Navigating Early Cancer Detection: Promises and Integration Challenges in Healthcare Systems

Navigating Early Cancer Detection: Promises and Integration Challenges in Healthcare Systems

Navigating Early Cancer Detection: Promises and Integration Challenges in Healthcare Systems

Early detection in cancer is crucial for improving patient outcomes, reducing treatment burden, and lowering healthcare costs for one of our largest global health concerns. Biomarker sequencing, enabled by advancements in genomics and sequencing technologies, has revolutionised cancer diagnostics by identifying specific molecules indicative of cancer development and progression. Multi-cancer early-detection liquid biopsies offer a promising approach for non-invasive and comprehensive cancer screening. However, successful implementation and adoption of these technologies require careful consideration of ethical, logistical, and regulatory challenges. To navigate these challenges, manufacturers must segment target populations to avoid overdiagnosis, facilitate the implementation of relevant technologies to allow the scaling of tests, as well as foster relationships with KOLs to ensure they are incorporated into clinical guidelines respectively.


The burden of cancer

Cancer poses significant challenges to our health, well-being, and the global healthcare community. As the second leading cause of global mortality, after cardiovascular diseases [1], it demands substantial attention and resources. Efforts to comprehend its complexities and develop effective treatment strategies persist, with the oncology pipeline representing more than a third of all speciality drugs in development in the US [2]. Our calculations have revealed that the direct medical costs incurred by the economy due to the treatment of the five most prevalent cancers exceed an astounding $520 billion annually.

An alternative approach to lowering the burden of cancer, aside from improving treatments, is through cancer screening and early diagnosis. When cancer care is delayed there is a lower chance of survival, greater problems associated with treatment and higher costs of care. In fact, the 5-year survival rate for the three most common cancers (breast, bowel, lung) is more than 6 times higher when the disease is diagnosed at the earliest stage compared to late-stage diagnosis [3]. Additionally, medical expenses have been shown to escalate significantly with each stage of cancer, as depicted in Table 1 [4]. The data highlights that, on average, a savings of $25,000 per patient can be achieved in the first 12 months by diagnosing the disease just one stage earlier.

Tumour Stage Average Costs per Patient (12 months after diagnosis) (USD)
0 $60,000
I/II $82,000
III $130,000
IV $135,000

Table 1: Estimated average 12-month costs following diagnosis for each cancer stage [4]


While tissue biopsy serves as a reliable tool for detecting and assessing cancer, its accessibility can be invasive and challenging, particularly in cases of metastatic diseases like late-stage lung cancer. Furthermore, tissue biopsy is impractical for early cancer screening when tumours have not yet formed. Although existing screening methods, such as mammograms for breast cancer, Pap tests for cervical cancer, and low dose computed tomography for colorectal cancer, have demonstrated effectiveness for specific types, they are limited in terms of sensitivity, specificity, and applicability to a single cancer type. In the United States, guidelines only recommend routine screening for four cancer types (breast, cervical, colorectal, and lung) [5], leaving approximately 70% of cancer deaths without standardised screening protocols [6]. Evidently, there is a pressing need for a comprehensive, cost-effective, and widely applicable cancer screening protocol to meet the demands of large-scale screening efforts.


Unleashing the potential of cancer biomarkers

Biomarkers have the potential to assume a critical role in cancer diagnostics as they encompass unique molecules, including genes, proteins, or other substances, that act as measurable indicators essential for detecting, diagnosing, and monitoring cancer within the body. DNA sequencing methods serve as a powerful tool for identifying cancer biomarkers, as they enable the precise determination of the sequence of nucleotide bases within a sample, allowing for the detection of genetic alteration and patterns of gene expression that are indicative of cancer development and progression. However, traditional methods of biomarker identification and DNA sequencing, such as Sanger sequencing, often involved studying one or a few genes or proteins at a time, which was laborious, time-consuming, and expensive. For instance, the sequencing of the entire human genome, encompassing the complete set of genetic information in humans, was achieved through the Sanger sequencing method. This monumental endeavour demanded nearly 15 years of intensive collaborations among numerous laboratories worldwide and cost approximately 100 million USD [7]. This bottleneck was preventing us from using these biomarkers to their full potential.

However, advancements in genomics and sequencing technologies over the last two decades, spearheaded by Illumina Technologies, Pacific Biosciences and Thermo-Fisher Scientific, to name a few, have successfully unlocked this opportunity. The development of second and third-generation sequencing technologies, often termed next-generation sequencing (NGS), offer a high-throughput and cost-effective approach to reading large amounts of DNA or RNA. The major market leader Illumina, which controls about 80% of the global DNA sequencing market, unveiled their NovaSeq X series late last year, which will reduce the sequencing cost to 200 USD per human genome while having the power to sequence more than 20,000 genomes per year [8]. This dramatic cost reduction and expanding capacity have significantly increased the accessibility of the technology, exemplified by the recent collaboration between Thermo Fisher Scientific and Pfizer to extend its reach to over 30 countries lacking affordable access to advanced genomic testing [9].

By leveraging the power of NGS, researchers have made significant strides in identifying novel cancer biomarkers across various cancer types. These biomarkers can be used for early detection, stratification of patients into appropriate treatment groups, and monitoring of treatment response, ultimately leading to more precise and personalised cancer care. The industry is now poised for rapid growth because of recent advances in the field, including more sophisticated diagnostic technologies and a great understanding of disease heterogeneity.


Biomarker sequencing has paved the way for liquid biopsies

With these NGS technologies in their arsenal, researchers and start-ups have now cast their eyes on liquid biopsies – a revolutionary blood test designed to detect circulating cancer DNA. As cells die, DNA fragments are expelled and circulate within the bloodstream. The rapid proliferation of tumour cells results in heightened cell death, leading to an excess of cell-free DNA being released into the blood, commonly referred to as circulating tumour DNA (ctDNA). The tumour-specific mutations in the ctDNA sequence can act as a new type of cancer biomarker and help to identify cancer patients from a group of healthy individuals, as described in Figure 1. Several companies are leveraging these markers to develop a single liquid biopsy test that can diagnose several cancers. These innovative screening tests, referred to as multi-cancer early detection (MCED) tests, employ NGS and artificial intelligence to identify and analyse ctDNA patterns. By doing so, they can accurately identify and locate cancerous tumours. In comparison to the conventional approach of cancer diagnosis using tissue biopsies, these MCED liquid biopsy tests offer earlier detection, scalability, minimally invasive procedures, and hold great potential for detecting rarer forms of cancer.

A basic overview of the MCED test journey.
Figure 1: A basic overview of the MCED test journey. [Illustration made by S&S]

A brief overview of the current MCED landscape

There are several early detection tests harnessing these concepts that are currently in development, some of which are presented in Figure 2. The competitive landscape is rapidly evolving, with numerous companies and start-ups actively pursuing advancements in the field. A few key players have emerged, each striving to develop their own proprietary technologies and methodologies for comprehensive cancer screening.
A non-exhaustive mapping of the current MCED market landscape.
Figure 2: A non-exhaustive mapping of the current MCED market landscape.

The Galleri test developed by GRAIL stands out as particularly promising. This innovative test harnesses the power of NGS and machine-learning algorithms to analyse indicative methylation patterns observed in ctDNA. The test boasts the capability to identify a distinct signal that is shared by more than 50 different types of cancer, and their latest findings provide compelling support for this performance claim [10]. To enhance the adoption and reach of the product, GRAIL is undertaking multiple strategic initiatives, including a collaborative effort with the U.S. Department of Veterans Affairs to screen 10,000 veterans [11]. Furthermore, the company is currently conducting a large-scale study with the National Health Service involving approximately 140,000 participants in the UK [12]. This ambitious endeavour is projected to conclude by early 2026, aiming to provide the necessary evidence required to prove its efficacy for early detection. Although Galleri is yet to obtain Food and Drug Administration (FDA) approval, the test is available to older patients in the U.S. with a higher cancer risk under a Clinical Laboratory Improvement Amendments (CLIA) waiver [13].

Acknowledging the immense potential of this technology, GRAIL was acquired in 2021 by Illumina Technologies, the aforementioned front-runner in NGS technologies, for an astounding $7.1 billion [14]. However, to foster competition and lower market entry barriers, regulators in the United States and Europe have mandated Illumina to divest GRAIL in early April of 2023 [15]. This action by the Federal Trade Commission underscores their recognition of the technology as a critical solution, indicating ample room for further growth and the entry of other players into the market.

In 2019, Thrive entered the field of multi-cancer early detection with their CancerSEEK technology backed by $110 million in Series A funding, marking the largest investment ever for a John Hopkins-licensed technology [16]. Their MCED liquid biopsy test combines genetic mutations in cfDNA with the analysis of nine proteins, enabling screening for eight prevalent cancer types that account for over 60% of cancer-related deaths in the U.S. Notably, this includes four cancer types for which there are currently no available screening tests. Conducting a comprehensive study involving over 1,000 patients, Thrive achieved an impressive average detection rate of 70%, catching 98% of ovarian cancers [16]. Despite the scope of CancerSEEKs screening range being narrower than that of Galleri, Thrive was still acquired by Exact Sciences (a molecular diagnostics multinational) for up to $2.15 billion just 2 years after its establishment [17].

Although these tests are not meant to replace existing screening methods (mammograms, Pap tests, colonoscopy, PSA blood tests, etc.), they can serve as valuable complements to current screening strategies and aid in the detection of other types of cancers lacking established screening protocols. But of course, much work is needed, and with experience and larger samples, these assays will improve. With sequencing consistently becoming cheaper and more accessible, it is only a matter of time before this technology is made viable. This leads us to the next considerable challenge – how will this technology be implemented?

Charting the path to successful market adoption

Companies with new early cancer detection technologies need to be vigilant and address several key aspects to ensure successful implementation and adoption:

regulatory landscape Firstly, the regulatory landscape plays a vital role in the implementation of MCED tests. Striking a balance between facilitating innovation and ensuring rigorous oversight is essential. Regulatory authorities need to establish clear guidelines and standards for the use of these tests, positioning the technology to promote public trust whilst fully leveraging its potential. This undertaking is far from simple, as exemplified by the utilisation of prostate-specific antigen (PSA) in cancer screening, where the ongoing controversy regarding the trade-off between screening benefits and the risks of overdiagnosis and overtreatment has resulted in divergent protocols between the US and UK [19-20]. It is evident that regulatory guidelines can differ across countries, further complicating the journey towards achieving global market access.

the integration of multi-cancerFurthermore, the integration of multi-cancer early detection tests into the existing healthcare system presents logistical and economic challenges. These tests often involve complex technologies, such as the discussed NGS technologies and advanced data analytics, requiring specialised infrastructure and expertise. Implementing these tests on a large scale demands substantial investments in laboratory capabilities, efficient workflows, and healthcare professional training.

To drive market adoptionTo drive market adoption, active engagement with stakeholders is essential. Key opinion leaders (KOLs) play a crucial role in disseminating best practices, establishing guidelines, and advocating for the adoption of MCED tests. Collaborating with healthcare professionals enables education and heightened awareness about the numerous benefits of early cancer detection. Moreover, establishing favourable reimbursement policies through collaboration with insurers and policymakers facilitates the seamless integration of these tests into healthcare systems. By actively engaging with stakeholders, manufacturers can accelerate the widespread adoption of MCED tests and enhance the impact of early cancer detection efforts.

ground-breaking technology Lastly, the successful implementation of this ground-breaking technology necessitates a comprehensive strategic analysis to identify the target populations. Certain individuals without symptoms may harbour a non-life-threatening cancerous tumour that has minimal impact on their quality of life. It raises ethical considerations about whether it is justifiable to impose upon them the stress of a diagnosis and the potential side effects of treatments. Moreover, the issue of false-positive results should be considered. Galleri, for instance, currently boasts a sensitivity of 99%, implying that 1 in 200 individuals may receive a false-positive result [18]. While these statistics are likely to improve as the product evolves, it begs the question of whether subjecting the general population to the emotional burden of a false-positive outcome is sensible. Alternatively, it may be more prudent to categorise populations into risk groups based on factors such as age, genetics or specific exposures.

How can Sector & Segment help?

After all this extensive research into the technology and the validation of its efficacy, companies now need to begin considering their implementation strategies to ensure optimal market adoption. With a wealth of experience, the Sector & Segment team excels in researching and quantifying the specific needs, attitudes, and preferences of key stakeholders. By leveraging our expertise, we can help companies in the early cancer detection space pinpoint the differentiating factors that will drive success in the market. Specifically, our experts can provide support through:

  • Providing strategic guidance and expertise in the context of a merger or acquisition, including assessing target companies, conducting due diligence, and identifying synergies to maximize value creation during the deal process.
  • Assisting in patient segmentation and stratification, considering how oncologists from different cancer fields profile their patients, to facilitate the adoption of MCEDs.
  • Conducting market analysis and assessing the landscape for multi-cancer early detection tests, including market potential, competitive landscape, and regulatory considerations.
  • Conducting feasibility studies and financial analysis to assess the economic viability and potential ROI.



Luca Flury, Consulting Analyst at 

1. H. Ritchie, F. Spooner, and M. Roser, ‘Causes of death’, Our World in Data, 14-Feb-2018
2. M. Gavidia, ‘Growing innovation, cost expected in the Oncology Drug Pipeline’, AJMC, 15-Oct-2022
3. ‘Why is early cancer diagnosis important?’, Cancer Research UK, 30-Mar-2023
4. Blumen H, Fitch K, Polkus V. Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service. Am Health Drug Benefits. 2016 Feb;9(1):23-32. PMID: 27066193; PMCID: PMC4822976.
5. ‘Cancer screening tests’, Centers for Disease Control and Prevention, 20-Jun-2023
6. ‘Grail presents real-world experience with the Galleri® multi-cancer early detection test at 2023 ASCO annual meeting’, Business Wire, 03-Jun-2023
7. M. Kchouk, J. F. Gibrat, and M. Elloumi, “Generations of sequencing technologies: From First to next generation,” Biology and Medicine, vol. 09, no. 03, 2017
8. ‘Illumina unveils revolutionary NovaSeq X series to rapidly accelerate genomic discoveries and improve human health’, Illumina
9. ‘Thermo Fisher Scientific & Pfizer Partner to Expand Localized Access to Next Generation Sequencing-Based Testing for Cancer Patients in International Markets
10. ‘Grail announces final results from the Pathfinder Multi-Cancer Early Detection Screening Study at ESMO congress 2022’, GRAIL, 11-Sep-2022
11. ‘Grail announces collaboration with U.S. Department of Veterans Affairs and the Veterans Health Foundation to evaluate Galleri® Multi-Cancer Early Detection Test’, GRAIL, 31-May-2022
12. ‘Grail and National Health Service (NHS) England complete enrollment of 140,000 participants in largest study of multi-cancer early detection test’, GRAIL, 18-Jun-2022
13. ‘Grail receives New York State approval for Galleri Multi-Cancer Early Detection Blood Test’, GRAIL, 20-Sep-2021
14. ‘Illumina acquires Grail to accelerate patient access to life-saving multi-cancer early-detection test’, Illumina, Inc. – Illumina Acquires GRAIL to Accelerate Patient Access to Life-Saving Multi-Cancer Early-Detection Test, 18-Aug-2021
15. A. Kim Constantino, ‘FTC orders Illumina to divest $7.1 billion acquisition of Cancer Test Developer Grail
16. A. A. Idrus, ‘With $110M and Johns Hopkins Tech, thrive aims to make early cancer screening routine’, Fierce Biotech, 30-May-2019
17. A. A. Idrus, ‘Exact Sciences snaps up liquid biopsy company thrive in $2.15B deal’, LIVRO, DATA
18. ‘Grail announces positive new data with multi-cancer early detection blood test from CCGA study’, GRAIL, 31-May-2019
19. ‘American Cancer Society recommendations for Prostate Cancer Early Detection’, Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin, 24-Feb-2023
20. ‘PSA testing’, NHS choices, 18-Oct-2021

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Successful patient outcomes through patient-centric education: the role manufacturers should play

Successful patient outcomes through patient-centric education: the role manufacturers should play

Successful patient outcomes through patient-centric education: the role manufacturers should play

Patient education plays a key role in patient outcomes1 however it is often overlooked due to time constraints and patient shock at diagnosis, resulting in worst-case scenarios for the patient. A good example of this is diabetes. By managing diabetes, patients can prevent the worsening of the condition, and complications such as the need for a foot amputation. Nevertheless, almost 8,000 diabetes-related amputations are still conducted every year in the UK2. Why does this happen, if it is so preventable?

How informed a patient is will shape the trajectory or their journey, their treatment, and their interaction with their healthcare professionals (HCP). On the one hand, if patients are not informed, they can struggle to understand the causes and effects of their condition, the impact of the treatment and how their own lifestyle changes could affect their journey and recovery. This is particularly important for the 1 in 3 adults living with multiple chronic conditions3, as these are often both complex and require increased focus on the side of patients for effective management. On the other hand, a lack of patient awareness also creates challenges for the HCP, as they struggle to maintain patient compliance with monitoring visits and treatment engagement. Without effective education, patient needs suffer.

Patient education needs to be improved to positively impact patient outcomes. However, as HCPs have limited time to offer additional services to patients, manufacturers have the opportunity to play a big role in supporting patients from the start and throughout their journeys, becoming a life-long value partner.

Patients experience a significant life shift during diagnosis

Being diagnosed with a chronic condition brings forward several obstacles for the patient. Firstly, patients must understand their situation and what the course of treatment entails. This is often combined with the psychological need for an acceptance of the disease or ailment, as most patients experience shock, anxiety, depression and worry at the beginning of their journey4.

Additionally, patients must accept that the course of their life may now turn out differently. For example, in the case of diabetes, patients need to make adjustments to their diet. In the case of vascular disease, they have to give up certain physical hobbies. In the case of an ostomy, they have to adjust basic daily necessities. A large part of this relates to understanding the causes of their condition and how making changes in their lifestyle can help improve their health and prevent themselves from worsening.

Patients have a lot to ramp-up on about their condition, however, the majority of patients have low awareness and understanding of their ailment. Sector & Segment’s research has identified that this is not only the case at diagnosis but even years after living with the condition. As a result, patients do not make sufficient life adjustments and significantly hinder their health outcomes. These are the most common challenges that we have identified throughout our work in the healthcare sector.

Patients can experience complications if they don’t understand their condition straightaway

At the beginning of their journey, patients often receive a lot of material, which naturally results in them becoming overwhelmed. These patients may not process all the information and may have difficulty remembering key aspects once home from the doctor.

At the same time, HCPs have a lot to communicate to the patient at this time. In some cases, HCPs may see that the patient is overwhelmed and may not cover every topic in depth or from every nuance. In other cases, HCPs may simply forget to cover some of the peripheral health topics (such as nutrition) if they are not the essential treatment. In some cases, if the information is not understood immediately by the patient, it can cause complications to a procedure or treatment.

Sector & Segment conducted a multi-country project where we spoke with patients who developed surgical wound dehiscence following an operation. We observed that all the patients who experienced this complication were unlikely to have a deep understanding of what was expected of them post-surgery. Patients could not recall any specific advice from their HCP – which could have been resting, not smoking or drinking alcohol, eating healthily or not touching the wound. Consequently, these patients clearly could not understand how their behaviour resulted in a surgical incision not healing but were also unaware that their actions would have affected this outcome. This causes patients to disengage from their recovery and lose trust in their HCPs as well as the products that they are using for their treatment.

Without knowing the cause, patients have no solution

With some conditions, treatment alone is not enough – understanding and reversing the cause of the problem is essential. This is the case with chronic ulcers – while there is treatment for the wound itself, the main necessity is to treat the underlying condition which is causing the ulcer (e.g. diabetes or vascular insufficiency). By not treating the cause and only the wound, the patient can expect the ulcer to recur.

Sector & Segment conducted research across 4 countries which focused on the behaviour of patients with chronic ulcers. It was observed that awareness and understanding about the underlying condition was a key element missing across most interviewees. The research found that less than 10% of patients could confidently say that they understood the link between the underlying condition and how it has caused their ulcer. The remaining patients were not confident and could not explain the connection, and therefore were not following all the treatment recommendations for the underlying condition. Some of these patients had had their ulcers for over 2 years, but were still struggling to understand the cause and the treatment. The sample contained a variety of ages, work status, professions, and education levels, with no clear link found to the patient’s background. Without this awareness, patients are stuck in an endless loop with their chronic wounds, as they are not targeting the cause of the problem. The longer they are stuck in the loop, the less trust they have in the brands they are using for their treatment and the more likely they are to abandon the treatment altogether, potentially blaming the quality of the product and not their compliance levels.

Misleadingly, the situation doesn’t look that bad

One common issue seen with patients is them believing that “the worst case will not happen to me”. Patients often misunderstand how important it is for them to change their lifestyle after being diagnosed with a chronic condition. In most cases, the symptoms of the disease appear slowly, hence patients struggle to grasp the real impact of the diagnosis and often fail to make significant changes quickly enough.

While researching the diabetes patient journey, Sector & Segment heard from nurses in multiple countries that patients who are diagnosed with type 2 diabetes often struggle to understand how dangerous their diagnosis really is. The symptoms are often detected through routine blood tests and patients rarely feel a large difference in their daily lives. For example, it has been proven often that if patients lose a significant amount of weight, then they may be able to reverse the diagnosis5. However, given the lack of will and understanding from patients, this occurs infrequently.

Likewise, patients who severely mismanage their diabetes can develop diabetic foot ulcers which can result in amputation – a drastic complication all patients are taught about. However, wound care nurses comment that they regularly see patients with diabetic foot ulcers who have tried to treat it at home with aloe vera, only coming to see an HCP months later when the wound has significantly deteriorated. If patients were guided to treatment earlier on in their journey, they may be more inclined to follow the treatment and use the products available for their treatment, improving their outcomes and quality of life.

Misinformation online knocks patients off-course

Once the initial shock after the diagnosis subsides, curious and proactive patients may decide to begin conducting their own research on the condition, which mostly involves online research. Patients trust reliable sources such as government healthcare websites or patient association materials – however there is also a lot of other misleading information on the internet which could point the patient in the wrong direction, such as websites which may have the word “health” in the title but don’t have HCP backing.

Sector & Segment has observed oncologists across many markets complain that cancer patients believe that “sugar feeds cancer”, after reading this online. Happening upon this information, patients cut down on their eating and begin to lose weight. In reality, a consistent calorie intake is important for cancer treatment as the patient will require this energy to recover6. Oncologists spend a large proportion of their monitoring sessions “debunking” this myth and convincing patients to continue their normal eating habits.

It would be logical to assume that those patients who conduct online research about their condition are generally more interested in their care and would therefore have better clinical outcomes. However, the amount of misinformation available can hinder their healing process. Likewise, some conditions can have varying degrees of co-morbidities and severity, and patients may read correct advice for their condition, but one which does not necessarily apply to them due to various factors which they, themselves, may not understand. Patient-centric materials which focus on the main challenges patient face could raise condition understanding and improve patient compliance long term.

Patient-centric tools and services are needed to support patient engagement

To support patients, the education resources available to them should focus on their needs and their challenges. For example, if patients find it difficult to assimilate necessary information following diagnosis, then resources in the form of physical or online leaflets should provide them with an easy-to-read guide of “essential things to know after diagnosis” – this would allow patients to read in their own time and be able to refer to it as needed. Currently, this information is available on the internet, but not necessarily in one place for each condition.

Resources should be designed with the patient in mind, as often patients must rely on medical websites which are geared towards HCPs and are therefore quite difficult to understand. Hence, websites with a more approachable tone may educate the patient more holistically.

Endorsements by knowledge opinion leaders and expert HCPs can also help provide credibility and show patients that a source can be trusted. Whatever the resource, it should not only educate patients broadly, but also meet the patients’ needs and challenges, to support them on their journey.

Manufacturers need to play a large role in patient support, because no one else will

HCPs and healthcare systems alone do not have the resources to develop and provide the education and materials which patients require, hence product manufacturers have a large role to play in this regard to improve patient outcomes. By supporting the patient in the beginning, they can become a value partner and gain patient loyalty throughout the journey. It is important to engage patients early on, to ensure that they have a good understanding of how their own lifestyle changes can affect their treatment and to ensure there is trust between the patient and the healthcare ecosystem. Later on, as the patient progresses with their condition and accepts it, they may have other needs which need addressing such as the variety of products and treatments available to them. Simultaneously the manufacturer can support the HCPs by lessening their burden.

By supporting the patients throughout their condition, manufacturers can improve patient compliance and engagement, as well as improving clinical outcomes and patient quality of life. Depending on the condition and the needs of the patients, manufacturers could be providing a variety of solutions.

One option would be providing bespoke educational materials, such as the dedicated website about nutrition and cancer which has been designed by Nestlé Health Science7, which is a one-stop, verified source on everything a patient may want to investigate.

Similarly, manufacturers can provide tools for patients to track their daily activities and condition-related markers, an example of which is the My Ostomy Journey App by Convatec8, which allows patients to track daily intake, log foods, explore products and get instant help if needed.

Companies can also be offering emotional support for patients to avoid feeling alone in their fight. Pfizer designed their LivingWith app9, which not only provides cancer patients with information and trackers but allows patients to find support groups and make connections with other patients in their zip code.

Sector & Segment can support you with your patient-centric strategy

Sector & Segment has extensive experience deep diving into a market to understand the true challenges the patients and HCPs experience, as well as the patient needs that are not currently being met. Our experts can tailor your strategy according to the existing market dynamics, to best support the patient population and become a valued partner throughout the patient journey.

We can leverage our experience to help you:

  • Map out the patient journey and identify the largest pain points at each stage
  • Identify, segment, and quantify your customers by needs and drivers
  • Conduct digital listening and identify trends in consumer voices
  • Translate consumer insights into improving your product offering, pipeline, and positioning
  • Build materials such as patient testimonials, or working with your marketing team to script testimonial videos
  • Test online content with patients or with doctors


Margarita Svarceva at

1. Adams, ‘Improving health outcomes with better patient understanding and education’, Risk Management and Healthcare Policy, 2010
2. Office for Health Improvement and Disparities UK, ‘National Diabetes Footcare Report’, updated 2021
3. Hajat C, ‘The global burden of multiple chronic conditions: A narrative review’, Preventive Medicine Reports, 2018
4. DeJean et al. ‘Patient Experiences of Depression and Anxiety with Chronic Disease’, Ontario Health Technology Assessment Series, 2013
5. ‘Reversing Type 2 Diabetes’, Diabetes UK
6. Ravasco P. ‘Nutrition in Cancer Patients’, Journal of Clinical Medicine 2019
7. Nestle Health Science: My Cancer My Nutrition
8. Convatec: My Ostomy Journey App
9. Pfizer: LivingWith
Key Insights and Takeaways: GIANT Health Conference in London

Key Insights and Takeaways: GIANT Health Conference in London

Key Insights and Takeaways: GIANT Health Conference in London

In December 2022, our Consulting Managers Margarita Svarceva and Peter Hays attended the GIANT Health Conference in London. The two days were filled with engaging workshops, panels, and exhibitors. The conference was attended by many key stakeholders in the healthcare and innovation ecosphere including medical innovation start-ups, health and pharmaceutical companies, investors and regulators. Attendees were a mix of British, European and North American companies. We were immersed into the world of healthcare innovation, and we saw several key trends emerging. GIANT stands for ‘Global Innovation and New Technology’ show. The yearly event brings together individuals and companies in the healthcare innovation space through a 2-day exposition with 4 thematic presentation programmes. This year’s presentations were focused on Digital Pharma, the Future of Hospitals, Mental HealthTech and the new Integrated Care Structure in the NHS. The event aims to improve health and well-being of people around the world by facilitating healthcare innovation and supporting health-tech entrepreneurs and investors. The types of exhibitors present at GIANT Health 2022 can be segmented into the following categories, albeit not exclusively:

Figure 1: Lumeus app which uses music to encourage positive emotions (

Many companies are naturally offering a product or service through an app which can be easily accessed by the user or patient on their phone at any moment. A large majority were offering an app or included an app as part of their offering, either:
  • Offering a service through an online platform or phone app. Examples of this included mental health apps which support patients with chronic depression or anxiety, or platforms which allow patients with complex conditions to combine records from all their physicians in one platform, and to connect these physicians to share information and facilitate more integrated care.
  • Providing an app which links to a medical device or physical service. In this case, the companies are using technology for tracking and monitoring purposes but are collecting data through a physical device. This includes start-ups which are producing wearable devices for a specific patient group (e.g., Parkinson’s or Kidney disease) with the aim of alleviating symptoms, tracking essential daily markers or facilitating remote monitoring and communication, with the aim of assisting the care and treatment of a patient. These devices link to a platform or app, which is used for data collection, monitoring, communication and assistance.

Figure 2: The CUE1 is a wearable device designed by Charco Neurotech to help decrease symptoms of Parkinson’s disease (

Some of the start-ups offered more traditional medical devices independent of an app. These innovations provide either an improvement to healthcare infrastructure or a direct solution for a patient condition. This includes small-scale point-of-care testing, which are small devices that can provide various on the spot blood tests with results being available instantly. It also includes start-ups which had created a company around a new scientific approach or method. One example includes a company using genetic materials to identify bespoke treatment approaches for Oncology patients to improve outcomes. The companies that exhibited at GIANT Health in 2022 were on a spectrum of maturity. Some were newly created start-ups and still in development phases, while others were more mature companies with demonstrable success in one country looking to expand to new markets to find new patients or customers. A large proportion of companies were in-between, with a well-established offering but looking for investment and further support.

Our Key GIANT Takeaways

S&S sat in on various panels and industry discussions about the current challenges for MedTech and digital therapy companies and in particular the challenges new health technology companies have to navigate. We took the following lessons with us.

There is a lack of funding for implementation for MedTech and digitally enabled therapeutics

Across countries, but particularly in the UK, we are currently seeing an under-funded and under-staffed healthcare system. One remedy would be new technologies and innovation to supplement care with digital systems which provide support, monitoring and/or treatment to patients who are unable to access other forms of care. The challenge, however, is that while funding is readily made available for research and development of innovative technologies, this does not extend to implementation in the UK. This results in a large pocket of innovation, which is followed by brain drain, in which start-ups are seeking to launch somewhere they will receive more support. Consequently, the UK is losing out on many of the good ideas it helped foster.

Reimbursement is highly challenging for MedTech, particularly due to the need for real-world and clinical data

Figure 3: The PL Mini is a point-of-testing device which offers 37 different tests (

Most innovative digital therapies have a clear cost saving, process improvement or outcome improvement evidenced in their design. However, the current reimbursement frameworks treat these as a medical device rather than a treatment which comes with challenging regulatory hurdles. These start-ups are required to fulfil extensive evidence-based reimbursement criteria which can be challenging for many start-ups. Randomised control trials are expensive to conduct. Real-world data, which is collected from real patients or users as they engage with the digital treatment, are not always accepted, or are accepted with strict criteria. As a result, many digital therapies, which could complement the healthcare service, struggle to gain any reimbursement. On top of that, the NHS is a highly fragmented organisation with 42 ‘Integrated Care Systems’ (ICS). Once a new digital tool has enough evidence to even be reimbursed, they must deal with each ICS on an individual basis, which can be resource-draining for small start-ups. In reality, digital therapies are very scalable and easy to implement elsewhere once they are up and running – it is difficult to understand why they need to jump through the same hurdles again. A more open-minded NHS could integrate digital therapies to provide care to patients struggling to gain access to healthcare professionals.

There is a lack of understanding around the value of MedTech and digital therapies

Figure 4: Moonbird is an app-linked device which helps with anxiety by helping a patient control their breathing (

Tech tools and innovative platforms have been used in every industry for decades now. However, the healthcare system remains very slow at adopting organisational or monitoring technology which can lessen the current burden on care services. While there is constant news and updates about new ways technology is being used to make healthcare more accessible and equitable, as the GIANT Health London 2022 conference demonstrates, the existing systems are not realising the value that this technology brings. Healthcare has been the slowest at incorporating simple organisational tools into its daily function (e.g. online booking systems), hence advanced digital therapies such as specialised remote monitoring platforms, apps which deliver anxiety-reducing support or platforms which help track patients with chronic conditions, have not been incorporated into the NHS. The sheer low level of technological solutions available to patients, points to a clear lack of understanding on the value these could bring. Overall, most healthcare systems are not designed to be open to digital therapies and MedTech, and fail to take into account how their approach needs to be adjusted to bring them into the fold.

We can help guide you through the MedTech landscape

Sector & Segment has extensive experience working with Medtech companies to tackle the challenges we identify above. Challenges of funding, reimbursement and awareness are key pain points faced by most companies in the healthcare space. We have successfully worked with MedTech clients to identify whether public reimbursement is the best solution or if direct-to-consumer channels are more lucrative; whether a product is not being used due to awareness or due to negative perceptions; whether new market entry is an attractive strategy. Our experts could help you:
  • Map out drivers and inhibitors in the market
  • Size market demand and identify key client segments
  • Develop a go-to-market strategy tailored to your company and products
  • Concept test a new platform or product with healthcare professionals or patients


Margarita Svarceva at Peter Hays at
The Value of Segmentation in Healthcare

The Value of Segmentation in Healthcare

The Value of Segmentation in Healthcare

A trend towards the personalisation of medical care

Over the past decades, healthcare systems have been progressively shifting towards a more integrated and patient-centric approach to care. One form of this shift is tailoring treatments to the specific characteristics of the patient (e.g., phenotypes & genotypes), as evidenced by the framework created under the International Consortium for Personalized Medicine (ICPerMed). Another form, however, and the focus of this article, is the development of care-plans, products, and services that meet patients’ lifestyle needs and personal preferences in addition to clinical needs.

“…the importance of ‘what matters to someone’ is not just ‘what’s the matter with someone’. Since individuals’ values and preferences differ, ensuring choice and sharing control can meaningfully improve care outcomes.”

This second type of personalisation is increasingly being recognized by healthcare services. “Personalised care” is one of the five major practical objectives laid out by NHS England in their 2019 long-term plan, recognising that “…the importance of ‘what matters to someone’ is not just ‘what’s the matter with someone’. Since individuals’ values and preferences differ, ensuring choice and sharing control can meaningfully improve care outcomes.” In short, healthcare services seek to improve patient outcomes by both being more responsive to patient needs and providing patients with more agency.

This new mindset adds complexity to patient care and delivery of solutions: more stakeholders (patients and their caregivers) are now involved in care decision-making and non-clinical factors must be considered across hospital and community settings. These non-clinical factors, such as patient lifestyles and preferences, are much harder to measure for medical professionals, especially given the budget and staffing shortages faced in many healthcare systems. On the other hand, these challenges represent an opportunity for healthcare companies to enhance their own offerings.

Manufacturers also have an opportunity to play a role in creating long-term value for patients through personalization of care. Thanks to developments in telehealth services, app and web-based patient programmes and the integration of smart technology in wearable medical devices, companies can reach patients across a variety of channels and extend their services and product offerings more efficiently. This presents an opportunity to become the “partner of choice” with patients and caregivers along their journey.

Patient segmentation is now more important than ever

To take advantage of this opportunity, medical players are increasingly moving from a product to a patient-centric mindset. This requires developing a deeper understanding of psychological and behavioural facets of patients, and using that understanding to tailor services, communication materials, and products to wider patient needs.

Building this understanding is especially important in the case of body-modifying surgeries or wearable medical devices that can have long term repercussions on a patient’s self-image, confidence, and social life. It is common for patients to experience stigmas associated with living with an insulin pump for diabetic patients, with aids following hearing loss, or with an ostomy bag following a bladder or bowel resection. Needless to say, these patients have a complex set of personal, medical, and practical needs that require HCPs to engage on a deeper level and on topics that go beyond the learnings of a traditional curriculum or patient-approach.

Going down the Direct-To-Consumer communication (DTC) route may not be a suitable option for all Medical Supply or MedTech companies. For example, some companies have made a deliberate strategic choice to focus all their go-to-market efforts on Healthcare Professionals (HCPs) and payers in order to establish strong medical credibility and/or differentiate from Over-the-Counter (OTC) players. In other cases, local regulations may be restrictive and not allow for much direct communication to patients.

Yet, even in these varied cases and circumstances, building a deeper understanding of patients still represents an opportunity to develop tailored tools and services to support the work of HCPs and drive prescriptions and/or recommendations to their patients. In the UK, the NHS notes that “creating genuine partnerships requires professionals to work differently, as well as a systematic approach to engaging patients in decisions about their health and wellbeing”. To this end, HCPs have become more open to ad-hoc training and support tools to facilitate “the conversations which help patients make the decisions that are right for them”.

What we have learnt from recent segmentation work in medical devices

Sector & Segment recently conducted a large multi-country patient segmentation for one of our clients working in the field of medical devices with the goal of supplementing previous segmentation research on HCPs.

While interviewing HCPs, we learned that while clinical needs were assessed on a patient-by-patient basis, many HCPs divided their patients in terms of 1. broad age groups (18-30, 30-60 and over 60 years old) to assess lifestyle-related needs and 2. underlying medical conditions (chronic, acute, and emergency patients) to assess needs related to the level of psychological support required. This in turn would be used to determine how they would approach patients in terms of time and attention paid to address patients’ personal needs. For example, we found that HCPs spent more time with younger patients and were more likely to provide them with support on selecting a product that fit their daily life or with information on wider topics. By contrast, HCPs spent less time with “older” patients and prioritized meeting medical and practical needs, often overlooking the rest.

What we learnt working with patients, however, is that grouping them using broad segmentation criteria throws only a partial light on the challenges that they face, their needs, and the type of support that they seek along their journey.

1. Patient preferences and behaviours are complex, and age is not the sole factor when seeking to explain or predict them

While it is true that there are patient needs associated with age, like planning for a family or building a career, as well as practical challenges such as reduced dexterity and autonomy, those needs are not the sole determinant of patient behaviour. In our study, patients willing to engage with others about their condition and be proactive in researching information and products were equally present across all age groups. This revelation disproved our initial hypothesis that more mature patients were more likely to follow their HCPs recommendations rather than playing an active role in the decision making relating to their care. In fact, when looking at the distribution of behaviours and needs by age, the 60–75-year-old bracket had a similar distribution as other “younger” groups.

2. Needs and behaviours resulting from an underlying condition are not “set in stone” but can evolve over the course of the journey

A patient’s underlying condition plays a key role not only in determining their medical needs but also in shaping their emotional journey. Depending on their condition, patients may take a different approach preparing for and accepting the same surgical procedure. For example, if we consider the same surgical procedure conducted on three different types of patients: one with a chronic illness, one with cancer, and one involved in an accident, we will see different initial attitudes and behaviours.

  • For the chronic patient, the surgery may be a step in a long treatment after enduring years of pain, and they may be more mentally prepared for this event
  • For the cancer patient, this surgery could be just the beginning of their battle with cancer and represent uncertainty about the ultimate outcome
  • For a patient who underwent the same surgery as a result of an accident or trauma their initial reaction is likely to be shock due to the unexpected outcome

These differences in reactions, attitudes, and behaviours, however, are likely to change as the patient progresses through their journey. What we found, for example, is that trauma and oncology patients developed a more positive attitude towards the same procedure by the end of the second year, while chronic patients who were initially more positive in relative terms, took much longer to come to terms with their new life and required more constant support. This evolution in needs indicates the importance of breaking down the patient journey into phases and approaching each phase as an individual journey. Ultimately, this allows for a mapping of how needs and behaviours evolve over time and an opportunity to target patients with greater precision.

3. Furthermore, when patients present multiple comorbidities, behaviours/preferences associated with each condition may overlap or differ

A patient’s behaviours may not even be consistent when it comes to their approach to comorbidities. Our research has found that when patients have multiple comorbidities, they would often take on different behaviours and attitudes depending on the condition they are focused on, as well as prioritise one condition over another. This is commonly seen in chronic patients who often have several conditions or co-morbidities. For example, a diabetes patient may also have hypertension or cardiac disease, or a head & neck cancer patient may also have dysphagia. We have observed that patients with hypertension and diabetes are likely to prioritise hypertension because this represents the more serious condition which can lead to a heart attack, while diabetes has a slower progression and therefore a slower impact. In this case, a patient can be “proactive” towards their hypertension (engaging with HCPs, conducting their own research, connecting with other patients), while at the same time being “passive” towards their diabetes (not following the prescribed diet, not monitoring their glucose levels as closely, missing appointments). This further demonstrated the relevance of specific segmentations, since patients’ behaviours, attitudes and needs shift considerably between conditions and areas of care.

How not to lose a patient in 1 year

It probably doesn’t come as a surprise that over half of the patients in our research sample were dissatisfied with the level of information and support received from their HCP. They frequently found the support they received to be too generic or not relevant to their practical and emotional needs in that moment. Furthermore, they often did not follow their HCP product recommendation, switching to other manufacturers within one year from point of discharge.

From a manufacturer’s point of view, understanding who these patients are, why they stayed or why they switched and how they made this decision, can be paramount in setting out a sales and marketing strategy and developing detailed action plans.

Having well defined and quantifiable patient segments based on needs, channel of information and source of influence, as well as attitude and behaviours can help answer questions like:

  • What patient-segments should we prioritise?
  • What channels should we use to reach these patients more effectively and efficiently?
  • Do we already have products in the market to support these patients’ needs? How should we position our portfolio against patients’ needs? Should we prioritise some innovations over others? Do we need to rationalise our portfolio?
  • How can we offer more value to patients?

How we can help

Our experts can support your growth strategy by identifying and quantifying your customer segments, guiding your team to set priorities, develop tools and position your service and product offering for long-term success.

Contact Marie-Elisabeth Maigre (Consulting Director) at and Giada Garofalo (Director of Research) at to learn more.

How COVID-19 has impacted medical devices: the case of wound care

How COVID-19 has impacted medical devices: the case of wound care

How COVID-19 has impacted medical devices: the case of wound care

As healthcare systems across the world scrambled to contain the spread of COVID-19 in the spring of 2020, resources were shifted away from many areas of healthcare to treat patients with the virus. The stay-at-home public health messaging advised people, at least initially, to avoid unnecessary healthcare to reduce transmission and as a result many consultations and procedures in other areas of healthcare were cancelled or done remotely.

It comes as no surprise that amidst a public health crisis that medical devices, an industry that is inextricably tied to healthcare systems – from clinical trials to prescriptions – has not escaped the unprecedented negative impact of the pandemic. To be sure, not all medical devices have been impacted negatively; as products deemed to be vital for the treatment of COVID-19, notably ventilators, personal protective equipment (PPE) and equipment needed for diagnostic tests, were prioritised. Governments did what they could to ramp-up manufacturing capacity, approval and delivery, to avoid shortage of these and as a result some of these devices have experienced growths of over 300%[1]. Other devices, not essential to treating or preventing the spread of the virus, have been side-lined and have experienced sharp declines in their usage. Devices used in hospitals have been particularly impacted, due to reallocation of resources and drop in hospital visits, though devices in other areas such as in dentalcare have also seen declines. Whether in decline or not, what is common to all areas of medical devices is a shift towards digital health, a shift that presents players with both challenges and opportunities.

How the pandemic affected wound care

Due to the staggering number of cancellations and postponements of elective surgeries (estimated to be at around 28 million worldwide[2]), there has been a sharp decline in the use of hospital-based wound care products. In some instances, clinics have temporarily closed altogether. One surgery department in New York used to see around 350 patients a week with vascular issues before the pandemic[3]. In March, it largely shut down; staff shrank from 25 to four as they were triaged to ICU or sent home to work remotely. Hospitals have also reported a decline in emergency department visits, likely due to the change in patient behaviour as a result of national lockdowns and stay-at-home messaging[4]. This has meant a reduction in trauma-based wounds, with the exception of burn wounds which have remained more or less stable.

Treatment of chronic wounds has been impacted too, though not to the same extent as surgical ones. As clinics and other facilities became potential hotspots for transmission, healthcare professionals were forced to adopt new forms of treatment. Given chronic wounds are often associated with underlying conditions – such as diabetes – that are also conditions that make people more vulnerable to COVID-19, it is unsurprising that patient behaviour changed, given the risk of exposure to the virus. Of those that continued treatment, 76.1% stated that the pandemic changed their treatment one way or another[5]. As consultations and patient monitoring moved online, treatments were simplified by nurses to allow familiars or patients themselves to make the dressings. In the case of missed appointments it was reported that 12.8% of patients did not have their wound dressing changed during the pandemic, contributing to the overall reduction in use of products as well as leading to an increased number of patients with untreated, worsening wounds.

Wound Care players with more hospital focus were more affected

Of the key players in the market, including 3M, Smith & Nephew, Mölnlycke, ConvaTec and Coloplast, none came out of the first quarter of 2020 unscathed. All companies reported declines in revenues, with Advanced Wound Care and NPWT being amongst the worst affected segments. Companies such as Smith & Nephew that were most associated with hospitals, and therefore exposed to the cancellations of elective procedures, fared worst. On the other hand, companies such as Mölnlycke and Coloplast that focus more on homecare have proved more resilient and quicker to recover. Coloplast reported 2-4% overall growth in Q2 (though it was -2% in wound care)[6], whereas Smith & Nephew faced a sharp decline in revenue with -29.3% of negative growth[7]. Within Smith & Nephew’s portfolio, wound care was more resilient with only -17.6% decline (compared with -34% in Sports Medicine and Orthopaedics), but has been far slower to recover, due to the continued closures and changes to patient behaviour throughout summer.

China and, to some extent, Germany were quicker to bounce back

As with all aspects of the pandemic, there has been an unevenness across geographies in terms of impact and recovery. In Europe, differences in responses and preparedness brought about significant variations in the impact on the broader healthcare industry. Germany is widely reported as being the least impacted, whereas the UK is amongst the worst in terms of hospital admission rates, with over 516,000 cancelled surgeries[8].

Some companies have reported a speedier recovery in the US compared with other markets. However, within the US itself there is great unevenness in recovery, as New York and New Jersey continue to grapple with an enormous burden of transmission, whilst hospitals in Seattle move to restart elective procedures. Smith and Nephew reported slow recovery in emerging markets, with a negative growth of -14.5%, mainly due to restrictions in India, South Africa and Latin American markets, offset by a return to growth in China in the summer[9].

Future outlook: demographic trends are likely to revert revenue declines

 Looking ahead, it is critical to recognise how declines in revenues for some medical devices are situated within a changing landscape of healthcare, catalysed by the pandemic. Whilst most healthcare systems are still grappling with the virus, the eventual return to elective procedures in hospitals will allow companies to recapture at least some of the growth experienced before the pandemic. In the case of wound care, growth was at 4.6% CAGR, and demand is likely to continue to increase, assuming the continuation of demographic trends – an ageing population and growing prevalence of diabetes and vascular diseases. This is particularly the case for chronic wounds, which continue to be a significant burden for many countries (the UK National Health System spends £5bn each year treating them[10]) and which may have worsened for many patients during the pandemic.

Opportunities to capitalise on the growing importance of digital health

The pandemic has given healthcare a digital makeover. Digital health has boomed in 2020 and is unlikely to fizzle out, as remote healthcare options are cheaper and more convenient for many patients. Even during the summer as the virus waned, the proportion of face-to-face appointments remained far lower than prior to the pandemic. Both healthcare professionals and patients have shown a willingness to adapt. Remote appointments have shot up across the world: in the US, remote visits to Mayo Clinic, a healthcare provider, rose from 4% to 85%, whilst in China Ping an Good Doctor, an online health portal, had 1.1bn visits at the height of the pandemic[11]. Regulators and governments have also facilitated this shift, passing laws urging reimbursement of online services and facilitating approvals of these.

Companies in the medical devices industry should capitalise on these changes, particularly as global digital health revenues are estimated to rise from $350bn last year to $600bn in 2024[12]. Critically, companies would be advised to rapidly scale up their digital capabilities and develop online support for their devices as they are increasingly likely to be used in a homecare setting. With increased patient engagement and comfort, digital and remote healthcare could propel all areas of medical devices into greater growth than before the pandemic. If, however, companies fail to reorientate their portfolios towards these new healthcare needs and innovations they may miss out on this opportunity.