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Becker’s Healthcare Podcast
Advancing Multi-Cancer Early Detection with David Harding of Exact Sciences
00:18:06
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- [00:00]
A
Hi, everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare podcast series. Today we're going to talk about a recent survey of healthcare executives on the adoption of multi cancer early detection programs and systems readiness to implement those programs. So joining me for this discussion to talk about the survey, its findings and more, we have with us David Harding, Senior Vice President of Pipeline Products Management at Exact Sciences. And David is also one of the authors of the survey. So with that, David, welcome to the podcast. Thank you so much for joining Beckers today.
- [00:37]
B
Thank you, Erica. It's a real pleasure to be here with you today.
- [00:40]
A
We're so happy to have you with us. And before we dig into Exact Sciences survey and a little bit more about msaid, would you like to share just a bit more about yourself and your work in healthcare?
- [00:51]
B
Absolutely. I would say. For the last 20 years I have been fighting cancer and I've done that through various leadership positions in cancer diagnostics companies that have focused on screening for things like cervical cancer, for breast cancer, at Exact Sciences for colorectal cancer. And now the last four years of my life have been dedicated to bringing multicancer early detection to life. It's been really fulfilling to look at all these different areas of cancer screening and really help to advance the ball and, and make a real impact on human health.
- [01:31]
A
Great to learn that about you, David. Thank you so much for sharing. And it sounds like you have such a rich background in this field. And so I'd love to start with essentially what led you to conduct this survey that we teased at the beginning of the episode. I'd love to learn just a little bit more about the survey and especially what stood out to you from those survey findings, especially as it relates to really the future of cancer screening.
- [01:57]
B
Yeah, Erika, I'm going to start with the why first and maybe just a quick overview of multicancer early detection and what it is, if that's okay. Multicancer early detection is simply doing a very simple blood draw to screen for multiple types of cancer. That's more than just the four types that we screen for today. We are very motivated by the 70% of cancers for which there is no screening option available today. As you know, the standard of care is cervical cancer screening, mammography for breast cancer screening, colorectal cancer screening, and for high risk individuals, lung cancer screening. But there are so many more cancers. 70% of all detected cancers today do not have a standard of care screening option. And so it's really Important for us to understand how we implement this kind of a test and really understand the patient impact of it to begin with. So that's the underlying motivation. And we know that without truly understanding how health systems are thinking about multicancer early detection, it's really hard for us to achieve the patient impact that we all aspire to.
- [03:14]
A
Yeah, David, that's so helpful to know. So I think it sounds like this survey really was that baseline for your understanding on how health systems understand multicancer early detection, how they're thinking about it, whether they're considering launching programs related to it. And it sounds like, based on your description, this type of cancer screening really does present a pretty significant opportunity to change how cancer is diagnosed, treating it more effectively and earlier, making treatment more accessible, perhaps. So I'd love to know how you see multicancer early detection adoption really influencing areas like competition, collaboration, and especially momentum across health systems.
- [03:58]
B
Absolutely. As we look at this survey, we see out of the hundred or so people that we surveyed, and there was a ton of interest in this particular survey, so we take that as a really good signal that there is a lot of interest in multi cancer early detection in the healthcare space. Out of 101 people that were surveyed, we found the following. Number one, there's only a relatively small fraction of health systems that have actually implemented multicancer early detection. In fact, it was about 23%. The remaining percentage of respondents said that of those, 66% were interested in entering into multicancer early detection programs in the next six to 12 months. And so there's a big demand for this. Why is there a big demand? First of all, we know that patients are coming and they're asking about this, right? They're coming to their doctors and saying, doc, how can I know about my cancer risk beyond just the 4 standard of care screening options that I have today? What can you offer me? And we're offering that solution now to doctors through multicancer early detection. But health systems are now seeing that patient demand. They want to be on the forefront, they want to innovate. And what we find is that many of them are just not quite ready to move forward. And it's very important, as you mentioned, competition. It's so important for most health systems to be viewed as highly innovative, on the forefront of new technology. And this is a terrific way to not only be viewed as an innovator, but also to meet a rising patient demand. And I think those systems who are ready to implement multicancer early detection, to receive those patients are going to be viewed as the health systems of choice in the future. So we believe that getting ready to implement multi cancer early detection is supremely important for those who want to stay on the forefront.
- [06:06]
A
Yeah, David, I really appreciate some more insight into those survey findings. And really, as you're describing, some of what surfaced in the survey, that only a small handful of systems have implemented multicancer early detection testing, but 66% were interested in entering into programs. I mean, it seems like such a pivotal moment of very low adoption right now, but it feels like we're on the cusp of something bigger here. So what an exciting moment. I do want to address, though, this discrepancy between interest and readiness. So what do you think that gap tells us about where health systems stand today in bringing innovations into the fold? Whether that's multicancer early detection or other innovations?
- [06:48]
B
Yeah, it's a really interesting question. In the survey, we found that only 23% of health systems surveyed felt that they were truly ready to adopt multicancer early detection. A full 42% that said that they just aren't ready. And there was a whole other group that just said they hadn't even started thinking about it. So let's focus on that 42% that are thinking about it and really want to implement multicancer early detection, but are not feeling quite prepared. So there's a big gap between aspiration and readiness that we need to get into. And maybe we can talk about some of those, the challenges or what it takes to get ready.
- [07:32]
A
Yeah, yeah, David, I agree. That would be really helpful because I know just in reviewing some of the high level survey findings, some of the leaders surveyed cited barriers like unclear guidelines, workflow integration, challenges, even equity. So from your perspective, which of these challenges do you think are most pressing and really how can health systems go about addressing them?
- [07:55]
B
Yeah, as you mentioned, Erica, you know those three topics, right? Lack of clarity around the clinical guidelines, Equity and access concerns as a secondary issue. And then operational or resource constraints were mentioned by at least 40% of all the respondents in this survey. So let's talk about, you know, the lack of clarity around clinical guidelines and perhaps clinical evidence that's embedded into that. I think we do need to acknowledge that multicancer early detection is still, you know, very much in the early stages of its lifespan. And as a result, there is a lot of new data that's emerging all the time. But certain clinicians may feel like, hey, there's not quite enough yet. We haven't seen massive large scale clinical Studies and certainly guideline bodies have not yet weighed in on the best way to implement so. But I think there are ways that we can address this, right? As pioneers in the space, we have laid out playbooks for clinicians that say, hey, if you get a positive patient, here are the simple streamlined steps that you ought to go through to get that patient resolved and diagnosed. I think in implementing these with a number of health systems, we found that that thoughtful approach to really mapping out how you take a patient from positive to a diagnostic workup and then into treatment is really, really crucial to overcoming that barrier. We have playbooks, we have our own guidelines that we've developed, as have other players in the industry. And I think, you know, implementing those things can help resolve some of that barrier. Let's talk about equity and access concerns. I think that's another very important one. 47% of survey respondents indicated that, that that was a potential barrier. And so, you know, look, most of these tests are offered on a, an out of pocket self pay basis. And that certainly presents challenges when it's not uniformly covered by insurance. And so again, we acknowledge that. Again, we're very much in the early days of these MSAID implementations. However, what we've tried to do is make the price as affordable as possible so that as many patients as possible can get that simultaneously. We are working very hard in Washington D.C. to make sure that there is legislation that's passed that will support ultimately the coverage of MSAID tests. And so that's working its way through the government. It's going to take some time. In the meantime, we're trying to make that price as accessible as possible and make this available to as many patients as we possibly can. Talk about the third piece, which is around operational resource constraints. And here again, about 42% of respondents said, hey, this is a challenge for us, right? We're looking at the capacity of our primary care physician network. Can they take on more work? Can they take on another screening test? How do we make sure that this integrates seamlessly into our healthcare system? And how do we manage the many other priorities that we have in our system today? Again, when we think about how to help with this, we try to say, hey, make it as easy as possible. In successful implementations. We've gone in and loaded the order sets into the ehr. We've made the diagnostic pathway as simple as possible for imaging orders. We've tried to consolidate those in a way that's very easy for physicians to tackle. And, and we've done a ton of education of primary care physicians to help ease with the lack of knowledge and the lack of clarity around how to work up that positive patient. I think in places where we've done that and really invested the time in mapping it all out, the process goes very seamlessly and primary care physicians are able to incorporate that into their workflow. Other successful implementations have done things like create MSAID triage clinics. So we've seen that in a number of places across the country where an academic medical center, for example, or a larger health system will say, hey, we're going to bring together a cross functional group of primary care radiology and oncology to triage these MSAID positive patients in a way that's very rapid and gets them to the right place. Implementing patient navigation systems is also a really important pathway to easing that patient journey and making sure that the experience of the patient is seamless. And again, these are all areas where we and other players in the industry are happy to help.
- [12:41]
A
David, I so appreciate this overview for a few reasons. One, I mean these challenges that leaders have highlighted in the survey span everything from those on the ground operational concerns to the clinical evidence and research behind it, and then as far out and zoomed out as equity and access issues. So you know, the concerns are certainly wide ranging, but I love how you've outlined exactly how organizations like Exact Sciences and other players in the industry, as you've said, are building actively resources to address some of these challenges. So looking forward to hearing more about how the legislation in D.C. progresses forward and appreciate some of these tangible examples of how systems are educating their providers, how they're integrating this testing methodology into their workflows and making this possible. It's just been very insightful. I know our time together is winding down here. I wanted to just give you the opportunity to highlight anything else you think we may have glossed over too quickly or anything else that you wanted to leave our listeners with as they're considering multicancer early detection.
- [13:49]
B
Erica At Exact Sciences we have a lot of experience collaborating with health systems. In fact, over the course of our history we've done integrations with over 600 health systems to test well over 20 million patients. And I think that experience says that, look, all of this is possible. We can do the hard work that allows us to create simplified workflows, that allows us to efficiently work with primary care and other parts of the hospital systems to implement new standards of screening. And I think it's all really important as we think about the effort that's required to bring on these new types of capabilities. So there's help there and there's expertise there. And I think we know how to make these implementations work. I think the second and more important point is as we think about the impact that we can collectively create on human health through the implementation of multi cancer early detection, it helps us to work through any barriers that we might see. Our modeling suggests that regular implementation of multicancer early detection testing can reduce cancer mortality by up to 18%. And when you think about all the other tools that a health system might have in its tool belt to reduce cancer mortality, I don't think there's anything that comes close to an 18% reduction in mortality. So I think it's really important for us to continue to keep in mind the massive impact that we can have on the patients that we all serve and be prepared to work through these challenges that are pretty normal as we implement any new technology. I think we have the confidence to work through these things collectively as health systems and providers to health systems, we have a way to solve this problem. I just like to challenge every listener out there to think of people in their friends and family network who passed away because of cancer and maybe it's because of a cancer that didn't have a standard of care screening option and think of those people as we work through these challenges and evolve together to solve this really important problem of cancer mortality.
- [16:22]
A
David, it's been such a great conversation today. Appreciate all the passion you've brought to this topic, but wanted to see if there were any final thoughts or takeaways that you'd like to leave our listeners with.
- [16:31]
B
I think the final thought is there's no time like the present. Patients are out there. They have a need. 600,000 people are dying from cancer every single year and there's no time like the present to get started on this. It's quite straightforward. There is no giant investment required. It's an investment of a little bit of time and effort. And we are happy to collaborate with you. And there are ways to get started now, whether it's through an executive health program, through concierge medicine, or even more broadly through across at risk individuals or elevated risk areas. We can get started now and work with you together to help change the curve on cancer mortality.
- [17:18]
A
David, I really appreciate the passion that you've brought to this conversation that really comes through how much you care about this line of work and how this research that you've put behind health systems readiness to adopt this important testing methodology is. It's so clear and I appreciate, you know, all of the work that your organization is doing and kind of that message to bring others on board to achieve that same goal. It's so important. And I just want to thank you for your time and your insights today.
- [17:50]
B
Thank you very much, Erica. It's been a real pleasure.
- [17:53]
A
And we'd also like to thank Exact Sciences for sponsoring today's episode. Listeners, please be sure to tune into more podcasts@beckershospitalreview.com and have a great day.