Most Patients Received Inadequate Information on Switching to Biosimilars, Survey Finds

A survey assessing patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and medical oncologists found that many patients who switched to a trastuzumab biosimilar from the reference product (Herceptin) were not given sufficient information on biosimilars prior to the switch.

The findings, which were published in Breast Cancer Research and Treatment, revealed that patients were often not told what a biosimilar was or why they were being switched, not given an option to switch, or not told they were being switched at all. The authors of the paper raised concerns that lack of notification about switches and education regarding biosimilars is an issue of ethics, whereby patients are the ones who are being disadvantaged.

“Patients have the right to be informed regarding their treatment….Without information about their care, patients do not have agency, further conflicting with the goals of patient-centered care,” said the researchers.

Two surveys were developed and distributed across the United States to characterize experiences with trastuzumab biosimilars: 1 for patients and 1 for health care professionals. The survey was completed by 143 patients with HER2-positive breast cancer and 33 medical oncologists. The average age was 49.59 years for the patients and 46.16 years for the oncologists.

Overall, 63.9% of patients said they had switched from Herceptin to a trastuzumab biosimilar and 55.2% said they were offered the option to switch, of whom 8.6% declined.

In 40.8% of responses from those who were switched, patients expressed that they were not given prior notification that they would be switching to a biosimilar. Many patients said that the lack of notification led to negative emotions regarding the switch. Only 11% of the patients reported being satisfied with the information they received on biosimilars and switching.

Over 60% (61.0%) of patients reported learning about biosimilars through self-directed learning compared with 33.3% who learned from their provider and 35.2% who learned by asking on social media.

In total, 41.0% of patients said they wanted more time to discuss switching with a physician, 35.0% wanted more time between the notification and the switch, 52.5% wanted to have a better understanding of biosimilars, 41.3% wished they had access to printed education materials. Additionally, 54.8% of patients reported that they did not receive any education material from a pharmaceutical manufactuer.

The survey results also revealed that oncologists were not always aware that patients were being switched to a biosimilar.

“Despite their central role in cancer patient care, oncologists lack complete information. It is important to identify what information oncologists need both for their own situational awareness and to foster relationships with their patients. Ultimately, effective communication about trastuzumab biosimilars is not the sole responsibility of individual oncologists, but rather an objective in need of systems-level interventions,” the investigators commented.

The researchers recommended for more emphasis in studies to be on patients and their caregivers in order to inform treatment decisions and future guidelines.

“To develop tailored interventions, it is necessary to characterize the experience of not just clinicians (as traditional) but patients and their families and caregivers through research methods such as surveys and interviews focused on eliciting lived experiences and unpacking decision points and knowledge gaps. Findings should be used to inform the development and evaluation of interventions, resulting in practices that are tailored to the needs of patients and clinicians,” the authors wrote.

Reference

Papautsky EL, Carlson M, Johnson SM, Montague H, Attai DJ, Lustberg MB. Characterizing experiences of non-medical switching to trastuzumab biosimilars using data from internet-based surveys with US-based oncologists and breast cancer patients. Breast Cancer Res Treat. 2022;194(1):25-33. doi:10.1007/s10549-022-06615-2