Who Treats the Patients in GI Oncology

Two very common questions we are often asked by our clients are “What is a typical patient volume for this disease?” and “Who are the high-volume treaters?” Recently, we performed an analysis of nearly 1300 U.S. physician-reported recent patient volumes in selected GI tumor types, leading to interesting insights.

In line with overall incidence reporting, the patient volumes for colorectal cancer (CRC) are much larger than the other GI cancer types researched: hepatocellular, gastric and pancreatic cancer (Figure 1). Separating by typical practice setting, academics treat more patients in the smaller GI cancers by approximately 30% over average patient volumes. Yet for CRC, the community oncologists actually treat more patients than their academic counterparts, by 10%. Similar to our experience in other major cancers – such as breast, lung, and prostate – community oncologists see enough of these patients that they are sufficiently experienced to keep the patients under their care into later lines and with greater complexities, instead of having them referred to an academic center.

Figure 1: U.S. Physician reported patient volumes in GI oncology – Academic vs. Community settings


As in our previous post, Knowing is Half the Battle, there is a deeper story behind the numbers. Our research team identified other characteristics to separate out high-volume treaters. One aspect our clients often ask us about is the patient-facing role of key leaders in the field, so-called ThoughtLeaders.

MDoutlook uses a range of expert activities, so called expert domains, to establish different tiers of ThoughtLeaders. Our team first analyzed how commonly applied domains, such as body of peer-reviewed publications on the subject and participation in clinical trials, would separate patient volumes. Considering how closely-related these GI cancer types are, we identified those who either publish or are a trial investigator in 1 of these or multiple cancer types (Figure 2).

Figure 2: Impact of ThoughtLeader Activities (Publication or Clinical Trial Participation) on GI Patient Volumes

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As expected, those engaged in these types of activities did have a higher average patient volume. However, two conclusions stuck out to us:

  1. Those with expert activity in 2 or more disease states did not appear to have higher patient volumes than those with activity in just 1 disease. So, while performing these activities in multiple areas may have synergistic benefits for the physicians (they know how to publish or perform clinical trials), drivers of patient volume are really focused on activity for that particular cancer (see below).
  2. Considering these expert activities alone has a similar predictive value to patient volume as the practice setting.

Because one of our specialties at MDoutlook is enhanced ThoughtLeader insight, our research team went a step further to assess the self-reported patient volumes for the true ThoughtLeaders in each area. MDoutlook considers multiple expert domains for such determination: Authorship, Trial Investigator activity, Physician Peer Nominations, and Leadership roles. As shown in Figure 3, identified ThoughtLeaders in a specific disease state have the highest patient volumes. This also settles an oft-asked question if they are too busy in their expert activities to actually see patients! And this enrichment in patient volumes is even stronger when separating the ThoughtLeaders to only those at academic centers.

Figure 3: Patient Volume Enrichment for GI Cancer ThoughtLeaders

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Further analysis performed by the MDoutlook team (internal data) implies that the higher patient volumes of ThoughtLeaders are mostly a result of their prominence as an expert and less the mechanism to which they become an expert. And these experts conclusively do find the time to treat many patients.

Finally, when thinking about the entire market, we encourage you to keep one more aspect in mind: while ThoughtLeaders have considerably higher patient volumes than others, the majority of patients are treated by non-ThoughtLeaders. In our research, ThoughtLeaders comprise only 8-15% of the treaters in any given therapy area and total patient volume managed by this group comprises about 20% of the market.

Of course, a key value of the ThoughtLeaders is their impact and influence with the non-ThoughtLeaders. So with an informed, comprehensive ThoughtLeader engagement strategy, you can achieve the ‘double-whammy’ of propelling high-volume treaters in their practice and their larger sphere of influence.

MDoutlook utilizes these advanced methodologies to provide real, actionable insights to our clients. Our newest offering ONCpulse™ offers this sophistication while having your business questions answered in record time.

Contact us to learn how we can help you drive success in today’s rapidly changing environment.





Knowing is Half the Battle!

For 10+ years, MDoutlook has been helping clients to fight the battle to better understand how new clinical data drives treatment decisions. Early this summer, we completed a study that exemplifies how a data presentation at major medical meeting impacts oncologists’ treatment decisions.

As shown in Figure 1, we project that the star of the new data presentation, “Product X,” will see major increases in its usage. These increases will come primarily at the expense of the 2 current leaders: Treatment A & Treatment B. Tx A and Tx B are the 1st and 2nd most used treatment approaches in the sample geography, except one. In fact, Product X will become the leader or 2nd most used treatment in this setting in 5 of the 6 major countries researched (Figure 2).

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Certainly, those with Product X are pleased with these projections, and those with Tx A and B are worried and need to act immediately to prevent this loss of share. But what if Treatment C or D is your responsibility? In fact, their usage is going to be relatively unaffected by Product X. Granted, these treatments are used in smaller selected subsets of patients, but the treatment of these patients will continue as before (data not shown).

Before this data presentation, only a few physicians were using Product X in their practice, likely as an investigational approach or in an “off-label” decision. After the presentation, most physicians said they would be using it (Figure 3). However, notice the proportion who would continue using Tx A and B. By and by, there really won’t be wholesale losses in the number of physicians using these products. For the main three treatments, pretty much almost everyone will be using all three in their practice (with, of course, some country-specific variations, which are always important to understand!).


Looking further into Tx C and D, only a relatively small group of physicians is using these treatments (Figure 3); these proportions do not change from the baseline measurement (data not shown). Moving forward, Product X does not appear to impact overall usage of Tx C and D, used selectively by a subset of physicians in a specific patient subgroup. Therefore, if you are managing Tx C or D, you should not really be concerned about the impact of the data announcement compared to those responsible for Tx A and B.

Taking everything together, what’s the real outcome of this data presentation? Well, Product X will have a major impact on treatment selection. And this impact is best understood as a patient segmentation event: the main group of patients will be split into those being treated with Product X and those remaining with Treatments A & B. Treatments C & D will remain the preferred option for the selected subsets of patients currently receiving them and not impacted by Product X.

Whether you are Product X, or Treatments A-D, shouldn’t you want to know what will happen to your product’s usage? Don’t you think it is critical for your success to understand which physicians and how many will be using your product, and in which subsets of their patients? Whether the new data is a presentation at a major meeting, a publication in a peer-reviewed journal, or an announcement of regulatory approval/label-expansion, knowing and understanding sooner rather than later is half the battle!

Contact us NOW to learn how we can help YOU drive success in today’s rapidly changing environment, for instance with data announcements at upcoming meetings such as ESMO and ASH.