Countries worldwide are trying to balance rising costs, limited budgets and improving the quality of cancer care. In her talk, HPI research fellow Alessandra Ferrario presented achievements, challenges, and approaches that countries are using to improve global access to cancer medicines. Drawing from her research on performance-based agreements for medicines, utilization of cancer medicines and end-of-life care, she illustrated current challenges facing health care systems to enable equitable access while ensuring long-term financial sustainability.
In a joint HPI and CarPE seminar on October 9, Dr. Jonathan Darrow, Assistant Professor at Harvard Medical School and faculty member in the Program on Regulation, Therapeutics, and Law, discussed these eight - possibly unexpected - causes of high drugs prices in the US: rebates, insurance coverage, generic drugs, orphan drugs, biologics, hospital mark-ups, advertising, and, importantly, minimal efficacy. He offered several approaches to address high drug prices.
On September 28th, Anita Wagner served as co-chair of and gave the opening keynote presentation on cancer therapeutics in health systems at the 4th International Forum on Drug Safety and Policy in Xi’an, China. Hao Yu presented on the role of providers in medicines use.
On September 27th, Anita Wagner and Hao Yu discussed research on cancer therapeutics in China with faculty and students at the School of Pharmaceutical Sciences, Department of Pharmacy Administration & Clinical Pharmacy, Peking University.
On September 24th, Anita Wagner presented "Cancer therapeutics in health systems – at the intersection of science, politics, and economics" at the Healthcare Executive Leadership Program for Chinese Executives in Boston, USA. This program was organized by the DPM China Center.
On September 5th, Anita Wagner presented " Ethics on the edge – how the Ebert Award supports bridge building" in the weekly departmental seminar. She discussed how ethically challenging health systems questions arise around cancer therapies at the intersection of science, politics, and economics and illustrated, using the social-ecological model as a framework, ongoing and planned research to generate answers to these questions.
Collaborator and former HPI fellow Huseyin Naci presented "Risk of bias of randomized controlled trials supporting European Medicines Agency approvals of cancer drugs" at DPM on Wednesday, August 7th.
Research Fellow Alessandra Ferrario, together with colleagues at Boston University, the Niger Delta University, and the Nigerian FDA, published an editorial in the BMJ Global Health on the need for system thinking and increased training for pharmacists in substandard and falsified medicines. While the extent to which SF affects countries at different levels of health system development varies, SF are a global problem.
The authors cite a recent paper that sheds light on how underfunded universal health coverage systems could provide an incentive for suppliers to cut corners and for patients to seek medicines from alternative and potentially risky suppliers in countries at all levels of income. Therefore although the problem has been emphasized in countries with developing drug regulatory systems, the issue is really global and can affect all medicines from antibiotics to cancer medicines.
The high cost of new cancer medicines makes these medicines an attractive target for falsification and theft. In 2012 and 2013 for example, counterfeit bevacizumab was found on the US market.
In a context of global supply chains, addressing the problem of substandard and falsified medicines requires increased vigilance and the coordinated action of different professionals, government bodies as well as civil society. As the final custodians of medicines before they are dispensed to patients, pharmacists have an important role to play. This editorial aims to start a discussion on the need for multidisciplinary solutions, system thinking and the recognition that this is not just a problem of developing countries
A new qualitative study from former HPI fellow Christine Leopold, Carina Araujo-Lane, Carol Rosenberg, Melissa Gilkey, and Anita K. Wagner investigated OOP considerations in the care delivery process and oncologist's perspectives on value frameworks.
HPI Research Fellow Alessandra Ferrario presented on uptake of WHO-listed essential cancer medicines in China, Indonesia, Kazakhstan, Malaysia, the Philippines and Thailand at the international health economics congress in Basel (iHEA), Switzerland on July 17, 2019. The presentation was part of a session on Access to Medicines in Health Systems in Low- and Middle-Income Countries organized by the Medicines in Health Systems (MiHS) Thematic Working Group of Health Systems Global (HSG) – an organization dedicated to promoting health systems research and knowledge translation – and chaired by Associate Professor Sachi Ozawa from the University of North Carolina at Chapel Hill. Also presenting were colleagues Samuel Orubu from Niger Delta University and Vera Lucia Luiza from the School of Public Health, Fiocruz, Rio de Janerio.
Recently, Associate Professor Anita Wagner joined the Dana-Farber/Harvard Cancer Center (DF/HCC). She joins other DPM faculty members of the DF/HCC, including James Frank Wharam, Maryam Asgari, and Natasha Stout.
Alessandra Ferrario, Research Fellow at HPI, gave the opening presentation at the international workshop on risk-sharing agreements for health technologies in Brasília, Brazil on 13 May 2019. This workshop was organized by the Ministry of Health of Brazil. Alessandra presented evidence on the international experience with risk-sharing agreements for high-priced medicines including cancer medicines. During her visit to Brazil, she also visited the Faculty of Pharmacy at the Federal University of Minas Gerais to foster collaboration with a local researcher on cancer care and access to medicines. She concluded her visit by giving a presentation on her global work on cancer at the National School of Public Health at the Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro.
Dr. Robin Yabroff, Strategic Director, Economic Burden of Cancer, at the American Cancer Society visited CarPE on Wednesday, April 24th. She discussed with CarPE fellows and faculty extensive research she and her colleagues have conducted on types of medical financial hardship among cancer survivors in the US and potentially modifiable factors at different levels in the health system.
Dr. Yoursuf Zafar, Associate Professor of Medicine and Public Policy at the Duke Cancer Institute, spoke with CarPE members about the reasons for and effects of financial toxicity of cancer care, and strategies to intervene, specifically at the patient and provider levels of the health system.
Dr. Stacie Dusetzina, Health Policy Ingram Associate Professor of Cancer Research at Vanderbilt University Medical Center, visit DPM to connect with CarPE faculty and fellows. She presented results of her research examining policy interventions to improve access to cancer drugs, in light of rapidly increasing prices.
On March 28th, DPM Research Fellow Alessandra Ferrario presented an e-poster on her global research on access to essential medicines in six Asian countries at the 6th Annual State of Global Health Symposium. The poster session featured various presentations on how to improve access to care for cancer patients in low- and middle-income countries. The symposium was opened by a keynote speech by the National Secretary of Health, Argentina who discussed Trade-offs Between Effectiveness, Equity and Sustainability of Emerging Health Technologies in low- and middle-income countries. This event provided a forum for interactions and exchange between academics, scientists and emerging social entrepreneurs.
On February 4th, Biostats Research Fellow Dr. Dongdong Li (pictured) presented "Statistical Inference Using Large Administrative Data on Multiple Event Times, with Application to Cancer Survivorship Research." In 2016, there were an estimated 15.5 million cancer survivors in the United States. This number is expected to increase to 20.3 million by 2026. This research was motivated by the need to address questions such as: 1) Are breast cancer survivors at a higher risk of cardiovascular disease (CVD) compared to the general population? 2) Is there any association between relapse/second cancer and CVD? and 3) How many treatment and stage diagnosis affect survivor CVD outcomes? Dr. Li developed statistical approaches to analyze right-censored multivariate event time data. She conducted both asymptotic and simulation studies to examine the consistency, efficiency, and robustness of the proposed approached and applied the new methods to data collected by the British Columbia Breast Cancer Survivorship Program.
Ed Silverman, senior writer, and Pharmalot columnist presented January 30, 2019, at the HPI seminar on the issue of drug pricing in the US and globally. Increased drug spending is largely driven by the introduction of new high-priced patent-protected medicines, particularly cancer medicines. Ed Silverman covers pharmaceutical policy for STATnews and has written widely on issues around prices of cancer medicines, most recently commenting on the 2018 World Health Organization report on cancer drug prices which is being discussed at the 144th session of the WHO Executive Board 24 January - February 2019.
Congratulations to CarPE and HPI collaborator Dr. Larissa Nekhlyudov on the newly published Handbook of Cancer Survivorship. Dr. Nekhlyudov, a clinician-researcher who cares for cancer survivors at the Dana-Farber Cancer Institute and Dr. Michael Feuerstein, a psychologist and cancer survivor himself are co-editors of the Handbook. This second edition of the authoritative handbook (https://www.springer.com/us/book/9783319774305) gives a wide range of providers practical insights and strategies for treating cancer survivor's long-term physical and mental health issues. With survivorship and its care becoming an ever more important part of the clinical landscape, this book is an essential reference for oncologists, rehabilitation professionals, public health, health promotion, and disease prevention specialists and epidemiologists.
On December 12th, Alessandra Ferrario (pictured below), a postdoctoral fellow at DPM, presented "Availability and use of cancer medicines in six Asian countries working towards universal health coverage" at the Dana Farber/Harvard Cancer Center (DF/HCC) Celebration of Early Career Investigators in Cancer Research. This annual half-day symposium aims to showcase the young talent at the DF/HCC who are producing key research in several areas of population science, including epidemiology, biostatistics, outcomes, diversity, and survivorship. The date, 12/12, is also International Universal Health Coverage Day, which marks the anniversary of the United Nations' historic and unanimous endorsement of universal health coverage (UHC) in 2012. The resolution urges all countries to accelerate progress toward UHC as an essential priority for international development.
On November 14th at noon at DPM, Dr. Oreofe O. Odejide, MD, MPH, presented, "Why are Patients with Blood Cancers Less Likely to Receive Quality End-of-Life Care", as part of the Health Policy and Insurance Research Seminar Series. In this seminar, she examined patient, physician, and policy factors that affect the rates of intensive care near death and low rates of timely hospice enrollment for blood cancer patients. Dr. Oreofe is a member of the Dana Farber Cancer Institute Hematologic Malignancies staff and a member of the Division of Population Sciences.
Anita Wagner (pictured below) gave an invited presentation, "Challenges of new cancer therapeutics in health systems: Financial toxicity and uncertainty", at the 8th U.S.-China Health Summit in Chengdu, China.
Anita Wagner presented, "New cancer therapeutics in health systems: Opportunities, challenges, approaches, questions", at the Peking Union Medical College School of Public Health in Beijing, China.
Anita Wagner has been chosen as a Visiting Scholar at The Hastings Center, where she'll spend two weeks conducting bioethics research. On Tuesday, August 7th, Dr. Wagner, pictured above, presented a seminar at the center, entitled, "New cancer therapeutics in health systems: opportunities and challenges".
As part of the Division of Health Policy and Insurance Research (HPI) Seminar Series, CarPE is proud to co-sponsor a talk by Pari Pandharipande, MD, MPH on Wednesday, June 20th at noon at the DPM. In her talk, "The Role of Imaging in Decision-making: Insights Gained from Decision Science", Dr. Pandharipande will discuss research projects from her group at Massachusetts General Hospital that utilize prospective observational and simulation modeling study designs to address the value of imaging in clinical settings ranging from emergency care to cancer treatment.
Division of Health Policy and Insurance Research (HPI) and CarPE fellow Alessandra Ferrario will present "The Intensity of Care at the End-of-Life in Women with Breast Cancer" as part of the Division of Health Policy and Insurance Research (HPI) Seminar Series on Wednesday, June 6th at noon at the DPM.
Anita Wagner and Alessandra Ferrario participated in a meeting at SickKids Hospital in Toronto to discuss collaboration opportunities for improving access to medicines for pediatric cancer in low- and middle-income countries. This collaboration builds on priorities identified at the Pediatric Oncology Roundtable to Transform Access to Global Essentials (PORTAGE), which took place in Sharjah, United Arab Emirates (UAE) in January 2018. Despite advances in the treatment of childhood cancer and high rates of survival in high-income countries, there is poor and variable survival in low- and middle-income countries, where most children with cancer live. Improving access to medicines is a key component in strengthening health care systems to improve health outcomes of children with cancer worldwide.
The team is pictured above. From the left: Phoebe Lombard (SickKids); Dr. Sumit Gupta (SickKids), Dr. Lindsay Frazier (Dana-Farber Cancer Institute/Harvard Medical School), Dr. Avram Denburg (SickKids), Anita Wagner (DPM/Harvard Medical School), Professor Susan Horton (University of Waterloo), Dr. Brandon Maser (SickKids), and Alessandra Ferrario (DPM/Harvard Medical School).
Anita Wagner was among the distinguished speakers at the Charite BIH Entrepreneurship Summit 2018: From Vision to Patient, sponsored by the Berlin Institute of Health. Dr. Wagner will take part in the Novel Funding Models / Affordability of Medication session, on the panel titled When Markets Fail Patients.
As part of the Division of Health Policy and Insurance Research (HPI) Seminar Series, CarPE is proud to co-sponsor a talk by HPI fellow Christine Leopold, PhD, on Wednesday, April 11th. Her talk, "(Un)affordability of anticancer drugs and the need to set priorities based on value measures", presented three studies using quantitative, qualitative, and conceptual frameworks to tackle the question on the affordability of anticancer treatments and to propose ideas on how to set priorities based on value measures.
CarPE team members and collaborators from Dana Farber Cancer Institute and the Ontario Institute for Cancer Research had recent work published in the Journal of Clinical Oncology. The paper, titled "Breast Cancer Diagnosis and Treatment after High-Deductible Insurance Enrollment", was the result of work conducted by Frank Wharam, Fang Zhang, Christine Lu, Anita Wagner, Stephen Soumerai, Dennis Ross-Degnan, Larissa Nekhlyudov, and Craig Earle. The study found that women who were switched to high-deductible health plans (HDHPs) experienced delays in breast cancer diagnostic testing, early-stage diagnosis, and chemotherapy initiation.
On Thursday, February 8th, Anita Wagner presented "Expanding a Portfolio of Health Systems Research on Cancer Therapeutics" to the Department of Population Medicine as part of the department's Brown Bag Seminar program. This presentation detailed progress made as part of Dr. Wagner's Robert H. Ebert Career Development Award. These awards support the work of faculty of the Harvard Medical School Department of Population Medicine who demonstrate exceptional promise in the area of ambulatory care, primary care, or preventative medicine. The awards provide resources to develop leading-edge programs in teaching and research to pursue scientific and professional activities consistent with the department's mission.
We welcome back Anita Wagner (pictured above) from Singapore, where she gave two talks at the Asian Bioethics Review Research Conference on "The Ethics of Universal Coverage: Towards a Holistic Framework for Access to High-Cost Medical Interventions". In this conference, participants and facilitators discussed how existing ethical frameworks may be augmented to help policy-makers and healthcare administrators define approaches for providing access to expensive innovative therapies, in the face of multiple unmet health care needs and constrained resources. Dr. Wagner was invited to give a keynote address, "Highly-priced (cancer) medications: policy approaches", and the presentation, "Highly-priced cancer medications: issues for universal health coverage".
Fellow Alessandra Ferrario, pictured above left with Drs. Lindsay Frazier and Avram Denburg, attended the Pediatric Oncology Roundtable to Transform Access to Global Essentials (PORTAGE), which took place in Sharjah, United Arab Emirates (UAE). Growing recognition of the mounting role that pediatric cancer will play in global childhood mortality has created a window of opportunity for innovative collective action on this issue. Childhood Cancer International (CCI) in collaboration with The International Society for Pediatric Oncology's (SIOP) Essential Medicines Working Group (EMWG) have committed to joint engagement with key academic, policy, advocacy, and industry stakeholders to advance priority actions aimed at improving global access to cancer medicines for children.
With the generous leadership, support, and collaboration of Friends of Cancer Patients (FOCP), Sharjah, UAE, CCI in collaboration with SIOP have convened PORTAGE. This inaugural meeting was championed and hosted by the FOCP. During the meeting, representatives from the global childhood cancer community, international health governance institutions, international development institutions, civil society, corporate partners, academia and the pharmaceutical industry jointly discussed tractable, scalable, and sustainable solutions to address barriers to global access to pediatric cancer medicines and radiotherapy.
On Tuesday, December 12th, CarPE welcomed Ann M. Geiger, PhD, MPH, Deputy Associate Director of the Healthcare Delivery Research Program within the National Cancer Institute's Division of Cancer Control and Population Sciences. Dr. Geiger's presentation, "Cancer Care Delivery Research - Why It Matters" addressed the need for increased attention to cancer care delivery, the lack of an adequate evidence base to guide this complicated care (which often involves many different types of clinicians over an extended period of time), and how NCI is promoting research to address this gap. It was a most welcome and informative visit! Pictured above, from left to right, are Mei-Sing Ong, Christine Leopold, Anita Wagner, Ann Geiger, Dennis Ross-Degnan, and Frank Wharam.
Mei-Sing Ong participated in the 2nd annual Adolescent & Young Adult Cancer Congress, "Working Together - Achieving More". This research strategy meeting was presented by Teen Cancer America.
CarPE members learned more about a new generalized platform for capturing health outcomes and exposure directly from patients. This new platform was developed by DPM programmers and can be adapted to a variety of research questions. Zac Wyner, pictured above, and Chayim Herzig-Marx presented to the group.
CarPE Co-director Natasha Stout, PhD, pictured above, attended the 2017 DCCPS New Grantee Workshop, held September 18-19, in Washington, DC. Sponsored by the Division of Cancer Control and Population Sciences of the National Cancer Institute, the workshop invited new extramural investigators with information, tools, resources, insights and insider perspectives to help successfully manage current grants and to understand future funding opportunities. Dr. Stout was recently awarded her first R01, "Understanding the Impact of Breast Density Notification Laws on Supplemental Breast Cancer Screening Use and Outcomes".
Members of CarPE (pictured above from left to right: Mei-Sing Ong, Yuhree Kim, and Christine Leopold) attended a two-day training workshop sponsored by OptumLabs. This hands-on, intensive boot camp focused on the applied uses of the OptumLabs data asset and how to use it to maximize research opportunities and insights. Researchers received in-depth training, met members of the OptumLabs team, and discussed study design and how to best select a research view to answer different research questions.
Postdoctoral Research Fellow Melanie Kornides, ScD, MPH, MS, BSN, pictured above, practiced her job talk, “Cancer prevention in pediatrics: Lessons Learned from HPV Vaccination in the U.S.” at a DPM Brown Bag Seminar on September 21st. Dr. Kornides is a postdoctoral research fellow at DPM’s Center for Healthcare Research in Pediatrics (CHeRP) and the Center for Cancer Policy and Program Evaluation (CarPE). She is currently applying for research faculty positions. She brings over 10 years of clinical practice experience as a registered nurse and family nurse practitioner to her research program in cancer prevention and primary care for children and adolescents.
Christine Leopold (pictured above, right) and Donna Barry, Executive Director of Global Oncology (pictured above, left), presented a poster on "Global cancer initiatives in low and middle income countries - measuring what exists to identify what is missing" at the 2017 pre-Congress of the International Health Economics Association in Boston on July 7, 2017.
Christine Leopold (pictured above, left) and Larissa Nekhlyudov (pictured above, right), presented abstracts, including The Impact of the Affordable Care Act on Cancer Survivorship, at the American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago.
CarPE hosted an informative webinar presented by Joe Henk and Lisa Basile of OptumLabs. This detailed overview of the OptumLabs Data Warehouse highlighted cancer research capabilities.
CarPE co-hosted a department-wide DPM Strategies Seminar to showcase and review datasets available to faculty, with a focus on how each can support cancer-related research.
Melissa Gilkey presented a talk, "Which messages should providers use—and avoid using—to motivate HPV vaccination?" at the 2017 Annual Meeting of the Pediatric Academic Societies in San Francisco, CA.
Anita Wagner was invited to present "Targeted cancer therapies in low and middle-income countries: A health system issue" at the Radcliffe Seminar, "Redesigning Health Systems for Precision Medicine".
Frank Wharam's abstract, “Breast Cancer Diagnosis and Treatment before and after High-deductible Insurance Enrollment”, was chosen for a plenary presentation at the Cancer and Primary Care Research International Network (Ca-PRI) 2017 meeting in April in Edinburgh, Scotland.
Melissa Gilkey presented a talk, "Parents who decline HPV vaccination: Who later accepts and why?" at the 2017 Annual Meeting of the American Society of Preventative Oncology. Fellow Melanie Kornides presented a top-ranked abstract of the same name at the conference.