IQVIA Survey Implications

Summary

In this episode, Dr. Alyssa McManamon and Dr. Wayne Jonas discuss the results of a yearly IQVIA survey on attitudes and access to integrative approaches for whole person cancer care. The survey shows an increase in positive patient attitudes and usage of integrative oncology. However, there is still a gap between what patients want and what health systems offer. Patients are using complementary therapies to improve their survival odds and manage side effects. The survey also highlights barriers to integrative oncology, such as the need for funding, adequate staff, and clinical guidelines. The role of oncologists in initiating conversations about integrative oncology is crucial, but there is a communication gap between patients and oncologists.

Takeaways

• Positive patient attitudes and usage of integrative oncology are increasing.
• There is a gap between what patients want and what health systems offer in terms of complementary therapies.
• Patients are using complementary therapies to improve survival odds and manage side effects.
• Barriers to integrative oncology include the need for funding, adequate staff, and clinical guidelines.
• There is a communication gap between patients and oncologists regarding integrative therapies.

Chapters
00:00 Introduction and Background
01:24 Definition of Whole Person Care
02:24 Increasing Patient Attitudes and Usage of Integrative Oncology
03:18 Patients Using Complementary Therapies to Improve Survival Odds
04:11 Barriers to Integrative Oncology
05:33 Patients Choosing Healthcare Systems that Offer Integrative Therapies
06:20 Providing Whole Person Care as a Cancer Team
07:17 The Role of Oncologists in Integrative Oncology Conversations
08:40 Communication Gap between Patients and Oncologists
09:06 The Importance of Guidelines in Integrative Oncology
12:41 Barriers in Implementing Integrative Therapies
16:43 Implementing Integrative Therapies in Oncology Practice
20:18 Future Outlook and Educational Tools

Resources

• IQVIA Survey (2022)
• SIO/ASCO Pain Management Guidelines
• CME Course: Whole Person Cancer Care Course 

Want to learn more?
Check out the book: "Healing and Cancer: A Guide to Whole Person Care"
Vis

Check out the book: "Healing and Cancer: A Guide to Whole Person Care"
Visit https://www.healingandcancerbook.com/ for more information.

Connect:
Twitter: @DrWayneJonas
Facebook: Dr. Wayne Jonas
Instagram: @drwaynejonas
LinkedIn: Dr. Wayne Jonas
LinkedIn: Alyssa McManamon

Visit Healing Works Foundation www.healingworksfoundation.org for more information.

Dr. Wayne Jonas is a board-certified physician and Dr. Alyssa McManamon is a triple-board certified hematologist/oncologist. The opinions expressed on this show are those of the hosts and guests and do not necessarily represent the views and opinions of their places of employment, the Department of Veterans Affairs, or the United States government. The opinions expressed on this podcast are meant for entertainment and education and should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Wayne Jonas and Dr. Alyssa McManamon have no relevant financial disclosures.

Transcript

Please note that this transcript is produced electronically and may not be an accurate representation of what was said. It may not be reproduced, edited, altered or modified in any way without prior written permission. Any use of quotes or excerpts from this interview requires explicit permission from Healing Works Foundation. Please contact us at healing@healingworksfoundation.org if you would like to use any part of this transcript for quotes or other purposes.

“How Healing Works with Dr. Wayne Jonas & Dr. Alyssa McManamon”

IQVIA Survey Implications

Alyssa McManamon (00:02.643)

So welcome to the next episode of How Healing Works. I'm Dr. Alyssa McManamon.

Wayne Jonas (00:07.882)

And I'm Dr. Wayne Jonas. Today we will be discussing a yearly survey of patients and oncologists conducted by IQVIA and funded by the Samueli Foundation and the Healing Works Foundation. The survey captures attitudes and access by both patients and oncologists to integrative approaches for whole person cancer care.

Alyssa McManamon (00:32.507)

And just to provide a little background, the annual survey began in 2022 with over a thousand patients and over just over 150 oncologists and participation included patients and oncologists who were facing a variety of cancer diagnoses, living and working in settings, both rural, urban and suburban, and with different levels of accessibility to integrative modalities or modalities or therapies that complement in conventional cancer care.

So to be clear, we're not talking here so much about, you know, adding things on top of conventional care as much as integrating therapies into standard treatment. So not instead of standard treatment. And these might be things such as mindfulness or exercise and movement, nutrition counseling, and even supplements that patients may be adding.

Wayne Jonas (01:24.61)

When we talk about integration, we mean integrating the care of the person along with their cancer tumor treatment together in a whole package. That's the definition of whole person care. Let's dig into the results of the survey to provide an overview for our audience. Now, when you reviewed the survey results, Alyssa, what key findings stood out for you?

Alyssa McManamon (02:00.307)

Yeah, I wasn't surprised to see that positive patient attitudes and kind of the usage of therapies and access to therapies are increasing because we hear the interest kind of, you know, across the country and even in my own practice. The survey did show that 57% of patients strongly believe in the benefits of integrative oncology to manage both their side effects and to improve their overall wellbeing.

Compared to the 2022 survey, this is actually a 7% increase, which was statistically significant. And the survey showed that nearly all, like 96% of health systems that were involved in the survey now offer at least one complementary therapy, and that was an increase of 10% over the prior year. However, the gap still exists between what patients want and what health systems offer.

And 71% of patients believe their health system should offer more complementary therapies for people with cancer. Interestingly, three of the most kind of in-demand patient modalities, such as exercise consultation, massage, or medical massage therapy, and meditation and mindfulness are offered in half or fewer than half of all institutions that were participants. And two of the three of those have good science behind them

and data and guidelines support their use, but they're really not present, as I said, in more than half of institutions. So patients are using complementary therapies to improve their survival odds. 44% of patients felt that was actually a reason to use these modalities, and also 42% felt that they were improving their ability to manage side effects from their cancer treatment by using different complementary modalities.

And so to increase the usage, patients were asked, what do you think would increase your ability to use these things? 25% or more of patients said they currently need more education on the benefits of such therapy or that more therapy are actually offered by their health systems. Some definitely mentioned reimbursement or help with funding for such modalities and a recommendation from the oncologist that there's benefit was also mentioned.

Alyssa McManamon (04:11.559)

So I think it's, you know, it kind of brings, just brings to mind that people say they want these things, they have interest, whether that's actually offered where they are. Yes, it sounds like at least one modality is offered where most people are, but whether that's the modality that they personally have interest in, that's where some of the conversation comes into play, to connect people with the modalities and the therapies that are actually available where they are.

Wayne Jonas (04:33.814)

I have to say there was a large checklist and they could just go down and check. Many of these things are sort of just routine standard things like helping people with stress and stuff like that. Although they all get implemented. And in whole person care, what we try to do is we try to actually match what the patient needs with the services that they need. And so really it was as much about not is it just around, but is it used and is it used appropriately at the right time? And we'll talk about that a little bit.

I have to say that one of the things that stuck out from this survey for me really I think would be of most interest to healthcare administrators and it showed a big jump, more than half, 55% of patients said they would have chosen a healthcare system that offered these types of therapies, especially complementary and integrative therapies, if they could go back in time. In other words, they would have used it to select where they got their treatment. This was a 15% increase over a single year. And so I think administrators might pay attention to this. Patients are looking around if they have a choice, if they're in an environment where they have choices over where they get their care to see if these things are offered. And those who actually engaged in those things and went to places that did that had higher satisfaction with their treatment when these therapies were offered.

Alyssa McManamon (06:01.083)

Yeah, I think that satisfaction piece really has incredible implications for decision makers kind of at that health systems level. And it's something that people pay attention to because it does affect both, as we said, patient satisfaction and then actually the driving of patients to those health systems. So it's important on both sides.

Wayne Jonas (06:20.462)

Yeah. So from your perspective as an oncologist, I'm not an oncologist, but I've been across the table from many oncologists and I consult and work closely with many oncologists. But as a practicing oncologist in a busy environment, what can the cancer team do? Because this is not just about the oncologist itself, but what can the entire team do to provide more whole person care for their patients?

Alyssa McManamon (06:47.619)

Yeah, I think, I mean, it really is, it's kind of about the ongoing conversation between the care team and people who are dealing with cancer treatment or people who have completed cancer treatment. So kind of finding out what people's needs are based on their concerns, and then being really clear about what is available either in your own health system or outside of it, and having an ability to connect people to services. I think that, you know, so part of it is a listening and part of it is also having a ready go-to script for when those conversations come up on how do I get people to the types of services that can fill their needs. And so, you know, we heard in the survey that oncologists are actually the single most influential factor in patient decisions, you know, driving their healthcare planning in terms of their treatment plan. Seventy-seven percent of patients said that oncologists are the single most influential factor. 

But there's also an interesting disconnect in that patients and oncologists agree that integrative oncology conversations are happening only 40% of the time. So they both were agreeing, and it was not a change from the year prior in 2022. When we look at who starts that conversation, well, patients say they start the conversation about a third of the time, 29%. And the oncologist initiates the conversation nearly half or 46% of the time. So the conversations are happening, but not at the same rate maybe of the interest or of the use of the patients and nearly two thirds, 64% of patients report using at least one complementary therapy, although they may not be kind of discussing that with their treating provider. In fact, the number was 59% or more of patients never informed their oncologist that they're using a complementary modality. So it does bring to question, well, if the conversation's happening 40% of the time, that makes sense because...

59% of people say they've never informed their oncologist about it. If that conversation had happened more than 40% of the time, then those numbers would make, they would match, I guess. So I think we're hearing that patients are bringing up the conversation, oncologists are bringing up the conversation, but it's certainly not happening 100% of the time. And then how can we know what people are doing outside of the treatment environment?

Wayne Jonas (09:06.314)

I think the key here from what I heard you just say is that oncologists may not be providing this care themselves, but they're really important in terms of either blessing and directing patients into care that can help them and directing them away from care or treatments that might actually cause problems. So they need to be in a leadership position and they need to work with their teams to really hand off the care appropriately in these areas.

I was sorry to see this almost 60% communication gap. That's been persistent in other surveys over many, many years. And it means that oncologists and patients are not talking to each other about that. Other surveys have indicated that a lot of times the big power differential that happens when you go in and you have cancer and you're looking for the best therapy and the oncologist has the...

you know, is the expert in that area. You don't want to upset that care. And so you just may not bring up things that oncologists may not be open to or not know anything about. And that's what other surveys have shown is that a lot of times patients don't want to interfere with the treatment that they're getting or they just don't think their oncologists know anything about it, which may be true in many cases.

But the result is it leaves this communication gap. It means that they're not talking to each other. It means that there's not a trustful relationship being cultivated where they feel like they can truly share and have open discussions about things that they may be doing and how does that interfere or enhance what the oncologist is providing. And so I think it's both a problem for potential risks and adverse effects that patients might get in. And increasingly, as evidence and guidelines come out and say some of these practices are useful for both quality and quantity of life, not really providing them with optimal care. So learning about this, providing an opportunity to have a dialogue about it, asking the patients about it to close that communication gap, I think becomes crucial from this information.

Alyssa McManamon (11:21.167)

Yeah, I think that's a great point about the guidelines because, you know, the Society for Integrative Oncology and ASCO have come together in a number of guidelines, and I'm sure we'll touch on those, you know, as we go through this, you know, this season's series of discussions. But being able to go to something where you know there is data, where you know there could be benefit that's evidence-based and...

even if other modalities you might not have familiarity with, but to have a touch point to go to be able to kind of say, well, I know this might be helpful. I don't know what you're asking about, but I can find out more. But I do want to share the data about X, Y, or Z to assist with the anxiety that's part and parcel of dealing with what you're dealing with right now. I think having something like a touchstone that's evidence-based like those joint guidelines is a really useful place to start for somebody who doesn't feel like they know a lot about integrative modalities.

Wayne Jonas (12:13.278)

Yes, and there are some additional guidelines that we've supported that ASCO and SIO, Society of Integrative Oncology and the American College of Oncology are going to be coming out with in future years. So I guess one of the questions was about barriers. As an oncologist, do you see barriers cropping up in your day-to-day practice?

Alyssa McManamon (12:41.039)

Yeah, there's always barriers. I think it's interesting, you know, the barriers that are always cited and that were cited in the survey, I mean, are important to kind of discuss for sure. So half of oncologists report, you know, the need for funding of complementary therapies. Where I work, that is actually not much of a barrier because so many of the complementary modalities are covered. For example, medical massage is a covered benefit. So if somebody has chronic or acute pain, I can get that covered for no fee for someone, but there's still time toxicity for the person to have to go and find a massage therapist because those are not on site where I work. But I would say that working in a system where acupuncture is a covered benefit, I don't have some of the barriers that other people have, but I would say that it's not surprising that half of oncologists do report the need for funding for complementary therapies in the survey. And then there's always a question of if you're trying to offer something within your department,

40% of oncologists said they don't believe they have the adequate staff to implement complementary therapies. I can totally relate to that. We're always dealing with staffing issues and I think most places across the country, particularly since COVID, have had staffing concerns that are amplified since COVID. And then a third called for additional clinical guidelines and more therapies. So two separate things. They called for additional clinical guidelines as we were just discussing to give support for the use of different therapies and an education base for the treating teams, but also for more therapies to be offered on site. And I think that, as I mentioned, the concern for how do people get to the therapies, how do we connect them if it's not actually right here where they're here for their regular appointments with us, that is a concern. And it would be great if things can be co-located. Otherwise we start to introduce even more time toxicity, as I mentioned, to the patients.

Wayne Jonas (14:34.174)

Yeah, I think sometimes the need for special skills like an acupuncturist or massage therapist, as you've indicated, need to be brought in. But many times it's just a matter of coordinating services that are already available. And that just means training your staff to sort of know where they are and help navigate the patients to those or trying to integrate it with the routine care that you get.

I was up at the NIH (National Institutes of Health) yesterday and I talked to one of the anesthesiologists about their preoperative and postoperative pain care. And without any prompting, he said, well, we offer a number of things for pain management. And then he said, including an on-site acupuncturist who's available. And it was the nurses and the care coordinators that made that happen.

So they needed both of those. They needed the acupuncturist, obviously. But they also needed the navigator to know about that and be educated in how to make that happen. I think that there is a gap that came out from this survey about training. And that was key. Just training people not only about what these things are useful for, drawn from the guidelines and evidence, of course, but also then training them in the implementation and delivery components and just organizing your system so that you can fill those gaps. And that'll help people feel more comfortable about asking you know, about what people are using and also what is available and what might be there to offer if they know that the services are available and there's an easy way to access those. So education is important and one of the things that we're hoping to do next year

is provide resources that can help train both oncologists, teams, and cancer caregivers in how to access and deliver these kinds of services. Now, you've implemented some integrative therapies in your oncology practice. And I'm wondering if you could give us some feedback on the conversation that you've had with your patients and what that's been like.

Alyssa McManamon (16:43.995)

Yeah, I think, I mean, I guess thinking of how the conversations even happen, you know, it's not necessarily from my just my personal interest or thinking this might be helpful. It's really from the foundational sort of using the Personal Health Inventory (PHI) as a way to open up a conversation with a patient about, you know, what matters to them and starting to understand what that is then from there saying, well, what things are we not doing that could get you to that goal?

When I think about patients that I've seen, it really comes from what matters to them and using that Personal Health Inventory (PHI) as the start of the conversation. So feedback, what I get from patients, what I've really learned is that...

I may think yoga is great, but yoga is not for everyone. I know that's pretty elementary and I should just know that, but when you've been helped by something, it doesn't mean it's going to help somebody else. 

Alyssa McManamon (18:04.707)

And so I guess what feedback I’ve gotten is that it's important to follow the lead of the person that I'm working with and learning from and that it may take a few visits before we really get to something that is of use to them. And this comes back to kind of people know in some sense what they can be helped by. And so for one person, it was about walking. It was really important for her to get back to walking because she'd been walking 10,000 plus steps a day before the diagnosis.

To get back to that , there may be lots of ways to get back to that after going through surgery and radiation or chemotherapy. But my idea of, well, then you could go to this gym when the weather gets bad, that was actually not the right solution. For her, she actually figured out, no, I'm not going to do that. I'm going to buy a...

I learned something, it's called a walking pad, I think. It's not a treadmill, I never knew these existed, lots of people might. And so she figured out that was gonna get her to her 10,000 steps because she wasn't gonna go to an indoor gym and walk on a track when the weather got bad. She was gonna stay in her house and use this walking pad. And that's what she's doing. I think that's great. I had to kind of, you know, just learn through iterative times with her what would get her there. And that, you know, I think she's gonna get to her goal that way and I think that's great.

Wayne Jonas (19:21.458)

I think those, you make some great points. I was talking to a patient yesterday who had back pain and he was asking for some non-drug approaches when we mentioned yoga. And he said, oh, I tried yoga and it didn't really help me. And I said, well, what kind of yoga did you do? And he said, well, I went to the yoga studio and just joined one of those classes. And so here was someone who was interested in that and actually gone to the trouble of going and trying it out,

but he had not gotten what was recommended in the guidelines, which is therapeutic yoga. In other words, somebody who is trained specifically how to show somebody to do yoga for things like back pain, for example, and there is certification for therapeutic yoga in those areas. And so it's important to identify what's important, what the patient wants, but make sure that they get a good evidence-based approach to it in those areas. And that's what the dialogue around these things helps to produce. 

Well, we're hopeful that the survey will continue to be distributed next year, and as we analyze data for changes in attitudes, both for oncologists, their teams, and patients. And I'm optimistic that this will continue to reflect positive outcomes, I hope, of these supportive therapies that we've talked about. And I'd urge people to look at our website and look at some of the guidelines as they come out.

Here at the Healing Works Foundation, we are partnering with Tufts University and with the American Cancer Society to get more educational tools and evidence-based trainings out for both patients and care teams.

Alyssa McManamon (20:59.571)

That's great. Well, thanks to everyone for listening to How Healing Works.

Wayne Jonas (21:03.486)

Stay tuned for the next episode. Thank you.