Towards Realizing Daiichi Sankyo's Patient Centricity
~ Listening to Patient Voices, Collaborating for Shared Value

As one of the strategic pillars of our current 5-year business plan, "Creating Shared Value with Stakeholders," we have strengthened the promotion of Patient Centricity as a core of our business activities throughout the entire value chain. In this regard, we organized a panel discussion involving the Outside Director with experience in clinical medicine and public health, the Patient Centricity Special Assignment, and top managements from our global organizations, who are leading Patient Centricity initiatives in the oncology and specialty areas to exchange opinions on our Group's perspective regarding Patient Centricity.

Introduction of experiences, insights, and current positions regarding Patient Centricity

Ueno
First, Dr. Komatsu, could you share your opinions on the current state of Patient Centricity in the medical field, based on your own experiences and insights?

Komatsu
When considering Patient Centricity, direct care for patients, the hospital management & administration, research and policy initiatives are important. Among these, the essence of Patient Centricity at the direct care level is to share common goals and values between patients and healthcare professionals^※1. In the healthcare field, there has been an increasing em- phasis on healthcare that takes into account the values and perspectives of patients. However, despite our efforts as healthcare professionals to under- stand and explain what is important to patients and provide healthcare, there is still a challenge of patients unable to voice the questions they want to ask. It is necessary to build a trusting relationship where patients can freely communicate so that healthcare providers can truly understand their needs.

40 years ago, the paternalistic model was predominant in healthcare where physicians decided the treatment for the patient and obtained patients' consent. However, nowadays, Shared decision-making, which involves col- laboration between healthcare professionals and patients, considering both medical and patients' needs, is highly valued. In my opinion, the essence of Patient Centricity is to discuss what is most important and optimal for each patient and reach a mutually agreeable conclusion.

• ※１https://doi.org/10.1377/hlthaff.2012.1133

Ueno
Next, I would like to ask Gissoo and Oliver about promoting Patient Centricity within our company. Based on your own experiences and insights, could you tell us how you are fulfilling your roles?

Gissoo
GAs the Head of Advocacy, Global Oncology Medical Affairs, I encourage our internal and external stakeholders to be focused on the needs of the patients and always keep the patient at the top of their mind when they go through their day-to-day work. Particularly in the field of oncology, asking patients’ perspectives about their lived experience with cancer and consid- ering how to meet the unmet needs of the patients is very important.

For example, we strive to incorporate the voices and perspectives of patients throughout the development process, from preclinical stages to late-stage clinical trials all the way to commercialization and every step in between. What we truly aim for is "inclusion" of patients in the entire process to share their valuable lived experiences which will make our processes more robust and patient centric.

Oliver
Looking back at the start of my career in the pharmaceutical industry, I worked as a sales representative 20 years ago. At that time, I had the opportunity to experience direct exchange with patients, by educating and raising awareness among patients. It also left me with the fundamental understanding that patients really must be the foundation of our decision-making.

This experience perfectly aligns with the concept of Patient Centricity that our Group aims for. One concrete example of putting this experience into practice is the launch of Lixiana®, the anticoagulant, in Europe, where I collaborated with Arrhythmia Alliance, the leading global Patient Organization in the field of arrhythmias. Together, we promoted various initiatives and educational campaigns with a patient-centric approach. Additionally, while I served as General Manager at Daiichi Sankyo Germany, I established strong relationships with patient organizations such as the German Stroke Foundation and the German Hypertension League. We discussed the current status and challenges of cardiovascular diseases (CVD) with diverse stakeholders from the patient’s perspective and provided support to improve quality of life (QOL).

Global Initiatives for Patient Centricity

Ueno
Please provide specific examples of initiatives and achievements relat- ed to Patient Centricity in the oncology and specialty fields

Gissoo
The Global Patient Advocacy team that I lead primarily focuses on cancer patients, caregivers, and other like-minded stakeholders. We focus on activities that add value to patients through our pharmaceutical products and services and enable cancer patients to live longer and better lives with less side effects. Specifically, we actively engage with many patients to gain a better understanding of their daily lives and the challenges they face in their treatment, access to medicines, mental health support and overarching survivorship needs.

Additionally, we engage with over 900 patient advocacy groups worldwide throughout the year. We are actively collaborating with the most suitable organizations to establish long-term relationships and jointly develop programs such as awareness-raising campaigns and educational initiatives that will help patients’ quality of life. Regarding the process, we developed the Patient Steering Committee that reflects the patients’ voices. Within this committee, we have identified challenges for cancer patients and are conducting activities to tackle the challenges based on our Advocacy Engagement Strategy (see Figure 1).

One of the goals of our Advocacy Engagement Strategy is to identify the unmet needs of patients in the disease areas of interest to our pipeline assets. For instance, many cancer patients face various challenges such as a not being aware of clinical trials or under- standing of biomarker testing. To address these issues, we collaborate with relevant organizations to raise awareness of the importance of testing and to provide support in improving patient access to clinical trials and increase biomarker testing rates. Additionally, we conduct surveys to directly ask patients about their reasons for choosing specific treatments or clinical trials, and we also established advisory committees with a focus on patient experiences with ADCs in both the US and Europe. These initiatives provide us valuable insights.

Furthermore, we support public education and campaigns to raise awareness in order to reduce the social stigma associated with cancer. Our daily efforts are to improve the quality of life for patients, with the goal for them to "thrive with cancer”, and to provide the necessary support for patients and their families to live better and longer lives.

Fugure１　Advocacy Engagement Strategy

Strategic imperatives	Actions to close gaps	Measures of success
Identify unmet patient needs in treatment on current compounds targets Low patient awareness of biomarker testing and the impact on appropriate treatment decisions Understanding patient lived experience including importance of Clinical Trials, QOL, side effect management and tolerability Counter cancer stigma to avoid discrimination feeling and overcome barriers	Patient advisory committees (US and EU) focused on burden of disease, MOA, lived experience and ADCs  Direct support of PAGs, medical societies and coalitions to increase knowledge, access and testing rates for patients Develop caregiver specific information through partnerships Engage cancer Patients through advisory boards and surveys to better understand treatment choices and adherence to regimens Support Public education campaigns / PSAs to reduce stigma for lung cancer patients	Development of tools for physicians to engage in more effective Shared Decision-making conversations Increased patient access to biomarker testing Improved patient AE support/management leading to improved QOL PRO Increase in patient referral to care

Oliver
I will discuss Patient Centricity with a focus on CVD. CVD is a leading cause of death worldwide, with Europe alone experiencing more than 10,000 deaths per day. Additionally, it is projected that the population of individuals aged 65 and above in Europe will reach 155 million by 2040, further increasing the incidence of CVD. Considering this situation, the EU Specialty Business Unit has implemented three specific initiatives.

Firstly, we established a Patient Engagement function in 2023 to strengthen our collab- oration with patient organizations. This function is working closely with the Oncology Business Unit Patient Advocacy team to ensure a consistent ap- proach across our entire Group. We aim to support healthcare professionals in managing the entire life journey of patients with cardiovascular disease from a long-term perspective, providing comprehensive care and support. The second is to strengthen our relationship with patient organizations. We have conducted surveys with patient organizations in 10 European countries and recognized that our company is widely known throughout Europe and there is an expectation for further collaboration. Based on these results, we have established cooperative relationships with 4 relevant patient organizations in Europe^※2. The third initiative is to raise patients’ awareness through education and campaigns. We have launched disease awareness campaigns for atrial fibrillation and dyslipidemia through two patient-focused websites^※3, to increase their literacy and also to promote the prevention in a holistic and human-centric way.

We also provide information on CVD through the website, “We Care for Every Heartbeat^※4 ”, which serves as a central hub for all activities. Fur- thermore, in collaboration with the Oncology Business Unit, we organize the "O-Mamori Award" to support or- ganizations implementing innovative projects that contribute to improving the quality of life, prevention, and education for patients. Following last year's event, we are planning to hold the "Dyslipidemia Flash Mob" event for disease awareness on this year’s World Heart Day, with the sponsorship of three patient organizations.

• ※2 Global Heart Hub, FH Europe, European Patients' Forum, European Patients' Academy on Therapeutic Innovation
• ※3 https://www.healthy-heart.org/とhttps://www.afibmatters.org/
• ※4 www.wecareforeveryheartbeat.com

Ueno
I believe the collaboration with over 900 patient organizations by Pa tient Advocacy and the comprehensive activities in the field of CVD by DSE are truly commendable. Dr. Komatsu, could you please provide your com- ments on Daiichi Sankyo's global initiatives?

Komatsu
I am deeply impressed by the efforts to build relationships with numerous patient organizations and the wide range of activities incorporat- ing Patient Centricity. I believe it is important to promote Patient Advocacy activities based on trust relationships with those organizations, as it allows us to provide appropriate information to patients and understand their actual concerns and needs. Furthermore, I also hope that by utilizing various types of media for educational activities, Daiichi Sankyo Group can contribute to the reduction of the stigma associated with cancer.

Challenges towards realizing Patient Centricity in the medical field

Ueno
I would like to ask Dr. Komatsu about the challenges in realizing Pa- tient Centricity in the healthcare field, from the perspective of an expert in clinical and public health.

Komatsu
While Patient Centricity is an important concept, many challenges and barriers still exist. For example, in the clinical setting, there is a significant gap in understanding between healthcare professionals and patients. Even if healthcare professionals strive to understand patients' values, there are still cases where patients themselves are unaware of their own needs. Therefore, it is necessary for us to strengthen our relationship with patients and their families and create opportunities for patients to freely express their thoughts, in order to identify their individual values and needs. To accurately understand patients' needs, we need to utilize various channels.

One initiative I am working on is the development of decision-making support and communication tools for patients. The tool is composed of a six-page note in which patients can record their daily lives, changes in their condition, and any questions they may have. By sharing this with their doctors during consultations, it enables patients and doctors to communicate smoothly and certainly. Even patients who may hesitate to express their concerns verbally can share information through the note. Developing such materials and tools can be challenging for individual healthcare institutions, so I believe that involving pharmaceutical companies and advocacy organizations in development would be beneficial for both patients and healthcare professionals.

Challenges and expectations for the future promotion of Patient Centricity

Ueno
Oliver, Gissoo, could you share your thoughts on the challenges in promoting Patient Centricity within your respective organizations and the expectations for our Group in promoting further co-creation of value with patients?

Oliver
We have varying strict regulatory environments in Europe. Therefore, significant efforts are required to communicate with patients in meaningful ways and provide value. Patients now have access to a wealth of informa- tion about their symptoms, diseases, and side effects, and their needs and demands have become diverse. In particular, in recent years, the importance of prevention has increased significantly, and patient organizations are increasingly engaged in disease awareness and education.

In the midst of these societal changes, the pharmaceutical industry has a responsibility to support communication between healthcare professionals and patients and contribute to the transformation of healthcare by not only providing valuable contributions through medicines but also enhancing patient empowerment through the provision of comprehensive disease awareness information.

In our global market strategy, in order to enable healthcare professionals, payers, and other stakeholders to make the best choices for patients, we focus on providing information from a deeper patient perspective and support on their activities. Collaboration with patient organizations is essential in these activities. We will continue to work responsibly and build long-term trusted relationships with patient organizations, as we believe that this is the key to success.

Gissoo
I agree with Oliver's opinion. It is a wonderful thing to have cross-or- ganizational activities, especially when significant changes are happening throughout our organization. Patient Centricity is a challenge that concerns all of us. It is important for each individual, within their respective orga- nizations and daily work, to consider how they can take actions with the patients’ perspectives. Although some teams may not be able to engage directly with patients, all of our work is ultimately connected to providing value to patients.

I think “listening” is the most important part, hearing what the patient's needs are and working internally with all of our cross-functional partners and alliance partners to be able to deliver on that promise to the patients that we could make their quality of lives better.

Komatsu
There is a concept called the Socio-Ecological Framework that is highly regarded in public health. It suggests that various levels of interaction, such as individual, interpersonal, community, and societal/policy levels, influ- ence people's health and behavior. Although companies have limited contact with individuals, society, and policy levels due to various regulations, I believe that they can contribute to the Socio-Ecological Framework by supporting patients in collaboration with healthc

Ueno
Through today's discussion, we have gained many insights from each specialized field. Firstly, it is necessary to further spread the mindset of Pa- tient Centricity in all countries, regions, and organizations within the Daiichi Sankyo Group. Everything we do as pharmaceutical companies contributes to improving patients' lives. By carefully listening to patients' opinions and incorporating their voices into our work and decision-making processes, we can provide effective solutions.

Collaboration with various stakeholders, including patient organizations, is essential for co-creating value with patients. We will continue to strengthen communication with various organizations and work towards a better society with Patient Centricity as our guiding principle.