Working In Oncology
Working In Oncology

Episode · 1 year ago

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


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.

You're listening to working in oncology, a podcast and video show that spotlights oncology practice staff and industry influencers who work behind the scenes to shape the future of oncology. The more knowledge the oncology community shares with each other, the more we all grow. Let's get into the show. Welcome to working in oncology. I'm your cohost for the day, Alicia Evans, and I'm joining by Sharine Al Safatti, Global Medical Affair Strategy lead oncology with bear pharmaceuticals. Hi Alisha, Hi Sharie. Thank you and welcome to the show. I'm really excited about our conversation today. So, when it comes to oncology care, I think many of us are in like a little bit of a bubble, so we may not have the opportunity to learn or experience a wide variety of treatment types within the same specialty. Let a little learn about what cancer care looks like across the globe, right. So I think you'll be able to provide some fascinating insights to our audience. I sure hope so. I hope so. I can definitely reflect on that from, you know, pharmaceutical employees standpoints and sort of the big trends and steps forward we've taken to support oncology care on the Pharma sides and also being in a global role, looking at maybe some of these differences that we see across the globe. Absolutely, but before we kept in the show, can you tell a little our viewers a little bit more about you, your background and what you do? Sure. So I was first exposed to drug development, the concept of drug development, when I was in college and my undergraduate years and I quickly developed a passion for it. And then I spent several years in academia going through graduate degrees to be able to get into the industry, and at that point I realized there was a huge divide between the academic world and the industry and the clinical world. And so what that means, what that translates, is this divide from bench to bedside, true bedside, so not only getting drugs approved but also providing patients access, especially in the ecology world, and so that became a passion and over the years, you know, after schooling, I joined the industry with beer. First I was with the Canadian team and then I wrote it relocated to the US with the global team. Now, so I'm actively pursuing that and we have many different divisions and functions within there as well, and but we all work collectively towards the same will, which is getting the data we need to get these drugs approved and also providing access for patients with an oncology, which is the most, almostly one of the most complex landscapes, as you knows, like interesting experience and and noble goal. Yeah, I mean it's very rewarding, right in the absence of being able to deliver care directly to patients, just listening to what they want, understand their needs and being able to navigate with different stakeholders, whether it's physicians, pharmacists,...

...payers, regulatory agencies like the FDA is working very closely with that group of stakeholders to be able to provide that. So we have a long way to go still, but I think we've taken huge steps forward from an industry standpoints. So I've heard you in the past mentioned and ecosystem of allied health professionals, so the system of nurses and other health professionals responsible for making patients making sure that patients get optimal care. So can you how do you incorporate them into the therapy development process. Yeah, sure, that's a very good question. So traditionally, when we think of who we work with in the clinical context, it's always been traditionally for Pharma, the healthcare professional, the treator youngcologist in the context of oncology, and that's not the case anymore. We've really changed the paradigm of that group that we work with. So when we think of the patient first and foremost, we really put the patient at the center of this model, this caregiving model that we focus on from a Pharma standpoint, and we look around the patient and we see, aside from the oncologist or the the key opinion leader HCP, you have the family members, caregivers, and then you have this allied network of healthcare professionals that include nurses, nurse practitioners, research nurses, clinical coordinators patient advocacy groups as well. So these are stakeholders that we are just us is important to us that we work very closely with. And so, from a research development standpoint, of course you have a lot of these rules that are integral parts of the clinical trial process, right, whether they're directly involved in the clinical trials themselves, whether they are involved as part of a multi disciplinary team that's delivering the care in this clinical trial setting. So from that contest they're extremely important. The other reason we have such a big focus and we're really trying to work on our relationships and understanding with this group of allied professionals is to understand what are the feedback that they give with regards to the patient journey and the pain points that come with that patient's journey, especially in the incology world where multi disciplinary care is so important. So we get them heavily involved, even before a drug is approved, in advisory boards, focus groups, medical education, continuing medical education events and different platforms where we really focus on listening to the allied health care professionals to see what else is coming out. What other feedback and guidance can they give us to help us optimize our clinical trial process? Are Protocols Right? Sometimes protocols we put in place to become outdated very quickly. And then, I would say, most importantly, what we rely on is also understanding the patient needs and the patient voice. So in oncology, as you know, a lot of times patients don't necessary certily have the opportunity, unfortunately, to voice what their needs and their goals their treatment goals are a lot of times in defaults to what the oncologist wants, which could be...

...overall survival, extending survival by a few months. But then when you speak to a patient you start to understand well, you know, this patient does want to attend their grandson's, you know, wedding or wants to go attend this golf game, and now it becomes really important to try and balance the patient's goals and that quality of life element with which treatments are being prescribed by the oncologist. Patients unfortunately don't have the opportunity to voice that, in part because it's not necessarily top of mind for the oncologists. They want to treat aggressively, and in other part it's because the patients don't necessarily want to speak up or don't have that strong voice. So a lot of times they actually default to the allied healthcare professionals that are part of that treatment journey to talk. They have the opportunity to socialize and to speak into voice what's on their minds and that voice becomes delivered indirectly through a lot of the nurses and nurse practitioners that we see, so that an interaction is extremely important for everyone involved, especially the patients. So it seems like the ally health professionals are kind of making a bridge between what the patient is explicitly explaining to the provider, the physician, and yet the patient actual needs. Are The translator, absolutely a translator, and getting to the crux of what is it that the patient wants to excellence? It's exciting that you're incorporating those insights into the therapy development process. It's so important for us. It's this loop. It's, you know, traditionally we think of drug development is pushing, you know, clinical trials and studies and then products out and and that's really changed. Now we get this early insights and feedback that come in from patients, from oncologists, treaters, allied healthcare professionals, and it really helps us shape as we move forward with drug development, the way do we design our protocols, thinking of what is it that the patient's going to want ultimately from this drug that would hopefully be addressing and unmet need. It's almost like a co creation kind of almost model. Absolutely I love it. As a global medical affair strategy lead you have insights into the state of oncology care around the world. Can you tell some like major differences you see from one nation to another and you could stand out and particular? Sure, yeah, I guess. I mean, when I think of major differences, I'm going to think of the inequalities that exists mainly across the different countries. That at least you know, based on my personal experience. We see, and I would say they narrow down, or they filters to three buckets. The first one is really around the treatment availability, first and foremost. Why some treatments are available in some countries and not other countries, and that really boils down to the patient population itself and the needs. Is this an unmet eat in this country? The way the clinical trials are designed, inclusion criteria, exclusion criteria, the patient populations that are included, arranging from age to ethnicity, and otherwise, where the trials are located as well. That's a big part too. So if you have...

...great studies that read out from certain countries but don't incorporate other certain patient populations based on their genetic profile, their ethnicities, then it's not a go ahead given in that country to get the drug approved. So it's multi factorial, but when it comes down to it, I'd say we've taken big steps forward and trying to consider global needs, but nevertheless there are several instances where drugs just aren't approved in certain countries. More often that not, what ends up happening is that there's a lack of time until we're able to address what that regulatory agency in that specific country needs. So there's still very, very strong follow up as a key priority to make sure drug treatments are available. But the treatment availability is definitely one. The other one that's heartbreaking is the access to drugs and reimbursement. So this one is unfortunately not only looking any better, it's actually looking a little bit worse in the sense that in the oncology world, drugs are very expensive and now more than ever, research has taken big steps forward and we are seeing new modalities, a lot of new mechanisms of action and modalities that are coming our way in a clinical trial perspect active and even getting approved by a lot of these regulatory agencies, including the FDA. But the issue is who's paying for the drug. You know, some countries have public payers and private payers. Other countries the 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 up happening is for some countries that can't afford to cover the these drugs because unfortunately it does have a financial burden on society, is that a lot of the colleges have no choice, their hands or tied but to default back maybe generic drugs, something like old traditional chemotherapies, where you know they still work, but it comes at the cost of a quality of life for patients. And we know that there are equally, if not more, efficacious drugs and, just to say, or if not safer, that give a better quality of life out there and approved, but the patient can afford it. So it's very frustrating to watch this. We do what we can off first to make sure that that access is there, but at the same time, to be fair, I wouldn't want to be in the shoes of the payers, because the peers have to make very difficult decisions. Right more therapies are coming their way. There are other therapeutic areas outside oncology that also need coverage. So it is a difficult decision. We can advocate as much as we want for patients, but but there has to be a balance as well with the cut the burden of the financial burden of the treatment, the cost of the treatment, on society as well. So it's that area is very tricky. And then I think the last area that it probably want to highlight here is precision medicine, because we're talking about oncology and this is everything that oncology represents right now is moving towards precision medicine. And so with precision medicine, when you're looking at finding that specific...

...treatment for the right patient with the right patient profile at the right time, a big part of that is the molecular testing, the testing that has to come with it to identify the patient, though. I mean some countries, like the US, are very much far ahead when it comes to testing. Other countries, unfortunately, don't have the infrastructure, the technologies or even the knowledge, the medical education to try and understand how they can leverage new testing platforms to identify these patients that have genetic alterations, find out what these alterations are, these drivers, and assign a targeted therapy to them. So there's a huge, huge discrepancy in that, even though we're moving light years quickly ahead towards precision medicine and making this standard of care. So, yeah, those are the three buckets. The treatment availability, you know, reimbursement and access issues, and precision medicine and the testing that comes with that. You also see a large discomancy each a difference in patient care, you know, in urban versus rule settings in the state, and I think we intil a lot of those same issues that you're seeing globally. Yeah, so a patient on the east coast versus the Midwest might not get the same treatment just because there's not availability. There's not at lack of access. Absolutely absolutely. In community settings right, a lot of these academic big academic sides have the technologies that they need to be able to treat new emerging there at the forefront clinical trials. To that's really important because in oncology, as you know, clinical trials are considered a line of therapy, not just a potential for a new drug but a true line of therapy itself. That usually come a little bit later, depending where, especially in advanced stages of cancer. So you're absolutely right when it comes to community because of distance, because of accessibility, because of feasibility, not going being able to be directed towards an academic side or not even having the time or someone to drive them to be a part of a clinical trial. There's really a huge discrepancy and inequality and in trials they're it's really important. Maybe these things will will expand in the future where more people will have access to these clinical trials, even though they're not located in a major city. Yeah, definitely, and and from our ends to from a farmer standpoint, when we look at setting up trials, we never only look at academic sides. We're also looking at community involvement and the infrastructure that's there to be able to provide adequate access for patients or at least a very clear platform where we can support patients coming in from a community setting to an academic setting in the best way possible. So are there any practices that you've noticed internationally that you wish would be implemented in the United State? I know you mentioned that United States was a little bit ahead of the curb on the molecular testing. What are some things that you find a state side that we're...

...cut of behind the curve, but we can you sorry, space for improvement. So I mean you you know, the US is really at the forefront and oncology care in a lot of areas from a research standpoint, definitely being able to bring drugs to market as quickly as possible, really being the leading country or one of the top countries that allow that approval process and access process to happen very quickly. That then triggers sort of a snowball effect for other countries coming in that are very dependent on FDA regulation. So a lot of best practices here as well. When it comes to psychosocial support, I've noticed that to vary and obviously their cultural differences here, or barriers rather in some other countries, but that psychosocial support network for oncology patients is massive and the ability to engage in conversation and dialog around this and bring in different disciplines and practices is really, I would say, a best practice here for other countries. The challenge I'm going to focus on her, which is really nothing new, is the reimbursement landscape and the access landscape. This is this is Hu whoge other countries have public systems or two tiered systems. It does, of course come on as a constance on 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 provide patients access. You're an amazing platform for getting a new drug approved very quickly, but then it's always the question of how can the patient get it right? We play our role at trying to provide Isis and support programs in compassionate use context, you know, through the different compliance hurtles that happen on the farmer side. But at some point even our hands or tied right after a drugs been on the market and a proof for a while. So accessibility for patients is huge here now that I live in the US and as well as I see it live, aside from, you know, working in a global role and forbear and in oncology, being a patient myself, to it's so challenging and this is 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 insure I get to the pharmacy and they well, your insurance company's not going to pay for this. So yeah, it's a shared responsibility and a lot of the accountability for for everyone, not just us. I mean we get thrown under the bus as Farma always because of mistakes the industry has made in the past. That we've taken huge steps forward to rectify those and really change in our way is and we do see that. I could tell you that personally now, not even commenting from a bear's point, but just looking at the industry and what's out there, and it's how it's helped family members of mind to bring these drugs to market. But it has to be a shared accountability and right now everybody's trying to offload this access accountability on someone else, from from the industry stakeholders. I definitely see that improving in the future. It has to, because the way it's going right now, it's not working for...

...anyone really is. He said, even on the farmer side you're running into difficulties. Providers are running going back and forth with insurance companies. Have WHO's going to pay who? How can we get the patient the best treatment? The insurance company has or the payer has a responsibility to all of their patients to make sure that they are able to fund everyone's medication. So hopefully in future there will be a solution, because there has to be a solution. I hope so. I hope so. I know it's baby stuff that everyone's trying to collectively take forward, but it's iterative, right, and there's not going to be this just you know, you all overnight everything is going to change, but it is iterative. So as long as everyone does their fair share and trying to make this happen, efforts collectively come together at some point and we do start to see changes. So so in the last year call of medicine has really taken off. We have, my necessity, have had to move away from office settings and go more for actual and I think this technology is, at least in part, here to stay. So it tell a lot of the patient experience is dependent upon upon their rapport with the medical team, and that's how to do on Via Zume or via team's meeting. Can you provide some insights on what a bettact that has worked for you, as you have just transitioned to more of a work from home tele medicine model or Kella education model? I should say yeah, sure, so. I mean I think a lot of them, a lot of these best practices apply to pretty much anyone in a remote context, but also especially for oncology patients from what we hear. So I can reflect on some best practices that were shared by some of our key opinion leaders or thought leaders in the oncology world. Actually hear from the US. Definitely they have set up more regular checkpoints, especially at the beginning of the pandemic, with the patients to make sure that these patients aren't don't feel oncology patients don't feel like they're left behind in the wake of the pandemic and that they've taken a backseat, even though unfortunately they have at some point. So more regular touch points with the patients, even quick text messages right through personal communication networks that some physicians are comfortable. Of course, this is a very much a personal choice. In the appointments that they have through tell a medicine that they set up, they usually set them up a little bit longer because they want to take the time to break the ice right. In the absence of facetoface, have maybe slightly lent your discussion ends with the patient around what's happening in their everyday life by a you know, within a clinical context, focusing on body language, two, which is really really important, I think for all of us really look at the body language and try and understand what is there anything else that they're trying to communicate, because in the absence of facetoface, it becomes a little bit harder to see, for exam full hand movements or, you know, nail picking or otherwise on a zoom calls. So trying to really trying to fit navigate through that as well. Overall, I mean it seems to work well. You of course have patients that are, you know, older, significantly older... age, that aren't as comfortable using these technologies, and so that's another barrier as well, is to try and get the patients 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 shown that. In what context is the the question, but definitely a lot of that best practices around that. On the farmer side, when we communicate, it's a little bit different because we're not working with or interacting with the patients directly or when it comes to our key opinion leaders or any of our allied healthcare professionals. Will we try and do is we try and keep any information that we're sharing shorter byitesized very much conversational light. We've taken a more laidback approach, which is nice. Right. When you think of Farma, you always think of very cookie cutter, very structured and sways and interactions are very normal, and what I personally like about what the pandemic is bought is we're all the same. It's more of a biotech approach of how we communicate and interact internally and then also externally with our external stakeholders. So it's more laid back, it's more genuine, I find, and people are much more willing to share what's truly on mind rather than feel like they're in this context where they just have to speak to whatever topic is being discussed in the immediate instance. So definitely a lot of advantages that have come from the tele medicine world. I don't know if it's going to predominantly be the main form. I don't think it will be. Actually we're seeing trends for otherwise, but we'll see what happens with that. So it's a new tool, may not maybe in the feature, not the only tool, but something that I can definitely see the application. As I said, with that, you know you're for rule, patients, for you communicate with specialists that are outside of their area. Maybe they don't have the resources to travel hundreds of miles to see a specialist. This might be a tool to it kind of get them additional access. For sure it's I mean it was coming anyway before. We were already looking at telling medicine and leveraging Tele Medicine. I think it was just resistance a little bit to change that was accelerated by the pandemic. But you're absolutely right when it comes to rural settings and patients not having to travel long distances or not having a caregiver to help them travel, you know, lower healthcare costs. Ultimately, that Tele Medicine supports, with the mixed model, is probably what's going to emerge in this is what we're seeing signals for right now. When you get to the bottom of a conversation with a patient or with a physician nowadays, especially in the oncology space, they still say nothing replaces the facetoface interaction. Absolutely nothing. But having a mixed model approach where maybe based on schedule and you start to alternate with tell a medicine versus in person visits, that that then mixed the most sense. So the acceleration because of the pandemic was imminent, but and it is here to stay, I don't think, in the context of how it was initially used at the start of the pandemic, just because we had... choice. So definitely more facetoface, especially to I mean it also helps for not only rural patients but patients that have to stay at home right that don't really cannot be traveling for any reasons or have to be in home because of care physical clinical conditions. So we'll definitely start to see an uptick of it across other therapeutic areas as well outside of oncology. Absolutely. I think it's interesting that you mentioned text message between patient and provider as a new form, because this is again another like tech. Technology was going, they are the world was going more towards that kind of communication and I guess that the pandemic has just pushed just over very much. So Yep, text message, other ways of contact with them, social media, tweeting, instagram, it's all happening. Of course there are all these compliance discussions right, and it's very much personal based on the patients or the healthcare professional as to what degree they want to use it and because these are primarily for private use. But we've definitely seen them an increase in the use of these different platforms. So this is the future. I think we have to navigate through the compliance barriers, but there's a huge opportunity to lever all the leverage all of these different platforms, not just tell the medicine, to be able to help that communication network that really puts the patient at the center of everything that we're doing. Absolutely and there are use cases for text message done in a compliant and compliant and effective manner, and I love what you said about patient are provider communications within healthcare in general becoming more laidback, relaxed and, as a result, genuine, and I think that the therapy development process can only improve when we can have real conversations with people in a way that they are comfortable with. I agree. It's again the technology is going to help write all the disruption that we're seeing because of technology in general across the healthcare industry. But the upside is welcome to that is the way we communicate, the choice of words, we use, Emoji's, all of these little things make a huge difference. Right getting a text message from someone with a Smiley face at the end, versus this, if you know, email, traditional email that's lengthy and has to be super corporate, etc. Huge difference for sharing truly what's on top of mine, for you in the different perspectives that you have. It's interesting that by putting a computer between ourselves, we become more human, I know, I know. And even the the tropic of backgrounds, right. So we've had this discussion so many times. Internally, some people choose to hide their background. I'm doing it right now. Some people choose to show their backgrounds intentionally because they want to be able to create that stronger bond between whoever they're speaking to on the other end of the line to say, Hey, this is how I live, this is how I am, here are my kids running across, you know, half dressed. Here's what's happening, that's happening. Yeah, so it makes it makes a difference, right,... does make it more personable. And then, of course their privacy issues were certain people just would rather not have the insides of their homes showings. It's very much a personal choice, but these are all real considerations that weren't really tangible before that have had to become tangible now because of the way we communicate. To lutely, and speaking of communication, they're often, as a caretaker involved. So it's not just one person, it's usually several people, and I just wanted to ask of it about that, that communication. So how do we incorporate or what do you see? How a best practice of incorporating kind of caretakers in this process? So we know. Sometimes, you know, you know, my husband will notice something that I don't notice. Yeah, or vice presile. I'll go to his doctor's office and I'll say, actually, he did want to ask you about yeah, we I mean we see this a lot. Right. I've been in clinic to preceptorships or other contexts where the patient won't voice what's actually happening and the care tickle will pop up and say actually, know, this person did this and that and this is what I saw, and then it really opens the eyes of the oncologist to say, okay, well, there is something else that's happening here. Is this clinical progression that we're considering or otherwise? So the caregivers play a huge, huge role on the farmer side, we recognize this, and so one thing that we've done differently than the past is we've now stair started to create contents, medical education material specifically directed not only towards patients, but patients and caregivers as well. So it is simple as taking one of our key publications that are usually a messive scientific jargon that anyone starts to read the abstract and they want to you know, if they're not in the field, just I will pronother said yeah, absolutely, and we recognize that. So we've now started to publish lay versions of these publications or abstracts so that the most important person, which is the patient, reads it and understands what this is about, and or the caregiver as well. We've also started to have shared conversations with caregivers, also in the context of focus groups, you know presentations where they come in and help educate us on 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 happen in clinic between the patient, the caregiver and the physician to identify these goals, treatment goals that end up becoming being shared with the physician and caregivers. So the caregiver piece is huge. The caregiver provides so much mental support and ease for patients as well, right knowing that there's somebody else there looking at them as they go through the unimaginable stress of navigating through the disease and just accepting what they're going through and and pulling all of their efforts to be able to fight it, all their positivity, all their internal strength, their mental and physical strengths to fight it. The caregiver then is able to support with all of the different elements right, and it's usualally rarely one caregiver ends up being a bunch of different caregivers that pay...

...their own role. And so when it comes to fighting cancer, and we have so many stories of survivors and people that are currently fighting it right now, and you look around that network and it really is truly shared effort, mainly coming from the patient, but that shared effort that the caregivers bring and it's very inspirational. I'm getting goosebumps now just thinking about it. It's so exciting that they are now becoming more and more process of are you a part of the therapy development process? Very much so, and and like a personal story from my end, you know, I've been in the space for over seven years and oncology and working in it and live and breathing it. In my graduate schooling was in it and then, unfortunately, my mom was diagnosed last year, the week before lockdown, with stage for non small though lung cancer, and so she's fighting it. But now I was thrown out of the professional world into the personal world of oncology and having to live through it with my mom and support her and whatnot. So, you know, a lot of these lessons that I'm now learning on the personal side I'm trying to pull back into a professional context to say this 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 the Farma Industry. Absolutely and I'm excited for how we're going to progress and how we're going to incorporate more and more. So started off, I'm sure, very closed loop and as an expand and, as I said, we're going to do this the co creation with the patients and with the network of allied health professionals and now incorporating the caregivers as well. I can only see positive things for the future of patient care. I love to add my conversations on kind of something hopeful and positive note. So if you could wave your magic wand, and I know not possible in real life, and change anything in oncology care today, what would it be? So one one I would say the patient. Boys empowering the patient more than what we've already done. We've taken big steps forward, but again, when you look at, for example, breast cancer patients versus maybe prostate cancer patients, were men traditionally don't speak up as much as women do. That voice, that patient voice. If I could wave the wand, I would empower every single oncology patient in whatever type of cancer. They have to be equally empowered from a medical education perspective but also from an ability to speak up about their cancer, not only, you know, motivating other patients and and having this domino effect were now other patients are empowered to talk, but really around creating that awareness and advocacy at the same level for whatever type of cancer. It is so that that I think my first one would be for that to encouraging patient self advocacy, encouraging patients advocacy and really empowering the patient from our ends to be able to get to that...

...step. Absolutely, and I know that you provide some resources, maybe resources available. What I'd like to do is kind of share that in your show note, in the show notes. So maybe we'll include some lakes or people can educate themselves and make share that with their patients. Sure, absolutely, whatever we can do to help that that patient education material get out there and and really across the globe in terms of supporting patients for what to look for and what they need and empowering them to meet their goals, their treatment goals as well. Absolutely. If any of our listeners want to continue the conversation and reach out with any found what questions? What's the best way for them to do that? They can reach out to me via Linton. I can also give you my email address, which actually you already have, so they can feel free to email me any anything I can do to support and you know, for the listeners out there, if they have any questions or even if I can answer them, at least redirect them in the right way, we do have a good network, not just within Farma but with all of these different stickholders involves or if there's anything we can do to create that link and liaise 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'll add those links as well to the show notes. This has been a great conversation show. You know what, I thank you again for joining us today. Thank you so much. Thank you for also playing your role and getting a lot of these important messages out there for everyone. You're doing amazing work and keep it up. I'm going to say by temporarily, but I'm sure we're going to cross paths again. Absolutely you've been listening to working in oncology. To ensure that you never miss an episode, subscribe to the show in your favorite podcast player. If you're listening in Apple Podcast, we'd love for you to leave a quick rating of the show. Just have the number of stars do you think the podcast deserves. Thank you so much for listening. Until next time,.

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