pan-canadian Oncology Drug Review Patient Engagement Guide October 2015

pan-canadian Oncology Drug Review Patient Engagement Guide October 2015

RECORD OF UPDATES Update Version Reported on pcodr Website Original April 2011 April 27, 2011 Revised June 2012 June 4, 2012 Revised October 2015 October 6, 2015 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW i

INQUIRIES Inquiries and correspondence about the pan-canadian Oncology Drug Review (pcodr) should be directed to: pan-canadian Oncology Drug Review 154 University Avenue, suite 300 Toronto, ON M5H 3Y9 Telephone: 1-866-988-1444 Fax: 1-866-662-1778 Email: info@pcodr.ca Website: www.cadth.ca/pcodr 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW ii

TABLE OF CONTENTS RECORD OF UPDATES... i INQUIRIES... ii 2 Background... 3 3 pcodr Review Process... 3 4 Participating in the pcodr review process... 4 4.1 How can patients participate in the pcodr review process?... 4 4.2 Who is eligible to provide patient input on a review and feedback on a recommendation?... 4 4.3 How can individual patients participate in the pcodr review process?... 5 4.4 How do members of patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) register with pcodr?... 5 4.5 How is patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input on a drug review and feedback on recommendations used in the review process?... 6 4.6 How do patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) provide input on a drug review or feedback on an initial recommendation?... 6 4.7 How do patient advocacy groups (or individual patients or caregivers in cases where there is no advocacy patient group) know when to submit input in the early stage of a review?... 8 4.8 How many submissions can patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) submit per drug?... 8 4.9 How much time do patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) have to provide input on a drug review?... 9 4.10 How will patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) know when to provide feedback on a perc initial recommendation?... 9 4.11 How much time do patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) have to provide feedback on a perc initial recommendation?... 9 4.12 Tracking a pcodr review and recommendation... 10 4.13 What are the steps to submit input on a drug review or feedback on a recommendation?... 10 5 A guide to completing the pcodr Patient Advocacy Group / Individual Patient or Caregiver Conflict of Interest Declarations... 11 6 A guide to completing the pcodr Patient Advocacy Group Input / Individual Patient or Caregiver Input on a Drug Review Template... 11 6.1 Submission length... 11 6.2 Information to complete the Patient Advocacy Group Input Template... 11 6.3 Information to complete the Individual or Caregiver Input Template... 12 6.3.1 Section 1 of the Individual or Caregiver Input Template General Information... 12 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 1

7 A guide to completing the pcodr Patient Advocacy Group / Individual Patient or Caregiver Feedback on a perc Initial Recommendation Template... 14 7.1 Submission length... 14 7.2 Information to Complete the Recommendation Feedback Template... 14 Appendix A: pcodr Patient Advocacy Group Conflict of Interest Declarations... 15 Appendix B: pcodr Patient Advocacy Group Input on a Review Template... 17 Appendix C: pcodr Individual Patient or Caregiver Conflict of Interest Declarations... 23 Appendix D: Individual Patient or Caregiver Input on a Drug Review... 25 Appendix E: pcodr Patient Advocacy Group / Individual Patient or Caregiver Feedback on a perc Initial Recommendation... 31 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 2

1 pcodr Invites Patient Engagement The role of the pan-canadian Oncology Drug Review (pcodr), a program of the Canadian Agency for Drugs and Technologies in Health (CADTH), is to assess the clinical evidence and costeffectiveness of cancer drugs, and to use this information to make recommendations to the provinces and territories to guide their drug funding decisions. Canadian patient advocacy groups registered with pcodr are invited to provide input about the cancer drugs under review by pcodr. Patient input on drug reviews and feedback on recommendations is important to the pcodr drug review process as it ensures patients experiences of living with cancer and undergoing treatment are routinely considered as part of the pcodr Drug Review Process. In particular, patient input means that those reviewing the drug can begin to appreciate the impact (both good and bad) that the drug under review may have on those taking it, as well as on those caring for patients living with cancer. As part of the work to align CADTH s pcodr and the Common Drug Review programs, and to build upon the best practices of both review processes, pcodr will accept patient input from individual patients or caregivers when there is no patient advocacy group representing patients for the particular tumour or cancer type for which a drug under review is indicated. IMPORTANT NOTE: Individual patients or caregivers who wish to provide input on a drug or indication are encouraged to first contact pcodr for direction by emailing info@pcodr.ca Please note that individual patient or caregiver input will not be accepted in cases where patient advocacy group(s) representing the particular tumour exist. In these cases, individual patients or caregivers who wish to provide input are encouraged to work with a patient advocacy group to have that group include the information in its submission. See Process in Brief on the pcodr section of the CADTH website (www.cadth.ca/pcodr) for a full description of the pcodr process. 2 Background While scientific and economic evidence has been used in making funding recommendations and decisions in Canada since the 1960s, the use of patient information (evidence) is recent with Quebec s Conseil du Médicaments, the Ontario Drug Benefit Program, the Common Drug Review and BC PharmaCare all having implemented patient involvement in their drug review processes, beginning in 2007. pcodr has considered these Canadian initiatives, as well as international processes, in developing its framework for patient engagement. Patient advocacy groups have also been involved in creating many aspects of the framework. 3 pcodr Review Process The pcodr review process is a methodical and consistent review of the scientific and economic evidence, and of patient perspectives. In summary, each review follows these steps: A pharmaceutical manufacturer or a tumour group sends an intent to submit form to pcodr, signalling that they will be submitting a cancer drug for review. During this planning phase, key pieces of information are gathered from the manufacturer or tumour group intending to make the submission. Clinical & Economic Guidance panels involved with the pcodr review are assembled or confirmed. Information is also gathered from the Provincial Advisory Group (PAG). 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 3

o The PAG provides primarily operational, as well as strategic advice, to ensure recommendations are useful to drug funding decision makers. The group consists of appointed representatives from each of the provincial Ministries of Health and provincial cancer care agencies participating in pcodr. The pharmaceutical manufacturer or tumour group then submits the drug for review. Within 10 business days of the submission being received by pcodr, patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) submit their input which is then incorporated into the reports being written by the economic guidance panel and the clinical guidance panel. This input is also sent directly to the pcodr Expert Review Committee (perc). For more information on the guidance panels and perc, please visit About pcodr on the pcodr section of the CADTH website (www.cadth.ca/pcodr). perc posts their initial recommendation and patient advocacy groups can then submit their feedback on that initial recommendation, along with other eligible stakeholders. perc then posts their final recommendation, taking into consideration the feedback provided on the initial recommendation. Details on how to participate in the pcodr process are the focus of this guide. Details on the types of information to provide at each participation step of a drug review are found in the pcodr Patient Advocacy Group Input on a Drug Review and the Patient Advocacy Group Feedback on a perc Initial Recommendation templates. Both templates are available under Process in Brief on the pcodr section of the CADTH website (www.cadth.ca/pcodr).for individual patients or caregivers, the template for submitting pcodr Individual Patient or Caregiver Input and Conflict of Interest Declarations form and pcodr Individual Patient or Caregiver Feedback on a perc Initial Recommendation, are also available under Process in Brief on the pcodr section of the CADTH website (www.cadth.ca/pcodr). 4 Participating in the pcodr review process 4.1 How can patients participate in the pcodr review process? Registered patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) are invited to provide written comments at two points in the pcodr review process: o Input can be provided early in the process for use in preparation of reports used by the pcodr Expert Review Committee (perc) to develop its recommendations; o Feedback can be provided later in the review after perc makes its initial recommendation. Patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) can only provide feedback on the initial recommendation if they first provided input in the early stages of the review. 4.2 Who is eligible to provide patient input on a review and feedback on a recommendation? Canadian patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) registered with pcodr are eligible to provide patient input on drug reviews. Input from patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) is accepted to ensure that the perspectives of many patients and caregivers are captured and reflected, collectively, in the pcodr review process. Patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) must register to participate in the pcodr process. (See section 4.4 of this guide for information on how to register) 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 4

While more than one registration per patient advocacy group can be made, only one input submission per group will be accepted. If more than one submission is made, only the first submissions will be considered. To be eligible to register with pcodr, patient advocacy groups must: 1. Have a mandate that pre-dates the group s decision to register with pcodr. 2. Have a means of contacting and communicating with its membership. 3. Represent patients or caregivers impacted by cancer. 4. Receive funding from more than one funder and no single funder can provide more than 50% of the group s operating funds. At the time of registration, patient advocacy groups are requested to provide general information on potential sources of conflict of interest. At the time of providing input on a specific drug review, a more detailed conflict of interest declaration must be completed for each patient advocacy group. These more detailed declarations of conflict of interest are requested for transparency and will not preclude the input from being considered in a drug review. See the pcodr Patient Advocacy Group Conflict of Interest Declarations Template under Process in Brief on the pcodr section of the CADTH website (www.cadth.ca/pcodr) for more information. For individual patients or caregivers to be eligible to register with pcodr, there must be no patient advocacy group(s) available in Canada representing the particular condition. The individual patient or caregiver will be required to identify him or herself and provide conflict of interest information, including whether any assistance was provided in preparing the submission. The name of the author will not be made publicly available. Patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) are only eligible to provide feedback on the initial recommendation if they first provided input in the early stages of the review. 4.3 How can individual patients participate in the pcodr review process? Individual patients who wish to provide comments or input are encouraged to contact a patient advocacy group representing their diagnosis, to request that their information be included with that group s submission. If there is no patient advocacy group for the particular tumour, patients should contact pcodr for direction by emailing info@pcodr.ca. 4.4 How do members of patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) register with pcodr? Members of patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) go to the pcodr Patient Input and Feedback page on the pcodr website (www.cadth.ca/pcodr). For patient advocacy groups, the member confirms that the group meets the eligibility criteria for patient advocacy groups (see section 4.1 of this guide for eligibility criteria). For individual patients or caregivers, the patient or caregiver confirms that there is no patient advocacy group(s) available in Canada representing the specific tumour and to complete the eligibility criteria for individual patients or caregivers (see section 4.1 of this guide for eligibility criteria). The group member (or individual patient or caregiver in cases where there is no patient advocacy group) completes the online registration request form and submits it to pcodr. (Please note: Group members can check pcodr s online list of registered 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 5

groups to determine whether a member(s) of your group has already registered.) The list is available under Submit and Contribute on the pcodr website. pcodr will email the group member (or individual patient or caregiver in cases where there is no patient advocacy group) a unique link to pcodr s registration page. The group member (or individual patient or caregiver in cases where there is no patient advocacy group) completes the registration form and is provided with a username. The group member (or individual patient or caregiver in cases where there is no patient advocacy group) is required to send an email notification to pcodr indicating that they have completed their registration and notifying pcodr of their username. The group member (or individual patient or caregiver in cases where there is no patient advocacy group) can log in to the secure pcodr site as soon as they receive confirmation back from pcodr that their registration has been completed. If group members (or individual patient or caregiver in cases where there is no patient advocacy group) have any questions regarding the process, do not receive the email with the link to the Registration page, do not receive the confirmation email or are unable to login, please contact support@pcodr.ca. 4.5 How is patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input on a drug review and feedback on recommendations used in the review process? Receiving patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input early in the review process allows pcodr to use the information to establish the plan (protocol) for conducting the review. It is important to incorporate outcomes and issues that are important to patients, into that plan. In addition to its use in the pcodr process, the information provided in patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) submissions may be shared with the provincial and territorial ministries of health, and cancer agencies that participate in pcodr, for use in their decision-making. Any patient-specific personal information will be removed. Obtaining feedback from patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) on an initial recommendation allows the pcodr Expert Review Committee (perc) to further consider outcomes and issues that are important to patients and to improve the clarity of its recommendations. It is important to note that the initial recommendation may or may not change following further perc deliberations, based on the feedback of patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) and other stakeholders. 4.6 How do patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) provide input on a drug review or feedback on an initial recommendation? Registered patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) are invited to provide written input at two points in the pcodr review process: early in the process for use in preparation of reports used by the pcodr Expert Review Committee (perc) to develop its recommendations; and after perc makes its initial recommendation. 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 6

Note that only one input per patient advocacy group (or one input from individual patient or caregiver in cases where there is no patient advocacy group), per review is accepted. If more than one input is received per patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group), only the first submission from that group will be considered. Patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) can only provide feedback on the initial recommendation if they first provided input in the early stages of the review. For each cancer drug that pcodr reviews, early in the review process, patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) can provide perspectives on the experience of living with cancer and the impact of the cancer drug under review, on patients lives. o This information, which gets incorporated into the guidance reports, is used to identify health outcomes and issues that are important to patients, and to inform the plan (protocol) that will be followed to review the cancer drug. o The clinical and economic guidance reports, with patient advocacy group input incorporated, are used by perc in making its recommendations. o The patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input is also directly shared with the perc for consideration along with other information it must consider. Patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) that provided input early in the pcodr process for use in the preparation of the guidance reports have an opportunity to provide feedback on the initial recommendation before it is finalized and issued to the participating ministries of health and provincial cancer agencies. The template is available under Process in Brief on the pcodr section of the CADTH website (www.cadth.ca/pcodr). Patient advocacy groups must provide input on a submission by completing the pcodr Patient Advocacy Group Input on a Drug Review template which outlines the type of information that pcodr requires for the review process. Patient advocacy group input must be submitted to pcodr by 5 P.M. Eastern Time on the day of the posted deadline. Similarly, individual patients or caregivers must provide input on a submission by completing the pcodr Individual Patient or Caregiver Input template which outlines the type of information that pcodr requires for the review process. Individual patient or caregiver input must be submitted to pcodr by 5 P.M. Eastern Time on the day of the posted deadline. If patient advocacy groups wish to provide feedback on the initial recommendation, and have provided input in the early stages, they must complete the pcodr Patient Advocacy Group Feedback on a perc Initial Recommendation template which outlines the type of feedback that perc looks for regarding initial recommendations. Similarly, if individual patients or caregivers wish to provide feedback on the initial recommendation, and have provided input in the early stages, they must complete the pcodr Individual Patient or Caregiver Feedback on a perc Initial Recommendation template which outlines the type of feedback that perc looks for regarding initial recommendations. Feedback must be submitted within 10 business days of the perc initial recommendation being posted on the pcodr section of the CADTH website. The template is available under Process in Brief on the pcodr section of the CADTH website (www.cadth.ca/pcodr). Two patient members and one patient alternate member serve on perc. Patient members are selected based on their demonstration of personal knowledge of, experience with and understanding of issues related to cancer and its management (among other qualifications). They present the information provided by patient 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 7

advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) directly to other members of the pcodr Expert Review Committee, along with participating with other members in the Committee s examination of the evidence as it deliberates to develop a recommendation. 4.7 How do patient advocacy groups (or individual patients or caregivers in cases where there is no advocacy patient group) know when to submit input in the early stage of a review? pcodr lists all drugs under review, and their corresponding deadlines for patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input on a drug review and for patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) feedback on a perc initial recommendation, on the pcodr section of the CADTH website under Find A Review (www.cadth.ca/pcodr). Patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) can also monitor this site for upcoming (pending) drug reviews. In addition, pcodr emails all registered patient advocacy group members (or registered individual patient or caregiver in cases where there is no patient advocacy group) to advise them of a pending or received drug submission and the deadline date for providing input. These email notifications will typically be sent one month in advance of the expected submission date confirmed by the drug manufacturer or tumour group. o Pending submissions from drug manufacturers and tumour groups: pcodr has requested that manufacturers and tumour groups (the organizations responsible for initiating a submission), provide notification six to twelve months in advance of filing a submission. As the intended submission date draws closer (about one month in advance), the submitter is asked to re-confirm the planned date of submission to pcodr. Once confirmed, pcodr will add the submission to the Drug Review Schedule and send e-mail alerts to all registered patient advocacy group members (or registered individual patient or caregiver in cases where there is no patient advocacy group). This gives advocacy group members (or individual patients or caregivers in cases where there is no patient advocacy group) lead time to prepare their patient input submission. pcodr posts the name of the drug, its indication, the name of the manufacturer (and tumour group if applicable) and the tentative deadline for patient advocacy group (or individual patients or caregivers in cases where there is no patient advocacy group) input. Once the pending submission is actually received, the tentative deadline for providing patient advocacy group (or individual patients or caregivers in cases where there is no patient advocacy group) input is replaced with a confirmed deadline. o Received drug submissions: pcodr posts the names of all drug submissions received, the names of the manufacturers, and the indication for the drugs and the deadline for submitting patient advocacy group (or individual patients or caregivers in cases where there is no patient advocacy group) input. 4.8 How many submissions can patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) submit per drug? Only one submission per drug will be accepted from each patient advocacy group, even if multiple members of the group are registered with pcodr. In the case of multiple submissions from a single group or individual patient or caregiver in cases where there is no patient advocacy group, only the first submission will be considered. 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 8

4.9 How much time do patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) have to provide input on a drug review? Patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) are asked to provide input within 10 business days of pcodr receiving a drug submission. Best efforts are made by pcodr to notify registered patient advocacy groups (or registered individual patient or caregiver in cases where there is no patient advocacy group) when confirmation of a pending drug review (about one month in advance) is received from a potential submitter, so that patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) have as much notice as possible about a pending drug review. Specific deadlines for patient advocacy group (or individual patients or caregivers in cases where there is no patient advocacy group) input are posted on the pcodr website. Patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input must be submitted to pcodr by 5 P.M. Eastern Time on the day of the posted deadline. 4.10 How will patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) know when to provide feedback on a perc initial recommendation? perc Initial Recommendations and the deadline for stakeholder feedback on initial recommendations are posted under Find a Review on the pcodr section of the CADTH website (www.cadth.ca/pcodr). In addition, patient advocacy groups (or registered individual patient or caregiver in cases where there is no patient advocacy group) will be advised by email when the initial recommendation is posted. The pcodr section of the CADTH website has templates which outlines the type of feedback that the pcodr Expert Review Committee looks for regarding initial recommendations, the Patient Advocacy Group Feedback on a perc Initial Recommendation template for patient advocacy groups and pcodr Individual Patient or Caregiver Feedback on a perc Initial Recommendation template for individual patient or caregiver in cases where there is no patient advocacy group. Patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) must use this template to provide input. The template is available under Process in Brief on the pcodr section of the CADTH website (www.cadth.ca/pcodr). Patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) feedback must be submitted to pcodr by 5 P.M. Eastern Time on the day of the posted deadline. 4.11 How much time do patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) have to provide feedback on a perc initial recommendation? Patient advocacy groups (or individual patients or caregivers in cases where there is no patient advocacy group) are asked to provide feedback within 10 business days of the perc Initial Recommendation being posted on the pcodr website. Patient advocacy group (or individual patients or caregivers in cases where there is no patient advocacy group) feedback must be submitted to pcodr by 5 P.M. Eastern Time on the day of the posted deadline. 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 9

4.12 Tracking a pcodr review and recommendation The progress of a drug through the pcodr review process may be followed on the pcodr section of the CADTH website on the Find a Review page. (See www.cadth.ca/pcodr). 4.13 What are the steps to submit input on a drug review or feedback on a recommendation? 1. Register the patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) with pcodr, by completing the Online Registration Request form under Submit and Contribute on the pcodr section of the CADTH website (www.cadth.ca/pcodr). As this step can take between 2-5 business days to complete, groups (or individual patient or caregiver in cases where there is no patient advocacy group) are encouraged to register well before the deadline to provide input. 2. For patient advocacy groups, if submitting input into the early stages of the review, download and complete the following two documents: the pcodr Patient Advocacy Group Conflict of Interest Declarations form and the pcodr Patient Advocacy Group Input on a Drug Review template from the pcodr section of the CADTH website. For individual patients or caregivers in cases where there is no patient advocacy group, if submitting input into the early stages of the review, download and complete the following two documents: the pcodr Individual Patient or Caregiver Input and pcodr Individual Patient or Caregiver Conflict of Interest Declarations form from the pcodr website. These documents can be found under Process in Brief on the pcodr section of the CADTH website. 3. Submit these two completed documents on-line through the pcodr section of the CADTH website by the specified deadline for the drug under review. You must be logged in, using your username and password, to submit on-line. Alternatively, the completed forms can be emailed to: submissions@pcodr.ca. Patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input must be submitted to pcodr by 5 P.M. Eastern Time on the day of the posted deadline. 4. For submitting feedback on an initial recommendation, download and complete the following document: (1) for patient advocacy groups: the pcodr Patient Advocacy Group Feedback on a perc Initial Recommendation template; (2) for individual patients or caregivers in cases where there is no patient advocacy group: the pcodr Individual Patient or Caregiver Feedback on a perc Initial Recommendation template. These templates are available under Process in Brief on the pcodr section of the CADTH website. Patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) feedback must be submitted to pcodr by 5 P.M. Eastern Time on the day of the posted deadline. 5. Submit the single completed document on-line through the pcodr website by the specified deadline. You must be logged in, using your username and password, to submit on-line. Alternatively, the completed forms can be emailed to: submissions@pcodr.ca. All input and feedback that is received will be acknowledged by e-mail to the registered member. 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 10

5 A guide to completing the pcodr Patient Advocacy Group / Individual Patient or Caregiver Conflict of Interest Declarations To maintain the objectivity and credibility of the pcodr process, all participants in the pcodr review process must disclose any conflicts of interest. All participants must declare potential, perceived or real conflicts that may influence or have the appearance of influencing the information submitted. Conflict of interest declaration is requested for transparency it does not negate or preclude the use of the patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input. Patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) must declare any potential conflicts of interest. At the time of registration with pcodr, patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) are requested to provide general information on potential sources of conflict of interest. At the time of providing input on a specific drug review, a more detailed conflict of interest declaration must be completed for each patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group). The detailed declaration is done by completing the Patient Advocacy Group Conflict of Interest Declaration Form for patient advocacy groups and the Individual Patient or Caregiver Conflict of Interest Declaration Form for individual patient or caregiver in cases where there is no patient advocacy group. This form requests the nature of financial support provided to the patient advocacy groups (e.g., payments, grants, holdings) and the estimated monetary value of these supports over the past two years. Details of the nature of supports received will be posted on the pcodr website, however, monetary values will not be disclosed. 6 A guide to completing the pcodr Patient Advocacy Group Input / Individual Patient or Caregiver Input on a Drug Review Template 6.1 Submission length Patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input should be clear, concise and at this time, only in English. It must be kept to a maximum of eight (8) typed pages (with a minimum 11-point font). If a submission exceeds eight pages, only the first eight will be considered. 6.2 Information to complete the Patient Advocacy Group Input Template It is important to note that scientific published references are not required, as pcodr has access to current scientific literature through the manufacturer s submission, tumour groups, and a rigorous, independent literature search. 6.2.1 Section 1 of the Patient Advocacy Group Input Template General Information The following information must be provided at the beginning of the submission: Name of the drug submission and indication(s) of interest Name of patient advocacy group Information gathering how the information that is included in the submission was collected. 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 11

6.2.2 Sections 2 to 4 of the Patient Advocacy Group Input Template The information provided in Sections 2 to 4 should be based on real-world experiences of patients living with a condition and its management and when available, the experiences of their caregivers. The information is intended to help pcodr and the pcodr Expert Review Committee understand the needs and preferences of the majority of patients with the cancer for which the drug is indicated. Objective, experiential information that is representative of most in the patient advocacy group is most useful. pcodr and the pcodr Expert Review Committee have access to current scientific literature through the manufacturer s submission, tumour groups and a rigorous, independent literature search. Therefore, there is no need for patient advocacy groups to submit published information. However, relevant unpublished studies may be submitted in addition to the template. 6.2.3 Section 2 Condition and Current Therapy Related Information This section seeks perspectives on how the cancer (related to the drug under review) affects the day-to-day lives of patients as well as how it impacts those who give care to these patients. Further, it seeks perspectives on currently available therapy and its advantages and disadvantages, as well as whether there are subgroups of patients who are in greater need of this therapy than the overall population of patients with this cancer. Please provide any information that would be helpful for pcodr and the pcodr Expert Review Committee to understand the experience of patients living with this cancer. 6.2.4 Section 3 Related Information about the Drug Being Reviewed This section asks for comments on the anticipated impact this drug may have. For those who have used the drug being reviewed, this section seeks your perspective on how the drug meets the needs and preferences of users and caregivers, its perceived advantages and disadvantages over currently available therapies and medicines, and the impact the drug may have on patients and caregivers lives. 6.2.5 Section 4 Additional Information This section provides the opportunity to submit any other information that would be helpful to the pcodr and the pcodr Expert Review Committee deliberations. pcodr is keen to learn from experience and to develop a user-friendly patient advocacy group input process. We would be grateful for comments on these materials, the templates or any other aspect of providing input. Your comments may be submitted to info@pcodr.ca. 6.3 Information to complete the Individual or Caregiver Input Template 6.3.1 Section 1 of the Individual or Caregiver Input Template General Information The following information must be provided at the beginning of the submission: Name of the drug submission and indication(s) of interest Indicate whether you are a patient who has the condition or disease for which the drug is used or a caregiver for someone who has the condition or disease for which the drug is used Contact information 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 12

6.3.2 Sections 2 to 4 of the Individual or Caregiver Input Template The information provided in Sections 2 to 4 should be based on your realworld experiences living with this condition and its management and when available, the experiences of the caregivers. The information is intended to help pcodr and the pcodr Expert Review Committee understand the needs and preferences of the majority of patients with the cancer for which the drug is indicated. Objective, experiential information that is representative of the patient is most useful. pcodr and the pcodr Expert Review Committee have access to current scientific literature through the manufacturer s submission, tumour groups and a rigorous, independent literature search. Therefore, there is no need for a patient to submit published information. 6.3.3 Section 2 Condition and Current Therapy Related Information This section seeks perspectives on how the cancer (related to the drug under review) affects your day-to-day lives, as well as how it impacts those who give care to you as a patient. Further, it seeks your perspectives on currently available therapy and its advantages and disadvantages, as well as whether there are subgroups of patients who are in greater need of this therapy than the overall population of patients with this cancer. Please provide any information that would be helpful for pcodr and the pcodr Expert Review Committee to understand your experience as a patient living with or caring for a person with this cancer. 6.3.4 Section 3 Related Information about the Drug Being Reviewed This section asks for comments on the anticipated impact this drug may have. For those who have used the drug being reviewed, this section seeks your perspective on how the drug meets your needs and preferences and those of the caregivers, your perceived advantages and disadvantages over currently available therapies and medicines, and the impact the drug may have on patients and caregivers lives. 6.3.5 Section 4 Additional Information This section provides the opportunity to submit any other information that would be helpful to the pcodr and the pcodr Expert Review Committee deliberations. 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 13

7 A guide to completing the pcodr Patient Advocacy Group / Individual Patient or Caregiver Feedback on a perc Initial Recommendation Template 7.1 Submission length Patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) feedback should be clear, concise and at this time, only in English. Feedback on the initial perc recommendation should not exceed three (3) pages in length, using a minimum 11 point font on 8 ½ by 11 paper. If comments submitted exceed three pages, only the first three pages of feedback will be forwarded to perc. 7.2 Information to Complete the Recommendation Feedback Template 7.2.1 Section 3.1 - Comments on the Initial Recommendation This section seeks to understand if patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) agree, in whole or in part, with the initial perc recommendation and the specifics as to why such an opinion is held. It also seeks to understand if patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) are in favour of seeking further deliberation and reconsideration of the recommendation by perc using the feedback provided. If further deliberation is not felt to be needed or desirable, the recommendation could proceed to a final recommendation; this would need the agreement of all stakeholders providing feedback to proceed with finalizing the recommendation. Lastly, this section is an opportunity for perc to learn if there is any lack of clarity in the recommendation document, and if see what could be done to improve the clarity of the information in the initial recommendation. 7.2.2 Section 3.2 Comments related to Patient Advocacy Group Input (or individual patient or caregiver in cases where there is no patient advocacy group) It is important for perc to know if it has understood the patient advocacy group (or individual patient or caregiver in cases where there is no patient advocacy group) input provided in the early stages of the review process and that this understanding is accurately reflected in the summary of its deliberations. It also allows patient advocacy groups (or individual patient or caregiver in cases where there is no patient advocacy group) to reflect on whether they feel their initial input was adequately addressed in the initial recommendation. Lastly, this section provides the opportunity to submit any other feedback that would be helpful to the pcodr and the pcodr Expert Review Committee deliberations. It is important to note that new evidence would not be considered at this part of the review process, however, it may be eligible for a Resubmission. The pcodr program can help determine if new information could be eligible for a Resubmission. pcodr would be grateful for comments on the feedback template or on any other of the approaches used to strengthen patient engagement in the review process. Your comments may be submitted to info@pcodr.ca. 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 14

Appendix A: pcodr Patient Advocacy Group Conflict of Interest Declarations Name of registered patient advocacy group: Name of drug and indication under review: Conflict of Interest Declarations To maintain the objectivity and credibility of the pcodr process, all participants in the pcodr review process must disclose any conflicts of interest. Patient advocacy groups must declare any potential conflicts of interest that may influence or have the appearance of influencing the information submitted. Conflict of interest declaration is requested for transparency it does not negate or preclude the use of the patient advocacy group input. Examples of conflicts of interest include, but are not limited to: financial support from the pharmaceutical industry e.g., educational or research grants, honoraria, gifts, and salary; affiliations or personal or commercial relationships with drug manufacturers or other interest groups. Section A: Payment Received 1. Has this patient advocacy group received any payments over the previous two years from any company or organization that may have direct or indirect interest in the drug under review? Yes No If no, please go to Section B 2. What form of payment did this patient advocacy group receive? (Check all that apply.) Operating Funds Royalties Gifts Program Funding (e.g., website) Research/educational grants Sponsorship of Events Honoraria Other, please specify: 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 15

Please provide the names of companies and organizations and the amounts of the payments in the box below. Section B: Holdings or Other Interests Has this patient advocacy group received or is it in possession of stocks or options of more than $10,000 (excluding mutual funds) for organizations that may have a direct or indirect interest in the drug under review? If yes, please list in the table below. Section C: Affiliations, personal or commercial relationships Does this patient advocacy group have personal or commercial relationships either with a drug or health technology manufacturer (including such manufacturer s parent corporation, subsidiaries, affiliates and associated corporations) or other interest groups? If yes, please provide the names of the companies and organizations and outline the nature of these relationships in the table below. I hereby certify that I have authority to disclose all relevant information with respect to any matter involving this patient advocacy group with a company, organization or entity that may place this patient advocacy group in a real, potential or perceived conflict of interest situation. Date: Name: Signature: 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 16

Appendix B: pcodr Patient Advocacy Group Input on a Review Template About Completing This Template This Patient Advocacy Group Input on a Drug Review template should be used by patient advocacy groups to submit input at the beginning of a drug review. The input template starts after these instructions. Please note that there is a different template for providing feedback on an initial recommendation. Patient advocacy groups must also complete the pcodr Patient Advocacy Group Conflict of Interest Declarations template when providing input at the beginning of a drug review, located in Appendix A of this document and available on the pcodr section of the CADTH website (www.cadth.ca/pcodr). Patient advocacy groups must be registered with pcodr to provide input on a drug review. To register with pcodr please go to Submit and Contribute on the pcodr website, complete the online registration request form and submit the completed form to pcodr (See the pcodr Patient Engagement Guide for information on eligibility and registration.) Please note that only one submission per patient advocacy group is permitted. This applies to those groups with national and provincial / territorial offices; only one submission for the entire patient advocacy group will be accepted. If more than one submission is made, only the first submission will be considered. Individual patients should contact a patient advocacy group that is representative of their condition to have their input added to that of the group. If there is no patient advocacy group for the particular tumour, patients should contact pcodr for direction at info@pcodr.ca. Please ensure that the input is in English, and that it is succinct and clear. Please use a minimum 11-point font and do not exceed eight (8) typed, 8 ½ by 11 pages. If a submission exceeds eight pages, only the first eight pages will be considered. Patient advocacy group input must be submitted to pcodr by 5 P.M. Eastern Time on the day of the posted deadline. Patient advocacy groups should complete those sections of this input template where they have substantive comments and should not feel obligated to complete every section, if that section does not apply to their group. Similarly, groups should not feel restricted by the space allotted on the form and can expand / contract the tables in the template as required. The page limit of eight (8) typed pages remains. You may delete the instructions, questions and examples under each heading on the Patient Advocacy Group Input on a Drug Review template for more space. Appendix A is NOT included in the eight (8) typed page limit for the Patient Advocacy Group Input on a Drug Review template. In sections 2 and 3 of the Patient Advocacy Group Input on a Drug Review template, guidance or examples are provided to help identify the type of information that pcodr will find most helpful to understand the needs and preferences of the majority of patients. Objective, experiential information that is representative of the majority of the patient advocacy group is preferred. 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 17

Patient advocacy groups are encouraged to address the questions posed in the input template as succinctly as possible and to communicate key messages. Scientific, published references are not required, as pcodr has access to current scientific literature through the manufacturer s submission and a rigorous, independent literature search. Published studies are reviewed by the clinical guidance panel and summarized in the Clinical Guidance Report. The patient advocacy group input must be submitted by the deadline date for this drug, posted on the pcodr website under Find a Review so that it can be available in time to be fully used in the pcodr review process. In addition to its use in the pcodr process, the information provided in your submission may be shared with the provincial and territorial ministries of health and provincial cancer agencies that participate in pcodr, to use in their decision-making. Any patient-specific personal information will be removed. Information about pcodr may be found at www.cadth.ca/pcodr. For more information regarding patient input into the pcodr drug review process, see the pcodr Patient Engagement Guide. Should you have any questions about completing this form, please email: info@pcodr.ca. 2015 CADTH-pCODR PAN-CANADIAN ONCOLOGY DRUG REVIEW 18