Working In Oncology
Working In Oncology

Episode · 1 month ago

What It Really Looks Like to Put Patients at the Center of the Care Model w/ Sherin Al-Safadi

ABOUT THIS EPISODE

Everyone in the healthcare sector has heard of (and likely works toward) a patient-centric model. But what does it really mean? And how does it look in practice?

Sherin Al-Safadi,, MSc, MBA, PhD Director of Global Medical Affairs Oncology at Bayer Pharmaceuticals, joins the show to discuss her experience and insights on Bayer’s global mission to provide access for patients.

We discuss the best practices and strategies used around the world to make sure the voice of the patient is kept at the highest volume — from the role of allied health professionals and caretakers to the evolving use of digital communication tools like telemedicine, text messages, and social media.

Here are the show highlights:

- The critical ecosystem of allied health professionals (3:16)

- The 3 “buckets” of care inequalities she’s seen across different nations (8:52)

- Best practices abroad that could be implemented in the U.S. (15:58)

- Developments, improvements, and opportunities in telemedicine (20:43)

- Text message, social media, and the evolving world of patient communication (26:21)

To hear more interviews like this one, subscribe to the Working In Oncology Podcast on Apple Podcasts, Spotify, or your preferred podcast platform.

O You're listening to working in oncology,a podcast and video, show that spot lights, oncology, practice, staff andindustry influencers who work behind the scenes to shape the future ofoncology, the more knowledge the oncologycommunity shares with each other, the more we all grow, let's get into theshow, welcome to working in oncology on yourcost for the day, Alicia Evans and I'm joined by Sharin Al Sa Vadi GlobalMedical Affair Strategy Lead Acholoe with bare pharmaceuticals, hi, Alisa Hishare. Thank you and welcome to the show. I'm really excited about ourconversation today. So when it comes to one college, you care, I think many ofus are in like a little bit of a bubble, so we may not have the opportunity tolearn or experience a wide variety of treatment types I like in the samespecialty let a little learn about what cancer care looks like across the globeright, so I think you'll be able to provide some fascinating insights toour audience. I sure hope so I hope so. I can definitely reflect on that. Fromyou know, a pharmaceutical employees standpoints and sort of the big trendsand steps forward, we've taken to support on college, a care on thepharmacies and also being in a global roll looking at maybe some of thesedifferences that we see across the globe absolutely. But before we jump inthe show, can you tell her little our viewers a little bit more about you,your background and what you do sure. So I was first exposed to drugdevelopment, the concept of drug development when I was in college in myundergraduate years, and I quickly developed a passion for it and then Ispent several years in academia going through graduate degrees to be able toget into the industry. And at that point I realized there was a hugedivide between the academic world and the industry and the clinical world,and so what that means. What that translates is this divides from benchto bedside, true bedside, so not only getting drugs approved, but alsoproviding patient's access, especially in the ecology world, and so thatbecame a passion and over the years you know. After schooling I joined to theindustry with bear first, I was with the Canadian team and then I rollrelocated to the US with the global team. Now so I'm actively pursuing that,and we have many different divisions and functions within bear as well, andbut we all work collectively towards the same woe, which is getting the datawe need to get these drugs approved and also providing access for patients withan oncology which is the most almost say. One of the most complex landscapes,as you know, sounds like a interesting experience and and noble goal. Yeah Imean it's very rewarding great in the absence of being able to deliver caredirectly to patients just listening to what they want, understanding theirneeds and being able to navigate with different stakeholders, whether it'sphysicians, Pharmacists Payers...

Regulatory Agencies, like the fasworking very closely with that group of state holders to be able to providethat. So we have a long way to go still, but I think we taken huge steps forwardfrom an industry standpoints. So I've heard you in the past mentioned anecosystem of allied health professionals. So the system of nursesand other health professionals responsible for making patients makingsure that patients get optimal care. So can you? How do you incorporate theminto the therapy development process? Yeah sure that's a very good question.So traditionally, when we think of who we work with in a clinical context,it's always been traditionally for Farma the health care, professional,the treater young cologist in the context of Ecology- and that's not thecase anymore. We've really changed the paradigm of that group that we workwith. So when we think of the patient. First and foremost, we really put thepatient at the center of this model. This caregiving model that we focus onfrom a former standpoint and we look around the patient and we see, asidefrom the Ancois through the key opinion leader, h CP, you have the familymembers caregivers and then you have this allied network of health careprofessionals that include nurses, nurse practitioners, research, nurses,clinical coordinators, patient advocacy groups as well. So these are stakeholders that we are just as important to us that we work very closely withand so from. A research development stand point. Of course you have a lotof these rules that are integral parts of the clinical trial process right,whether they're directly involved in the clinical trials themselves, whetherthey are involved as part of a multidisciplinary team. That'sdelivering the care in this clinical trial setting so from that contest,they're extremely important. The other reason we have such a big focus andwe're really trying to work on our relationships and understanding withthis group of alle professionals is to understand what are the feedback thatthey give with regards to the patient journey and the pain points that comewith out patient's journey, especially in the ecology world, where multidisciplinary care is so important. So we get them heavily involved evenbefore a drug is approved in advisory boards, focus groups, medical education,considering medical education events and different platforms, where wereally focus on listening to the allied hearth cure professionals to see whatelse is coming out. What other feedback in guidance can they give us to help usoptimize our clinical trial process or protocols right? Sometimes protocols weput in places become outdated very quickly, and then I would say mostimportantly, what we rely on is also understanding the patient needs and thepatient voice. So In on colleges, you know a lot of times. Patients don'tnecessarily have the opportunity, unfortunately, to voice what theirneeds and their goals their achievement. Goals are a lot of times in default towhat the oncologist ones, which could...

...be overall survival extending survivalby a few months. But then, when you speak to a patient, you start tounderstand. Well, you know this patient does want to attend their grandsons.You know wedding or wants to go at ten, this golf game, and now it becomesreally important to try and balance the patient schools and that quality oflife element with which treatments are being prescribed by the oncologistspatients. Unfortunately, don't have the opportunity to voice that in part,because it's not necessarily top of mine for the Ecologists, they want toTrut aggressively and in other part, it's because the patients don'tnecessarily want to speak up. Where don't have that strong voice. So a lotof times they actually default to the allied health care professionals thatare part of that treatment journey to talk. They have the opportunity tosocialize into speak into voice what's on their minds and that voice becomesdelivered indirectly through a lot of the nurses and nurse practitioners thatwe see so that an interaction is extremely important for everyoneinvolved, especially the patience. So it seems like that the ally healthprofessionals are kind of making a bridge between what the patient isexplicitly explaining to the provider. The physician and yet the patientsactual needs are the translator, absolutely translator and getting tothe crux of what is it that the patient wants to excellent? It's exciting thatyou're incorporating those insights into the therapy development process.It's so important for us, IT'S THE SLOOP! It's you know. Traditionally, wethink of drug development is pushing you know clinical trials and studiesand then products out and and that's really changed. Now we get this earlyin sights and feedback that come in from patients from cologist treaters,allied health, fair professionals, and it really helps us shape as we moveforward. Wi drug development, the way did we design our protocols. Thinkingof what is it that the patient's going to want, ultimately from this drug thatwould hopefully be addressing an unmeated. It's almost like a cocreation kind of almost model. Absolutely I love it as a globalmedical affair strategy lead. You have insight into the state of oncology carearound the world. Can you tell some like major differenceas you see from one nation to another, and he could stand out in particularsure yeah? I guess I mean when I think of major differences, I'm going tothink of the inequalities that exists mainly across the different countriesthat at least you know, based on my personal experience. We see- and Iwould say they narrow down or they filter to three big buckets. The firstone is really around the treatment availability, first and foremost, whysome treatments are available in some countries and not other countries, andthat really boils down to the patient population itself and the needs is thisan unmeant need in this country? The way the clinical trials are designs,inclusion criteria, exclusion criteria, the patient populations that areincluded are ranging from age to ethnicity and otherwise, where thetrials are located as well. That's a...

...big part too. So if you have greatstudies that read out from certain countries but don't incorporate othercertain patient populations based on their genetic profile, theirethnicities, then it's not a go ahead given in that country to get the drugapproved, so it's multifactorial, but when it comes down to it I'd say: We'vetaken big steps forward and trying to consider global needs, but neverthelessthere are several instances where drugs just aren't approved in certaincountries more often than not. What ends up happening is that there's a lagof time until we're able to address what that regulatory agency in thatspecific country needs so they're still very, very strong follow up as a keypriority to make sure drug treatments are available, but the treatmentavailability is definitely one. The other one. That's heart breaking is theaccess to drugs and reimbursement. So this one is unfortunately, not only looking anybetter. It's actually looking a little bit worse in the sense that in theancoogy world, drugs are very expensive and now more than ever, research istaken big steps forward and we are seeing new modalities, a lot of newmechanisms of action and modalities that are coming our way in a clinicaltrial perspective and even getting a proofed by a lot of these regulatoryagencies and including the FDA. But the issue is who's paying for the drug. Youknow some countries have public payers and private payers. Other countries,the drug is only out of pocket, so there's a huge discrepancy and inequality when it comes to that across the world, and so what ends uphappening is for some countries that can't afford to cover these drugs,because unfortunately, it does have a financial burden on society. Is that alot of our colleges have no choice? Their hands are tied, but to defaultback, maybe generic drugs, something like old, traditional chemotherapies,where you know they still work, but it comes at the cost of quality of lifepropation, and we know that there are equally, if not more efficacious drugsand just as safe or, if not safer, that give a better quality of life out thereand approved, but the patient can't afford it. So it's very frustrating towatch this. We do what we count of First, to make sure that that access isthere, but at the same time, to be fair, I wouldn't want to be in the shoes ofthe pairs, because the peers, if to make very difficult decisions right,mor therapies, are coming their way. There are other therapeutic areasoutside oncology that also need coverage. So it is a difficult decisionwe can advocate as much as we want for patience, but but there has to be abalance as well with the burden of the financial burden of the treatment, thecost of the treatment on society as well. So it's that area is very trickyand then I think the last area that I'd probably want to highlight here isprecision medicine, because we're talking about oncology- and this is everything that oncology representsright now- is moving towards precision, medicine and so with precision medicinewhen you're looking at finding that...

...specific treatment for the rightpatient with the right patient profile at the right time. A big part of thatis the molecular testing the testing that has to come with it to identifythe patient, though I mean some countries like the US are very much farahead when it comes to testing other countries. Unfortunately, don't havethe infrastructure, the technologies or even the knowledge, the medicaleducation to try and understand how they can leverage new testing platformsto identify these patients, that half genetic alterations find out what thesealterations are these drivers and assign a targeted therapy to them. Sothere is a huge, huge discrepancy in that, even though we're moving lightyears quickly ahead towards precision medicine and making this a standard ofcare so yeah, those are the three buckets the treatment of availability.You know reimbursement and access issues and precision, medicine and thetesting that comes with that. You also see a large discovery difference inpatient care. You know in urban versus rule settings in the states and I thinkwe run into a lot of those same issues that you're seeing globally yeah, so apatient on the east coast, vers of the Midwest, might not get the sametreatment just because there's no not availability, there's, not a lack ofaccess. Absolutely absolutely in community settings write a lot of theseacademic. Big Academic sites have the technologies that they need to be ableto treat new emerging there at the forefront clinical trials to that'sreally important, because in oncology, as you know, clinical trials areconsidered a line of therapy, not just a potential for a new drug, but a trueline of therapy itself that usually come a little bit later, dependingwhere, especially in advanced stages of cancer. So you're absolutely right whenit comes to community because of distance because of accessibilitybecause of feasibility not going being able to be directed towards an academicsider, not even having the time or someone to drive them to be a part of aclinical child. There is really a huge discrepancy and inequality in trials.There is really important. Maybe these things will will expand in the future,where more people will have access to these clinical trials, even thoughthey're not located in a major city yeah, definitely and from our ends tofrom a former standpoint, when we look at setting up trials, we never onlylook at academic sites, we're also looking at community involvement andthe infrastructure. That's there to be able to provide adequate access forpatients, or at least a very clear platform where we can support patientscoming in from a community setting to an academic setting in the best waypossible. So are there any practices that you've noticed internationallythat you wish would be implemented in the editing? I know you mentioned thatthe United States was a little bit ahead of the curb on the moleculartesting. What are some things that you find n a state side that we're kind ofbehind the curb? But we can you sorry...

...space for improvement, so I mean youknow the US is really at the forefront in Acoli care and a lot of areas from aresearch Tandon, definitely being able to bring drugs to market as quickly aspossible, really being the leading country or one of the top countriesthat allow that approval process and access process to happen very quickly.That then triggers sort of a snowball effect for other countries coming inthat are very dependent on FDA regulation. So a lot of best practiceshere as well when it comes to psycho social support. I've noticed that tovary, and obviously there are cultural differences here or barriers, rather insome other countries, but that psycho social support network for oncology,patience is massive and the ability to engage in conversation and dialoguearound this and bring in different disciplines and practices is really, Iwould say, O best practice here for other countries. The challenge I'mgoing to focus on here, which is really nothing new, is the reimbursement,landscape and the access landscape. This is this is huge. Other countrieshave public systems or two teared systems. It does, of course, come on asa Costan and society, but there are so many learnings there that are simple.That can be in baby steps. Translated back to the US here to try and providepatients access here, an amazing platform for getting a new drugapproved very quickly. But then it's always the question of how can thepatient get it right? We play our role and trying to provide ision supportprograms and compassionate use context. You know, through the differentcompliance hurdles that happen on the Pharmacie, but at some point even ourhands are tied right after a drugs been on the market and a proof for a while.So accessibility for patience is huge here now that I live in the US and aswell as I see it, live beside from. You know, working in a global role and forbear and in oncology being a patient myself to it's so challenging, and thisis something that really really you know I wish I could change overnight.Absolutely I mean yeah. I do also have personal stories of doctors prescribed x and they ensure Iget to the pharmacy and it oh well. Your inturn company is not going to payfor this, so yep, it's a shared responsibility and alot of the countability for for everyone, not just us, I mean we getthrown under the buses farmer, always because of mistakes. The industry hasmade in the past that we've taken huge steps forward to rectify those andreally change in our way is, and we do see that I could tell you thatpersonally now not even commenting from a very pinpoint but just looking at theindustry and what's out there and it's, how it's helped family members of mineto bring these drugs to market. But it has to be a shared accountability inand right now, everybody is trying to offload this access accountability onsomeone else from from the industry stake holders. I definitely see thatimproving in the future. It has to do because the way it's going right now,it's not working for anyone really, as...

...you said, even on the Pharmacie you'rerunning into difficulties, providers are runny going back and forth withinsurance companies, Him who's going to pay. Who? How can we get this patientbut best treatment? The insurance company has or the payer has aresponsibility to all of their patients to make sure that they are able to fundeveryone's medication, so hopefully in future there will be a solution becausethere has to be a solution. I hope so I hope so. I know it's baby steps thateveryone's trying to collectively take forward, but it's iterative right,there's not going to be this just you know you overnight. Everything is going tochange, but it is iterative. So as long as everyone does their fair share intrying to make this happen, efforts collectively come together at somepoint and we do start to see changes. So so in the last year, Tala medicinehas really taken off. We have my necessity, have had to move away fromofficestaff and go more virtual, and I see this technologies at least imparthere to stay. So it does a lot of the patients. Experience is dependent abauntheir report with the medical team and that's how to do on Visum, who are viateams meeting. Can you provide some insight on what a best ace has workedfor you, as you have T, transitioned to more of a work from home, tell amedicine model or tell a education model. I should say yeah sure so I meanI think, a lot of them. A lot of these best practices applied to pretty muchanyone in a remote context, but also especially for oncology patients fromwhat we hear. So I can reflect on some best practices that were shared by someof our K, opinion leaders or thought leaders in the oncology world. Actually,here from the US, definitely they have set up more regular check points,especially at the beginning of the pandemic, with the patients to makesure that these patients are don't feel oncology. Patients don't feel likethey're left behind in the wake of the pandemic and that they've taken a backseat, even though, unfortunately, they have at some points so more regulartouch points with the patients. Even quick text messages right throughpersonal communication networks that some physicians are comfortable. Ofcourse. This is a very much a personal choice in the appointments that theyhave through teller medicine that they set up. They usually set them up alittle bit longer because they want to take the time to break the ice right inthe absence of face to face have maybe slightly lenter discussions with thepatient around what's happening in their everyday life by a you know,within a clinical context focusing on body language to which is really reallyimportant. I think for all of us really look at the body language and trying tounderstand what is there anything else that they're trying to communicate,because in the absence of face to face it becomes a little bit harder to see,for example, full hand, movements or you know, nail picking or otherwise ona zoom calls so trying to really try to navigate through that as well. Overall,I mean it seems to work. Well, you of...

...course, have patients that are, youknow older significantly, older in age that aren't as comfortable using thesetechnologies, and so that's another barrier as well as is to try and getthe patient to embrace the technology and really take full advantage of it.So it's definitely a model that has worked. I think the pandemic has shownthat, in what context is the question, but definitely a lot of vegetablespractices around that on the PHARMACIE. When we communicate it's a little bitdifferent because we're not working with or interacting with the patientsdirectly or when it comes to our key opinion, leaders or any of our alliedhealth care professionals. Will we try and do? Is We try and keep anyinformation that we're sharing shorter bite, sized very much conversationallights, taken a more laid back approach, which is nice right when you think offarmer, you always think of very cookie cutter, very structured and ways andinteractions are very formal, and what I personally like about what thepandemic is bought is we're all the same, it's more of a biotech approachof how we communicate and interact internally and then also externally,with or external stake holders. So it's more laid back, it's more genuine! Ifind, and people are much more willing to share, what's truly on mind, ratherthan feel like they're, in a context where they just have to speak towhatever topic is being discussed in the immediate instance. So definitely alot of advantages that have come from the teller medicine world. I don't knowif it's going to predominantly be the main form, I don't think it will beactually we're seeing transfer otherwise, but we'll see what happenswith that. So it's a new tool may not maybe in the future, not the only toolbut some being, but I can definitely see the application. As I said, wasmention going for rural patience to communicate with specialists that areoutside of the area. Maybe they don't have the resources to travel hundredsof miles TC a specialist. This might be a tool to kind of get them additionalaccess for sure it's I mean it was coming anyway before we were alreadylooking at Ella medicine and leveraging telle medicine. I think it was justresistance, a little bit to change that was accelerated by the pandemic, butyou're absolutely right when it comes to rural settings and patience nothaving to travel long distances or not having a caregiver to help them travel.You know lower health care costs. Ultimately, that tell the medicinesupports with the the mixed model is probably what's going to emerge, andthis is what we're seen Tagnos for right now, when you get to the bottomof a conversation with a patient or with a physician nowadays, specially inthe oncology space, they still say, nothing replaces the face to faceinteraction, absolutely nothing but having a mixed model approach where maybe based on schedule- and you start to alternate with Tella medicine versusand person visits that that then makes the most sense. So the accelerationbecause of the pandemic was imminent, but- and it is here to stay, I don'tthink in the context of how it was initially used at the start of thepandemic, just because we had no choice...

...so definitely more face to face,especially I I mean it also helps for not only rural patients but patientsthat have to stay at home right that don't really cannot be traveling forany reasons or have to be in home because of care. Physical clinicalconditions so will definitely start to see an uptick of it across othertherapeutic areas as well as side of oncology. Absolutely I think it'sinteresting that you mentioned text message between patient and provider asa new form, because this is again another like tetch Ology was goingthere. The world was going more towards that kind of communication, and I guessthat the pandemic has just pushed just over very much so yep text messageother ways of contacting them: social, media, tweeting, instagram, it's allhappening. Of course. There are all these compliance discussions right andit's very much personal based on the patient or the health care professionalas to what degree they I want to use it in, because these are primarily forprivate use, but we've definitely seen an increase in the use of thesedifferent platforms. So this is the future. I think we have to navigatethrough the compliance barriers, but there's a huge opportunity to lever allthe leverage all of these different platforms, not just tell them medicine,to be able to help that communication network. That really puts the patientat the center of everything that we're doing absolutely, and there are usecases for text message done in a compliant, compliant and effectivemanner, and I love what you said about patient or provider communicationswithout health care in general becoming more laid back relaxed and, as a result,genuine, and I think that the therapy development process can only improvewhen we can have real conversations with people in a way that they arecomfortable. I agree it's again. The technology isgoing to help right all the disruption that we're seeing because of technologyin general across the health care industry, but the upside is welcome. Tothat is the way we communicate the choice of words we use EMOJI. All ofthese little things make a huge difference right, getting a textmessage from someone with a smiling face at the end versus the stiff. Youknow: email, traditional email, that's lengthy and has to be super corporateet CE, huge difference for sharing truly. What's on top of mind for youand the different perspectives that you have it's interesting, that by puttinga computer between ourselves, we become more human, I know I know, and even thethe tropic of backgrounds right, so we've had this discussion so many timesinternally. Some people choose to hide their background. I'm doing it rightnow. Some people choose to show their backgrounds intentionally because theywant to be able to create that stronger bond between whoever they're speakingto on the other end of the line to say hey. This is how I live. This is how Iam here my kids running across you know: Half dressed, here's what's happening,that's hope yeah,...

...so it makes it makes a difference right.It does make it more personable and then, of course, their privacy issueswhere certain people just would rather not have the insides of their homes,showing it's very much a personal choice, but these are all realconsiderations that weren't really tangible before that have had to becometangible. Now, because of the way we communicate solutely and speaking ofcommunication, there, often as a caretaker involved. So it's not justone person, it's usually several people, and I just wanted to ask a bit aboutthat that communication. So how do we incorporate or what do you see how abest practice of incorporating kind of care takers in this process? So we Iknow, sometimes you know you know my husband will notice something that Idon't notice, yeah or Vice Persei, go to a doctor's office and he'll sayactually he did want to ask you about yeah. We I mean we see this a lot right.I've been in clinic to preceptor steps or other contexts where the patientwon't voice what's actually happening, and the caretake will pop up and sayactually know this person did this and that- and this is what I saw and thenit really opens the eyes of the oncologist to say, okay. Well, there issomething else that's happening here. Is this clinical progression that we'reconsidering or otherwise, so the caregivers play a huge, huge role onthe Pharmacie? We recognize this, and so one thing that we've donedifferently than the past is we've. Now there started to create contents,medical education, material specifically directed not only towardspatience, but patience and caregivers as well. So it is semple is picking oneof our key publications that are usually a massive scientific jargonthat anyone starts to read the abstracts and they want to. You know ifthey're, not in the field. Just I will promote SAE yehallel, and we recognizethat. So we now started to publish lay versions of these publications orabstracts so that the most important person, which is the patient, reads itand understands what this is about and or the caregiver as well. We've alsostarted to have shared conversations with care givers, also in the contextof focus groups. You know presentations where they come in and help educate uson what is it that they're looking for that's less than the scientific side,but more around that quality of life elements and how the conversations havean inclinin between the patient, the caregiver and the physician to identifythese goals, treatment goals that end up becoming being shared with thephysician and Care Givers. So the caregiver piece is huge. The cargoeprovides so much mental support and ease for patients as well right,knowing that there's somebody else there looking at them as they gothrough the unimaginable stress of navigating through the disease and justaccepting what what they're going through a D and pooling all of theirefforts to be able to fight it all their positivity, all their internalstrength, their mental and physical strength to fight it. The caregiver,then, is able to support with all of the different elements right and it'susuallyt rarely one care giver. It ends...

...up being a bunch of differentcaregivers that in their own role, and so when it comes to fighting cancer andhave so many stories of survivors and people that are currently fighting itright now and you look around that network and it really is truly sharedeffort, mainly coming from the patient, but that shared effort that thecaregivers bring and it's very inspirational, I'm getting woosuen justthinking about it, it's so exciting that they are now becoming more andmore process, a Sarra part of the therapy development process. Very much so and like a personal storyfrom my end, you know I've been in the space for over seven years in oncologyand working in it and living and breathing it in my graduate schoolingwas in it and then, unfortunately, my mom was diagnosed last year, the weekbefore lockdown with Dashfort no smelt the lung cancer and so she's fightingit. But now I was thrown out of the professional world into the personalworld of oncology and having to live through it with my mom and support her.And what not. So you know a lot of these lessons that I'm now learning onthe personal side, I'm trying to pull back into a professional context to saythis is truly what we see on the personal side, but also what lessons.I'm learning that you know we can bring back to help the way we do things in afarmer industry absolutely and I'm excited for how we're going to progressand how we're going to incorporate more and more so started off, I'm sure veryclosed loop and as an expand and as I said, that we're going to do this. CoCreation, with patience and with the network of allied health professionalsand now incorporating the caregivers as well. I can only see positive thingsfor the future of patient care. I'd love to end my conversations on kind ofsomething hopeful and positive note. So if you could wave your magic one and Iknow not possible in real life and change anything in oncology care today,what would it be? So one one I would say the patientvoice empowering the patient more than what we've already done. We've takenbig steps forward, but again, when you look at, for example, breast cancerpatients versus maybe restate cancer patients where men traditionally don'tspeak up as much as women, do God voice that patient voice? If I could wave thewand, I would empower every single oncology patient in whatever type ofcancer. They have to be equally empowered from a medical educationperspective, but also from an ability to speak of about their cancer. Notonly you know, motivating other patients and having this domino effect.Where now other patients are empowered to talk but really around, creatingthat awareness and advocacy at the same level. For whatever type of cancer, itis so that that I think my first one would be for that to encouragingpatient self advocacy, encouraging pacience advocacy in really empoweringthe patient from our ends to be able to...

...get to that step. Absolutely, and Iknow that you provide some resources, have resources available. What I'd liketo do is kind of share that, in your show, note in the show notes, so maybewe'll include some lakes or pope can educate themselves and make share thatwith their patients, sure absolutely and whatever we cinder to help thatthat patient education material get out there and and really across the globein terms of supporting patience for what to look for and what they need andempowering them to meet their goals, their treatment goals as well.Absolutely if any of our listeners want to continue the conversation and reachout with any fol what questions what's the best way for them to do that theycan reach out to me Violento. I can also give you my email address, whichactually you already have, so they can feel free to email me any anything. Ican do to support and- and you know, for the listeners out there if theyhave any questions or even if I can't answer them at least redirect them inthe right way. We do have a good network, not just within forma but withall of these different stakeholders involved. So if there's anything, wecan do to create that link and lies our listeners or anyone else with out there.It would be a real pleasure so feel free to reach out any time for anything,wonderful and I will add those links as well to the show notes. This has been agreat conversation to that ere. Thank you again for joining us today. Thankyou so much. Thank you for also playing your rule and getting a lot of theseimportant messages out there for everyone. You're doing amazing work andkeep it up, I'm going to say by Temperaly, but I'm sure we're going tocross paths again. Absolutely you've been listening to working inoncology to ensure that you never miss an episode subscribe to the show inyour favorite podcast player, if you're listening an apple, podcast, we'd lovefor you to leave a quick rating of the show just tap the number of stars. Doyou think the podcast deserves? Thank you so much for listening? U, untilnext time,.

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