverage through high quality cancer centers and integrate their services into a region to increase the
access to therapy. Drive multidisciplinary care
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Enforce quality and efficiency standards/benchmarking to control high quality care delivery
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Strengthen the outpatient sector by creation of care networks, decision support tools and education programs
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Improve specialized cancer diagnostics (Imaging, Laboratory, Pathology etc.) to support therapy individualization
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Change reimbursement from pay per performances to value based care and improve access to modern cancer drugs
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Adapt health insurance to reduce need for out of pocket payments for specialized therapies to increase access to
healthcare
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Improve environment for innovative clinical trials to improve access to care and innovations
March 2015
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Contact
Wieland Voigt, MD Associate Professor
Specialist for Internal Medicine, Hematology and Oncology
Palliative Medicine
Head of Clinical Competence Center Oncology
Siemens AG
Healthcare
Customer Solutions Division
HC CX CRM HES CCC ONC
Allee am Roethelheimpark 3 A
91052 Erlangen, Germany
Tel: +49 9131 84-6988
Mobile: +49 172 2790401
mailto:[email protected]
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March 2015
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