Oncologists Look at Oncology: The Prognosis for US Cancer Care Results of a Benchmark National Survey SEPTEMBER 2008

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Oncologists Look at Oncology: The Prognosis for US Cancer Care Results of a Benchmark National Survey SEPTEMBER 2008 Confidential. Copyright National Analysts Worldwide, 2008 Not to be reproduced without consent

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TABLE OF CONTENTS Page # EXECUTIVE SUMMARY … … .… … 1 INTRODUCTION: OBJECTIVE AND METHOD … .… … . 6 DETAILED FINDINGS … … .… .. 10 CONCLUSIONS … … 29

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EXECUTIVE SUMMARY 1

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EXECUTIVE SUMMARY Study Objectives This benchmark consider, "Oncologists Look at Oncology: The Prognosis for US Cancer Care," is an online national study of 199 oncologists and hematologist/oncologists intended to take the beat of doctors who approach malignancy – particularly as for the cross-weights they encounter in view of changing clinical results and practice financial matters. This review was persuaded by our perceptions lately that oncologists are turning out to be progressively concerned and baffled by the changing repayment condition and its effect on both nature of care, and expert delight. This review was not charged by or for any customer; it is, somewhat, a free investigation into oncologists' advancing viewpoints on their calling and the care they convey to patients. The objective has been to portray the earth in ways that might be helpful to medication makers, medicinal services experts, approach creators and shoppers. Technique Study members were inspected from the Epocrates Panel, the country's biggest confirmed doctor board: All are board-affirmed or board-qualified in oncology or hematology/oncology, practically speaking for 6 to 30 years, and treating no less than 50 disease patients for every month. These qualification criteria were intended to guarantee that respondents had satisfactory clinical experience and could offer a longitudinal point of view on the calling. The arrangement is to rehash the study on a yearly premise to spot patterns and moving viewpoints. (Proceeded with) 2

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EXECUTIVE SUMMARY (Cont'd) Key Findings Six in ten oncologists (59%) express some level of confidence about the eventual fate of oncology care in this nation; a quarter (24%) are cynical and the rest (17%) are going back and forth. A large portion of the apprehensions communicated about the act of oncology fixate on monetary worries that are changing sure parts of treatment and might limit understanding choices. Oncologists report, for example, that their introduction of treatment choices is much of the time affected by patients' capacity to pay: Currently, they gauge that the discussion is molded by accounts as frequently as 39% of the time, and they anticipate that this figure will achieve 55% throughout the following five years; five years back, oncologists put that gauge at 20% of the time. The introduction of treatment choices is unmistakably affected by a patient's protection status: Conversations with patients who have private protection are formed by treatment costs just 35% of the time contrasted and 44% of the ideal opportunity for patients with Medicare just, and 52% for patients who are uninsured. One particular way the discussion amongst doctors and patients has changed accordingly of financial weights is the inclination for oncologists to be more real to life when confining results: Nearly six in ten (57%) concur that the requirement for patients to consider out-of-pocket expenses has driven them to be more unequivocal about what treatment is probably going to offer. High out-of-pocket expenses have not just affected the discourse amongst doctors and patients; they have likewise driven patients to move needs in settling on choices about treatment: Half (53%) trust that patients are incited by treatment expenses to put monetary prosperity over their odds to live more, and a comparable rate (47%) trust that high out-of-pocket expenses have driven patients to place more accentuation on personal satisfaction than on length . (Proceeded with) 3

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EXECUTIVE SUMMARY (Cont'd) One solid pattern is the propensity of private practice oncologists to send more patients to healing center communities for IV treatment since repayment is lacking (73%), frequently obliging patients to head out further to get mind: Shrinking repayment and high out-of-pocket expenses have constrained generally 50% of private oncology practices to quit overseeing certain exorbitant IV treatments The greater part of oncologists (68%) trust that the pattern of sending patients to doctor's facilities for IV treatment is an unwelcome one Looking ahead, about three in four oncologists (74%) trust that increasing expenses will inevitably surpass society's aggregate capacity to pay for ideal oncology mind. Oncologists offer a blended anticipation on the value estimation of treatments being developed: Six in ten (57%) concur that they are "idealistic" that new medications will offer noteworthy change in results yet almost the same number of (46%) express some skepticism about the remedial estimation of costly new disease tranquilizes On adjust, 66% of oncologists (63%) trust that medication costs have outpaced viability increases in the course of recent years Technologies about which oncologists are most hopeful incorporate novel biologics and little atoms and in addition focused on treatments; there is impressively less good faith about hostile to tumor immunizations and quality treatments Financial components are impacting not just patient care; they are additionally affecting how much money related and proficient fulfillment oncologists get from their practice. It is clear, in any case, that oncologists discover their wallets more antagonistically influenced than their expert satisfaction: Half (51%) discover oncology less monetarily remunerating than anticipated yet just three in ten (29%) think that its less specifically fulfilling than anticipated (Continued) 4

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EXECUTIVE SUMMARY (Cont'd) These qualms are driving more oncologists to state that they would dishearten youngsters from seeking after oncology (or pharmaceutical for the most part) than five years back (20% versus 5%). Regardless of whether this attitude will at last prompt to a genuine lessening in the total supply of oncologists is indistinct yet there are signs that oncologists as of now by and by may react to repayment shortages and cost weights by being more particular about the patients they treat: Nearly three in ten (28%) anticipate they will decline Medicare-just patients in the following couple of years and approximately a third (35%) hope to deny uninsured patients. For additional data on this review, please contact either: Susan S. McDonald, CEO or Debbie Kossman, SVP (smcdonald@nationalanalysts.com) (dkossman@nationalanalysts.com ) 5

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INTRODUCTION: OBJECTIVE AND METHOD 6

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Introduction: Objective and Method … THIS INAUGURAL SURVEY WAS CONDUCTED BY NATIONAL ANALYSTS WORLDWIDE TO DEVELOP A BENCHMARK VIEW OF THE ONCOLOGY LANDSCAPE THROUGH THE EYES OF MEDICAL ONCOLOGISTS Waged forcefully over three decades, the "War on Cancer" (pronounced by President Nixon in 1971 with the institution of the National Cancer Act) has all the earmarks of being yielding outcomes: Since the mid-1990s, growth mortality has been declining consistently, and some challenge to discuss certain tumors as "incessant sickness." New biologic operators and little particles, specifically, have enhanced certain malignancy results in striking ways. In the meantime, declining passing rates have, typically, been secured at the cost of rising consideration expenses, and "People born after WW2" will add significantly to that financial weight as they age: Along with the accessibility of exorbitant new medications, changing repayment strategies seem, by all accounts, to be moving treatment costs: interestingly, the money saving advantages of forceful disease treatment are a theme of genuine dialog and open civil argument. Impelled by these patterns and the discussions around them, this study of US oncologists was created to help us see this changing scene from their point of view. Specifically, the review concentrates on oncologists' perspectives on the clinical execution and money saving advantages of growth treatments, and the effect of changing financial matters and repayment strategy on the act of oncology – including the way of MD-patient exchange: It doesn't address particular treatments; it is implied, rather, to light up how oncologists contemplate tumor mind and where it might head. 7

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Introduction: Objective and Method … THIS STUDY WAS AN INTERNET SURVEY OF 199 U.S. ONCOLOGISTS CONDUCTED IN JUNE – JULY 2008 Questionnaire advancement (and eventually, information examination) were educated by broad top to bottom discussions with doctors before handling the review so as to distinguish issues and create speculations. Study respondents were drawn from the Epocrates doctor board – the country's biggest, checked doctor board. Epocrates Honors Market Research program has the biggest selected in, confirmed doctor board in the business with more than 130,000 U.S.- based doctors, and additionally 400,000 associated social insurance experts. Respondents were required to meet a few qualification criteria intended to guarantee sufficient experience and a longitudinal point of view on the act of oncology: Nearly every one of the (98%) are board-ensured in medicinal oncology or hematology/oncology; the rest of the 2% are board-qualified. All have been practically speaking in the vicinity of 6 and 30 years since finishing their association. All observe no less than 50 disease patients for every month (mean = 270). The greater part of respondents (six in 10) are private practice proprietors; the rest of salaried – by and large in healing centers or other institutional settings (see Sample Charact

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