NSCLC Treatment Pathway

Faced with the prospect of having to reset revenue expectations for its entire portfolio of lung cancer targeted agents, a large biotechnology company turned to Health Advances to identify the drivers and barriers to lung cancer treatment and strategies to overcome the low overall treatment rate.


Health Advances was engaged by a client with both marketed drugs and pipeline products for the treatment of non-small cell lung cancer (NSCLC). The client’s internal research identified an unexpectedly low overall treatment rate among patients with advanced-stage NSCLC relative to other cancers, and wanted to better understand the drivers and barriers to treatment in this disease.

Health Advances was tasked with confirming the low treatment rate among these patients, and identifying the drivers and barriers to treatment at each stage in the referral and treatment pathway. Key questions to address included:

  • To what extent can the low treatment rate be explained by demographic variables, such as age and socioeconomic status?
  • What are the critical decisions at each step in the diagnosis, referral, and treatment paradigm, and who are the key influencers of each decision?
  • What role do cultural perceptions of lung cancer (such as the stigma of smoking) have on patients and decision-makers?

Health Advances Approach and Findings

Health Advances conducted a comprehensive review of published literature and statistical databases to define the characteristics of the NSCLC population relative to other cancers, and conducted an in-depth research program with primary care physicians, pulmonologists, and oncologists to clarify the referral and treatment paradigm. Patient age, socioeconomic status, performance status, comorbidities, and advocacy/social stigma were analyzed and compared with treatment rates across other cancers. The team determined that demographic variables could not entirely explain the relatively low treatment rate relative to other cancers.

The team constructed a detailed map of the referral and treatment pathway for NSCLC, confirming the clients’ reported treatment rate and identifying the points in the referral sequence at which patients drop out.

Finally, Health Advances prioritized, described, and quantified the major barriers to referral or treatment at each step.


  • Health Advances identified the factors and the magnitude of their contribution to the low treatment rate in advanced NSCLC.
  • The most significant factors – the poor functional status of the population and the relatively unattractive benefit/side-effect profile of current therapies – are difficult to address. However, some factors can be addressed by the lung cancer community to increase treatment rates; for example, a small group of primary care physicians and pulmonologists were found to hold outdated views on the benefit/side-effect profile of active treatment for lung cancer. Education of these groups about new therapies may improve referral and treatment rates.
  • More accurate understanding of the referral and treatment decisions aided the client in developing forecasts and budgets and to determine which potential tactics for increasing the eligible treatment population warranted investment.