Access Pharmaceuticals, Inc. Conference Call with Prescribing Nurse Practitioner
“MuGard has made a huge impact in our practice. Our patients are thrilled…they are absolutely ecstatic.”
Jeffrey Davis, CEO of Access Pharmaceuticals, Inc.: Today we will be speaking with, Joanne Schlesinger, a prescribing nurse practitioner, associated with a private oncology practice, in Phoenix, Arizona. Joanne provides services and does rounds at three area hospitals. Access introduced MuGard to the practice about three months ago. We have taken note of several investor questions over the past few months and we will work through these questions with Joanne regarding the impact of oral mucositis on her patients, her experience with other therapies for oral mucositis and her experience with MuGard. To start, she will introduce herself and give us some background on her practice and the hospitals she works in and her role in her practice.
Joanne: Hi, Jeff. As you mentioned, I'm a nurse practitioner in Arizona. It's a private practice with four physicians and four nurse practitioners. In Arizona, nurse practitioners see patients as well as doctors and have the ability to prescribe medications. We (nurse practitioners) see patients regularly. A large part of my role in my practice is managing many of the side effects and problems that chemotherapy causes. We spend a significant amount of time with the patients between chemotherapy visits.
Jeff: What are the types of patients that you see in your practice? And, what are the tumor types, treatment types? Do you see both patients undergoing radiation as well as chemotherapy?
Joanne: Yes. Our practice has pretty much everything across the board from head and neck cancer patients with chemo/radiation, a significant amount of breast, lung, colon, and even melanoma patients. There's no distinct specialty. And because there's four doctors and have a lot of hospital consults, we see everything. And that's where we've noticed that mucositis doesn't have a particular favorite. It really spans across the board. And if patients become neutropenic (white blood cell reduction), they will more often than not develop mucositis. It's not necessarily even then dependent on the chemotherapy, but rather on your blood count.
Jeff: And based on your experience over the last decade, have you seen a rise in the incidence of oral mucositis due to patients living longer and being on more therapies, introduction of new therapies or introductions of cocktail therapies, for example?
Joanne: Yes. We definitely have chronic mucositis for chronic chemotherapies, because we have patients living for two, three, four years on chronic chemotherapy, even longer than that. So, we see it in many of our chronic chemotherapy cases. The more chemotherapy they're on, the more likely you're going to be neutropenic. Their defenses are very, very low. And the body, the first thing it does with low blood counts is allow increased mouth sores to develop.
Jeff: Now, most laypeople know that when you undergo chemotherapy or radiation, you very often are going to experience nausea and vomiting. And there is a obviously large market for anti-emetic therapies. You, as a caregiver or a nurse practitioner, treating these patients and caring for these patients, how do you view the side effect of oral mucositis in comparison to nausea and vomiting? Is it equally as big a problem or an issue for these patients? Bigger, smaller, depends on the patient?
Joanne: It's equally as big as nausea and vomiting. And if it isn't treated and it isn't treated upfront, it can halt chemotherapy. When patients end up in the hospital for oral mucositis that's grade three or four, they cannot eat or drink. So, it is as severe as nausea where someone can't eat and they get so dehydrated they end up in the hospital. Because severe mucositis, becomes to esophagitis and they have difficulty swallowing which interferes with their intake and leads to dehydration. When a patient becomes severely dehydrated, there is a higher risk of hospitalization.
Our goal, besides keeping them eating and keeping them out of pain, is to not delay the next cycle of chemo, because we want to keep their chemo on track. But, it's also keeping them out of the hospital. I mean, there are multiple goals here. But, number one, keeping chemo on track.
In our practice, MuGard has allowed us to become even more proactive in the treatment and prevention of mucositis because, before, we only had really Miracle Mouthwash, which wasn't used preventively. Magic mouthwash is given upon patients developing symptoms. Now, we're treating people upfront with MuGard. And we really see a big difference - much less incidence of mucositis.
Jeff: Before we get into your clinical experience with MuGard, historically before we knew about MuGard, what was typically done by you or your practice with respect to educating patients about what oral mucositis is, or the potential for this side effect? And then, you touched on it a little bit, but, what did you use in the past to treat patients once they got it?
Joanne: We did not educate proactively, because we didn't have a medication to treat it. So, we would advise about it and wait to see if a patient developed mucositis. Then, we would treat the symptoms of mucositis with Miracle Mouthwash, which is “swish and spit” or “swish and swallow”. You can use it either way. And I would say that that's really been our main line of defense, though it doesn't treat it mucositis. It doesn't increase how quickly they're going to heal. It numbs the sores for a short time.
Jeff: And how durable is that sort of palliative numbing effect of Magic Mouthwash?
Joanne: There is a pain relief benefit. Although, this alone is not as desirable as it's not treating the mucositis and patients are still in a significant amount of pain. I don't think it's a treatment, or it certainly isn't the answer. We're usually still searching for something else to go use in conjunction with it, as alone it does not solve the problem.
Jeff: So, you wouldn't have used anything prophylactically, because there was nothing really. You'd just use a Miracle or Magic Mouthwash after the patient presents with mucositis?
Jeff: Now, when did you start using MuGard, and what has your clinical experience been? Are patients using it prophylactically? Are they using it after the onset of symptoms? And what has your clinical experience with MuGard been?
Joanne: We've been using MuGard for about four months. We have about 80 patients using it and it has worked in all but one patient. We've used it very aggressively due to the positive results we have seen. We have a very large practice. We did not start with just new patients. We also started MuGard on people with active mouth sores. On these patients we saw improvement as well. So, we've used it in two ways; with new patients hoping they would use it prophylactically, and patients receiving treatment with mucositis. In patients receiving treatment with mucositis, we definitely saw a clear benefit. Their sores were healing quicker and their pain greatly decreased.
The new patients, we found, weren't really using it as indicated at first. It's important for us to also realize is, when patients are undergoing chemotherapy, prior to their first chemotherapy we provide them with multiple prescriptions. And it's just an overwhelming amount for any one person to understand. We also learned that some patients were not starting MuGard prior to treatment, but rather waiting for mouth sores to develop, and then initiating treatment after development of mouth sores we realized the need to restructure our teaching mechanisms on how important and effective it is to start using it beforehand.
Jeff: So you believe the clinical benefit seen, and a stronger education effort, will help move those who haven't been using MuGard prophylactically or preventively to do so next time around?
Joanne: Correct. And what we've seen is with some of our harder chemo regimens where they're getting the mouth sores, they're using MuGard, and then, they're healed. Now, we can tell them to before cycle two, "Start using it. Don't go off of it. This is how this drug is indicated”. If you use it before the sores appear, you're going to have a better benefit." Now, they'll believe us. So, what we're seeing is between cycles, after the first incidence of mucositis, they will use it all the time. And unfortunately, sometimes it takes that first incidence to keep them on it.
Jeff: Once a patient has used it even after getting oral mucositis, his next cycle of chemotherapy or his next regimen, if he progresses and they switch to a different regimen, would he be more likely to use it right upfront, having had the positive experience?
Jeff: Have you seen any other product that you've used in oral mucositis that provided as good a clinical benefit as MuGard that you've seen in the least few months?
Joanne: No. There is another competitive product, but it's labor intensive. It comes in two packages and it requires the patient to mix it together, which is rather difficult. These patients, after a few rounds of chemo, they aren't feeling particularly well. So, having to mix something together isn't always manageable for them.
Jeff: So, “ease of use” to the patient is important?
Joanne: Absolutely. Patients, after one or two rounds of chemo, are pretty knocked down. We need something straight up. Something that's easy to use, one, two, three. MuGard has made a huge impact in our practice. Our patients are thrilled. They call for prescriptions. I mean, they are absolutely ecstatic. It's the first product for oral mucositis we've had to give them that has made a difference.
Jeff: Well, that's all the questions I have. I appreciate you taking the time. Thank you very much, Joanne.
Female Colorectal Cancer Patient, MuGard Experience, Long Island, NY
“The usefulness of the MuGard product can best be summarized by my mother who has had a two year bout with oral cancer. After one use, WONDERFUL! … effective … several hour duration … stops pain and improves speech … ends dry mouth. This company has a bright future. Thank you.”
-Mark E Anderson, MD, California
“Patient had a FABULOUS response to MuGard. She had gotten so bad the doctor took her off the drip for three days. She began the MuGard prior to temporarily stopping the drip. When she began again, NO OUTBREAKS! She is continuing to use it as directed…We'll keep you posted.”
-Caregiver to female colon cancer patient, California
“Patients are very pleased and MuGard is helping.”
-Northeast practice nurse
“…Where've you been all these years??”
-Western oncology practice
“We have a patient at the center who had another treatment around a week ago and her mouth was already covered with mucositis. She started on MuGard, and used it 5-6 times a day. When they checked on her yesterday, she only had one small area. The patient raved about how much she loved this product and it truly works…The patient was going around telling all the doctors here about what an amazing product MuGard is!”
-Oncology practice, North Carolina
“Amazing…We have been treating a patient diagnosed with left floor of the mouth squamous cell carcinoma. The patient began treatment on August 30, 2010. He will be receiving a total dose of 5940 cGy to the affected area. He will be completing his treatment in three days.
Since the patient began treatment he was instructed to use 5 - 10 ml of MuGard, swish and expel or swallow 4 - 6 times daily for prevention and relief of oral mucositis. To date the patient has no complaints of dysphagia (difficulty swallowing) or odynophagia (pain swallowing) and has only experienced mild xerostomia (dry mouth).
I will continue to encourage our head and neck patients to use MuGard on a daily basis…
-Chesapeake Potomac Regional Cancer Center, Maryland
“MuGard has become a valued and effective tool in my battle with cancer. Words can't express my gratitude. Your product has changed my life.”
-Female Colon Cancer, New York
MuGard News Alerts
Sign up to receive FREE e-mail alerts about MuGard: