OneRoche �Women’s Health

With Her Today. With Her for Life.

Women-Centric Cancer Care - Global Market Research

27 June 2022�FINAL REPORT

Table Of Contents

Introduction & Research Overview

Definition of WCCC

WCCC Unmet Needs

Country-Level Insights

Accomplishing WCCC

Wrap-Up

[Reminder] This workshop is part of our work package aimed at defining WCCC

Current process

We propose the following definition framework as our target “end game”

Proposed framework to define WCCC (to be populated by mid-July)

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WCCC is

care that ...

[what good looks like]

... which can be

achieved by ...

[what needs to change to make it happen]

... and this matters because …

[the problem(s) we are trying to solve]

Captures what key stakeholders hope to achieve �for the best interest of women with cancer

Roche can help as [our legitimacy/role]

External partners should work with us because [their motivation]

Call to action

Dimension 1

Dimension 2

Dimension 3

This research was aimed at understanding gender-linked pain points and inequities in women’s cancer care and to begin exploring solutions

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1

2

3

Align on a shared definition of WCCC

Understand / confirm pain points and inequities present today in WCCC and prioritize for Roche action

Explore potential ways for Roche to address challenges in WCCC and drive positive impact

OBJECTIVES

In total, 131 respondents across multiple geographies were interviewed for this research

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*Payer from a prevention/screening-focused organization added to broaden payer perspective

Note: Screening criteria found in Appendix

Table Of Contents

Introduction & Research Overview

Definition of WCCC

WCCC Unmet Needs

Country-Level Insights

Accomplishing WCCC

Wrap-Up

In seeking to define WCCC, interviewed stakeholders agree it should span 4 pillars which reflect the ideal experiences and address the unique needs of women with cancer

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Words Used to Describe Women-Centric Cancer Care

WCCC is multi-faceted: several keywords rose to the surface in captured definitions

Stakeholders note WCCC should be holistic yet individualized to womens’ needs and their family roles, but also must encourage women’s equality and empowerment

Quotes Describing Women-Centric Cancer Care

“Support [or else] the treatment is not as effective.” – BR

“Differences in physical size, bone health, and menopause“ – CA

“Be understanding of family roles“ - US

“Equality in medical care” – LB

“Supportive of my self-image “ – BR

“Recognizing mental health issues” - FR

“Realise she’s the mainstay of the family” - CA

“Women are not the decision owners [now]” – LB

“Not just the physical…anything that is looked after, for the woman.” – CA

“When mama gets sick, it is tough for the family” – US

“Remove the stigma associated with cancer” – KE

“Discuss impact on (sexual) relationships“ – FR

“Body, mind, spirit, and emotions“ – US

“Ask about and discuss fertility/family planning” – FR

“Focus on women specific experiences” – KE

“Empowering to take responsibility of [their] own care” – US

“Increasing awareness and knowledge” – KE

“Acknowledge personality differences in men & women” – DE

“Addresses needs related to family life” – US

Between stakeholders, there is also some variation in what WCCC definitional pillars are most critical

• Focus on “equal access” as most important for WCCC
• Payers in BR, LB, and KE have greater attention to inequalities in access to care due to family role and family-focused nature of WCCC

• Focus on “equal access”
• More often recognize family-focused and holistic aspects of WCCC compared to payers

• Holistic and family-focused care are terms used to describe WCCC by most, if not all, women
• Although less frequently mentioned among US, CA, and EU2 women, empowerment is more important and needed among BR, LB, and KE women

• Individualized care which considers a specific woman’s needs resonates best among most physicians
• Oncologists and nurses in BR, LB and KE place greater emphasis on access to resources and timely care

• Tend to describe a similar definition of WCCC as women with cancer but place greater emphasis on empowerment

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Payer

Policy-maker

Woman with cancer

Healthcare provider

Patient advocate /

influencer

Note: Pie charts show which pillars need focus to reach the aspirational definitions of WCCC per individual country

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Country Perspectives: Importance of Each Pillar to Achieving WCCC

Brazil

United States

France

Lebanon

Kenya

Canada

Germany

WCCC Definition Pillars:

Lastly, variation is also seen across countries in what definitional pillars are more or less important in stakeholders’ views of what WCCC should mean

Table Of Contents

Introduction & Research Overview

Definition of WCCC

WCCC Unmet Needs

Country-Level Insights

Accomplishing WCCC

Wrap-Up

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Unmet Needs

Medical / physical needs

• Segmented care and communication between specialists (vs. continuous, patient-centered care)

Emotional / mental health needs

• Inability to readily connect with other women in similar situations
• Greater need for mental health counseling, as cancer diagnoses tend to impact women differently than men
• [Germany] Lack of access to psycho-oncologists
• Need for cosmetic / aesthetic services

Support beyond treatment

• Need for a unified and comprehensive (nurse) navigator on resources available for women with cancer
• Difficulty finding and understanding available educational / financial resources

“There was a huge lack of communication between the doctor, nurses and me, also making me miss my treatment” - US

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INDIVIDUALIZED

Unmet Needs

Tailoring care to a woman’s personal needs and needs as a woman

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FAMILY-CENTRIC

Unmet Needs

Revolving care around current and future family life

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EMPOWERING

Unmet Needs

Empowering women to receive equality of care

Table Of Contents

Introduction & Research Overview

Definition of WCCC

WCCC Unmet Needs

Country-Level Insights

Accomplishing WCCC

Wrap-Up

In the United States, aspirational WCCC is most focused on providing holistic care

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United States

COUNTRY-LEVEL FINDINGS

• Creation of more, better women-specific education for HCPs and women (i.e., in consultation w/ reproductive endocrinologists)
• Easier access / coverage for wig design, cosmetic, and reproductive health services
• Allowing flexibility and possibility to adjust work schedules to accommodate HCP visits
• Hospitals and specialists offering continued care, including preventive post-treatment care
• Campaign awareness for non-breast cancer women’s cancers (e.g., Ovarian cancer)

• Fertility concerns and impact of cancer on family, including lack of fertility and abortion care
• Having to work in order to be eligible for disability payments / insurance coverage, which can present day-to-day challenges and lead to fatigue
• Feeling that cancer takes away a woman’s femininity and leads to feeling “less of a woman”
• Women tend to have longer survivorship, leading to a need for more post-treatment support
• Access to prevention, screening and treatment despite insurance status for all women

Aspirational improvements

Unmet needs

“Post-treatment, osteoporosis prevention is important since 25% of women who break their hip will be dead in a year. We must think about survivorship, not only of the cancer.” – Payer

“Who doesn’t know pink ribbon? But nobody knows any phrases that go along with ovarian cancer, uterine cancer, or even cervical cancer. Ovarian cancer doesn’t have symptoms until stage IV. Women die from it because they don’t get diagnosed early enough.”

– Woman with cancer

= Level of influence to address possible unmet needs (1=very minimal; 5=very high)

Stakeholder influence

Importance of Each Definitional Pillar to Achieving WCCC

Similar to the US, optimal WCCC in Canada must be holistic and individualized

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Canada

• Enforcement of policies to ensure women have access to disability benefits and medication coverage through employer
• Measuring and tracking quality and reach of women’s cancer care (e.g., via a “women’s health report card” issued by policy-makers) to encourage equality of care across provinces
• Streamlining of communication / improved coordination between providers (possibly digitally)
• Improved access to / availability of peer-to-peer counseling digitally and in-person

• Income equity gap affects women’s access to care (and extent of gap differs by province)
• Indigenous / rural women are especially underdiagnosed / under-treated / have delayed access to cancer (esp. lung / cervical) care
• Women’s concerns may not be taken seriously and given much attention, due to healthcare system bias (especially regarding pain/menstruation related complaints)
• Lack of survivorship support and resources

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Aspirational improvements

Unmet needs

“We have evidence that women are marginalized in terms of the income equity gap, which at least British Columbia has been working toward fixing.” – Payer

“What’s missing is the crosstalk – for example, the people who screen don’t talk to the people who diagnose. If they did, care would be more holistic and lead to better outcomes.” – Oncologist

= Level of influence to address possible unmet needs (1=very minimal; 5=very high)

COUNTRY-LEVEL FINDINGS

Stakeholder influence

Importance of Each Definitional Pillar to Achieving WCCC

In Germany, emphasis on family-centric and holistic care would help achieve WCCC

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Germany

• Inclusion of psycho-oncologists in women’s cancer care MDTs across hospitals
• More holistic services (e.g., make-up course, children edu./counseling, caregiver/ spousal counseling) provided as part of care delivery
• Creation of a national patient-accessible integrated platform to navigate and use support resources (e.g., financial support, household support, educational resources)
• Support for peer-to-peer counseling (e.g., within community or center)

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• Psychological well-being (e.g., body image) and access to psycho-oncologists
• Existing interval and age thresholds for cancer screening programs (i.e., breast cancer screening)
• Lung cancer awareness among women
• Family life stress and need for household support
• Influence of family role (e.g., financial impact)
• Family planning and out of pocket payments for oocyte preservation

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Aspirational improvements

Unmet needs

“I believe that the German healthcare system is not biased towards men although I do recognize that psychological issues are more present for women.” – Payer

“Women feel the need to properly and efficiently provide for their families and social lives and will place their own health last.”

– General Practitioner

Stakeholder influence

= Level of influence to address possible unmet needs (1=very minimal; 5=very high)

COUNTRY-LEVEL FINDINGS

Importance of Each Definitional Pillar to Achieving WCCC

In France, WCCC can be achieved using a holistic and family-centric approach

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France

• Treatment centers providing more holistic care (e.g., marriage support, child education/ counseling support)
• Improving accessibility or incentivizing women to participate in screening (emphasizing why screening is important and outcomes of not screening)
• A national repository providing (online) navigation / guidance on available resources which can be led by multiple stakeholders (i.e., government, PAGs, physician associations, pharma)

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• Psychological well-being impact of diagnosis is greater among women (e.g., body image, fear, concern)
• Lack of national cervical and ovarian cancer screening programs paired with low screening participation rates
• Impact on family life (e.g., expectation still to take on mother role, divorce)
• Lack of oncologist attention for family planning and sexual education

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Aspirational improvements

Unmet needs

“The mental health burden for women is heavier as women are still considered to be mothers and are still responsible for running the household.” – Woman with cancer

“Women generally need more psychological management as they’re often more affected by their diagnosis then men.” – Oncologist

= Level of influence to address possible unmet needs (1=very minimal; 5=very high)

COUNTRY-LEVEL FINDINGS

Stakeholder influence

Importance of Each Definitional Pillar to Achieving WCCC

In Kenya, stigma and lack of access to care must be addressed to improve WCCC

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Kenya

• Development of regional (women-specific) healthcare centers to improve access
• Establishing local education programs from government and/or pharma for physicians and patients in “easy to grasp” local language
• National (governmental/educational) funding to promote female physician representation
• Treatment center or PAG facilitation of peer-to-peer counseling and support programs
• Availability of treatment at local/community levels to reduce transport and access challenges

• Stigma related to a cancer diagnosis (e.g., witchcraft, supernatural, self-inflicted)
• Women’s role poses a bigger financial barrier in access care given they need spouse approval
• Rural areas are especially underserved due to travel distance to a care center
• Male physicians could evoke distrust towards the health care system among patients

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Aspirational improvements

Unmet needs

“We need to empower women with knowledge to oppose the stigma around cancer.” – Oncologist

“Women might feel uncomfortable when treated by men due to societal or religious backgrounds and also think other women understand them better.”

– Woman with cancer

= Level of influence to address possible unmet needs (1=very minimal; 5=very high)

COUNTRY-LEVEL FINDINGS

Stakeholder influence

Importance of Each Definitional Pillar to Achieving WCCC

In Lebanon, ideal WCCC needs to focus on equal treatment of women with cancer

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Lebanon

• Ensuring more equal treatment of women and men is a priority at the policy level
• Promotion of national (possibly together with government/policy makers and/or pharma) campaigns for greater awareness of women taking care of and prioritizing their health
• Improved accessibility and awareness to increase/provide free screening / exam programs nationally
• Centers and/or PAG facilitation of support groups for women to meet other women with cancer (virtual or in-person)

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• Societal expectation that women put needs of their children and spouse before themselves
• Women don’t work as much or earn as much as men and are reliant on men for financial support
• Sexual health is taboo to discuss given Lebanon is a conservative country, and oocyte preservation is not covered by insurance
• Economic crisis has reduced women’s ability to seek medical attention by further delaying reporting of symptoms / care seeking

Aspirational improvements

Unmet needs

“When a patient is able to ask what she wants, when she can trust the healthcare system and the treatment, this would be successful.” - Caregiver

“The patient is the last one to know they have cancer. Most families prohibit the patient from knowing. We face this more with females than with males. I ask the family to decide the treatment.” – Oncologist

= Level of influence to address possible unmet needs (1=very minimal; 5=very high)

COUNTRY-LEVEL FINDINGS

Stakeholder influence

Importance of Each Definitional Pillar to Achieving WCCC

In Brazil, WCCC improvements must incorporate a woman’s role in the family

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Brazil

• Continued HCP education about issues specific to women with cancer and normalize these issues among women
• Improved access to regular exams and screening; one influencer suggested integrating screening services into the work environment
• Greater use of short and understandable educational videos (about fertility, sexual health) and promote via social media / influencers
• More visible, widespread awareness campaigns for all women’s cancers

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• Generally, stakeholders report a lack of family planning and fertility resources
• Caretaking responsibilities impact a women’s ability to access and prioritize cancer care
• Divorce is more common in women with cancer, and can impact financial resources a woman has
• Societal inequalities lead to barriers in access to care for women

Aspirational improvements

Unmet needs

“There is great inequality regarding the role of women in the family. I know many women with cancer who were abandoned and had no support from their partners. Many attempted suicide and I have witnessed the deaths of girls with cancer because of a lack of support.” – Woman with cancer

“"Distancing of the woman from the family due to their cancer affects the family and I see this more in women, regardless of social class because the woman has to take care of everything.” – Oncologist

= Level of influence to address possible unmet needs (1=very minimal; 5=very high)

COUNTRY-LEVEL FINDINGS

Stakeholder influence

Importance of Each Definitional Pillar to Achieving WCCC

Table Of Contents

Introduction & Research Overview

Definition of WCCC

WCCC Unmet Needs

Country-Level Insights

Accomplishing WCCC

Wrap-Up

Ideally, women’s cancer care would offer a network of connected service offerings that are unique to women and would also include in-home resources

Holistic

• Mental health counseling
• Multi-disciplinary team approach
• Nutrition counseling / healthy food options
• Emphasis on women’s survivorship
• Going beyond ‘bodily comfort’ in palliation (e.g., mental and spiritual comfort, family comfort)
• Navigator / patient advocate
• CME course for HCPs specifically for bone health and other longer-term concerns
• Spiritual services
• Integrative practices (e.g., yoga, meditation, acupuncture, relaxation rooms)

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Individualized

• Plastic surgery / breast reconstruction
• Counseling for sexual health issues
• Education / access to clinical trials opportunities
• [At-home] In-home medical triage team
• [At-home] Symptom-tracking / access to nurse
• [At-home] Some treatment / injections

Family-Centric

• Support for women who are managing the household (e.g., with shopping, household chores)
• On-site childcare
• Education and counseling for children / family members
• Family planning / fertility services, genetic counseling
• Educating family/caregivers on how to support the women with cancer during and post-treatment
• [At-home] Telehealth or hybrid doctor’s appointments so family member / caregiver can dial-in if need to work

Empowering

• Support groups and peer counseling
• Financial planning and assistance
• Data-driven policy based on quality metrics
• [Work-related] Policies for work leave flexibility
• [Work-related] Policies to improve long-term work leave assistance for women with cancer
• “A safe place to talk”

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WCCC

Delivery

Delivering Women-Centric Cancer Care

Some women want access to more holistic home-based services, including nutritional / psychological support services, 24/7 chat / phone access to providers. There is not the same need for actual cancer treatment at home.

Stakeholders also propose a variety of creative digital solutions to improve women’s cancer care

Digital Solutions for Women’s Cancer Care

• Centralized platform to provide navigation on beyond-treatment resources such as household or financial support, availability of psychologists, advocacy organization contacts
• Anonymous Q&A platform connecting women with HCPs and/or other women with cancer for specific questions related to more uncomfortable topics (e.g., sexual health)

HOLISTIC

1

EMPOWERING

• Virtual support groups or peer-to-peer mentorship to share and help validate women’s experience
• Website to provide disease and self-screening (breast cancer) education/instruction videos in local and understandable language
• Platform where medical information can be captured to share with stakeholders in case formal medical records are not accessible (multiple stakeholders thought this would be empowering to women)
• Digital platform to arrange shared rides / transportation among women with cancer

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INDIVIDUALIZED

• Social media “advertising” of clinical trials
• Symptom tracking tool to track whether women should seek emergency care; tool could also provide remote counseling if unable to attend clinic in person or provide treatment and/or screening reminders

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• Virtual / hybrid doctor’s appointments so partner can log on from work or other responsibilities if needed
• Virtual counseling or support for partner / children / other family members
• Less expensive alternative for conducting grocery shopping online to avoid physically going to stores
• Website to educate physicians and (separately) women with cancer and caregivers on sex, and fertility issues

FAMILY-CENTRIC

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For her

• Understandable education on health and cancer (i.e., videos, materials with simple language, messages stemming from a relatable women with cancer)
• Encouragement to talk about sexual health
• Personal support (career, financial, etc.)
• Childcare support and housekeeping

For women and community

• Peer mentoring programs (1:1)
• Community programs to support women through their journey (i.e., offer childcare or household support, help with local education)
• Access to screening in convenient settings where women are present (e.g., at work, school drop-offs)

For women in society

• Awareness campaigns featured in places where women are present (e.g., at work, school drop-offs) which also emphasize why screening/treatment is important
• Social media-based awareness campaigns (esp. for non-breast cancer)
• Educating doctors in medical school on unique needs of women
• Education campaigns starting in elementary school on equality between men and women
• Promoting women in medicine and policy-making, especially in countries where women are under-represented

For women as patients

• Knowledge of patient rights and choices, and access to patient advocate during appointments
• Access to 24/7 chat with healthcare providers
• Assembled list of suggested questions to ask providers
• Access to own medical record

Lastly, stakeholders proposed multiple suggestions for broader solutions aimed at achieving women-centric cancer care

Broader Solutions for Women’s Cancer Care

Key success factors derived from interviews

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Though stakeholders struggle to suggest concrete metrics or KPIs, they believe several elements should encompass what “successful” WCCC looks like qualitatively

Early and accurate diagnoses

Especially mentioned in Brazil / Lebanon / Kenya*: early diagnosis is a critical aspect of ideal WCCC

Demonstrated equality of care

Especially mentioned in Brazil / Lebanon / Kenya: women must be treated equally to men in their care when it comes to access to care as well as treatment planning/decision-making

More access to prevention and screening

Regular access (availability, ability to go to appointments) to screening and preventative activities are a key success measure for ideal WCCC

Better understanding of women’s needs

Providers and care teams should take time to understand the individual needs of a woman when it comes to her care and customize treatment-plan/support to the extent possible

Easier and earlier access to other specialists

Ideally, women want their care teams to include a variety of stakeholders beyond oncologists and other cancer specialists, such as gynaecologists, psychologists, social workers, physical therapists, etc.

Greater awareness

Awareness campaigns can be leveraged to promote the importance of screening and care among women (highly visible; clearly communicating potential consequences of not-screening), especially in Brazil / Lebanon / Kenya

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*Diagnoses in these countries often happen too late for available treatments to be effective

Once we have clear objectives, consider what KPIs could be use to measure actual progress in achieving WCCC

Table Of Contents

Introduction & Research Overview

Definition of WCCC

WCCC Unmet Needs

Country-Level Insights

Accomplishing WCCC

Wrap-Up

[Reminder] We embrace an iterative process,

refining ideas across multiple rounds

Approach

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WH’s desired outcomes / shared goals; WWW Series; Social media listening; Pilots; Apr. 04 kick off, etc.

Outcomes posted for offline review

Global market research outputs

WCCC

MVP

INPUTS

WORKSHOP OBJECTIVES

OUTPUTS

FRAME

MAY 30

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• Introduce the definition framework for WCCC
• Craft the WCCC definition �First 2 dimensions

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WCCC �definition v1.0

BUILD

JUNE 27

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• Share market research outputs, and align on key insights
• Identify insights to further articulate in the WCCC definition

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Insights impacting

WCCC definition

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ALIGN

JULY 06

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• Revise the WCCC definition �First 2 dimensions

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WCCC �definition v1.1

1. Including ask the team to have a thorough review of market research outputs

2. All dimensions

Outcomes posted for offline review¹

Outcomes posted for offline review²

In view of our workshop on July 06 ...

Immediate next steps – Prep. work

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Global market research outputs

INPUTS

WORKSHOP OBJECTIVES

OUTPUTS

BUILD

JUNE 27

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• Share market research outputs, and align on key insights
• Identify insights to further articulate in the WCCC definition

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​

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Insights impacting

WCCC definition

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Outcomes posted for offline review

In light of global MR outputs, Quadrant will:

• Pressure test definition components identified (i.e., May 30 outputs)
• Enrich the list if any big aspects is missing / refine 1^st summary
• Summarize findings into a 1-pager

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For the July 06 workshop, we will kindly ask you 3 things:

• Immerse into global MR outputs, incl. Appendices
• Carefully read the 1-pager
• Start reflecting on: “for the component you believe is most important for WCCC, what is the one thing we need to change?”

Appendix

While caregivers / families and HCPs have the most direct influence on women’s care, other stakeholders exert influence indirectly, in a variety of ways

High-Level Screening Criteria and Demographics

Patients / Caregivers

• Primarily patients (vs. caregivers) recruited
• Only women patients allowed (caregivers could be men)
• Representative mix of young and older demographics
• Representative mix of racial & ethnic demographic
• Mix of early-stage vs metastatic, with the majority early stage

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HCPs

• Mix of genders
• 70%+ time in clinical setting
• Oncologists and pulmonologists prescribing systemic therapies
• Mix of rural and urban settings
• Some with clinical trial experience
• Some representation from Women's Cancer Centers of Excellence, in relevant geographies

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PAG / Policy-maker leaders/ influencers/

• Engaged in developing guidelines (local or national), supporting the cause of gender equity in healthcare / cancer care

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Recommended interviews from the market research

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Interviews and transcripts can be accessed here

During our April 4^th meeting, multiple themes were discussed specific to WCCC

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Misdiagnosis & Poor Access to Preventive Care

• Reluctance to get screened and late diagnosis due to social taboos & stigma
• Women’s healthcare issues often delayed or trivialized as opposed to symptoms reported by men

Distrust in the Healthcare System

• Cultural barriers, patriarchy, racism, ableism, transphobia and sexism deterring women from the consultation of [predominantly male] medical specialists

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Other themes included stigma associated with disease (e.g., cervical cancer being sexually transmitted), stigma associated with sexual health conversations and information-seeking, stigma surrounding treatment decision-making and postponing diagnosis, impact of cancer diagnosis on the family (including communication with husband and children), and impact on personal life

With input from the team, we aligned on 6 core themes to prioritize for market research

In breakout sessions, 6 core themes emerged as front-runners for market research

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Deprioritized themes will not be a core focus of research, but we still plan to include country-specific �probes where appropriate; additional topics on stigma/fear/taboo will be woven within the 6 core themes

Misdiagnosis & Poor Access to Preventive Care

• Reluctance to get screened and late diagnosis due to social taboos & stigma
• Women’s healthcare issues often delayed or trivialized as opposed to symptoms reported by men

Distrust in the Healthcare System

• Cultural barriers, patriarchy, racism, ableism, transphobia and sexism deterring women from the consultation of [predominantly male] medical specialists

Not seen as specific to women

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