Areas of Clinical Focus
We are about the patient
Modern drug development is evolving from a product-driven process to a patient-centric model, where the needs, experiences, and outcomes of patients guide every stage of innovation. This approach redefines the way therapies are discovered, designed, and delivered, ensuring that medicines are not only scientifically effective but also aligned with the realities of patient lives.
At its core, patient-centric drug development integrates direct patient input into research and development pipelines. From clinical trial design to formulation choices, patient perspectives help determine what endpoints matter most, what delivery methods are feasible, and what quality-of-life improvements are valued. This creates therapies that are more relevant, better tolerated, and ultimately more effective in real-world settings.
“We emphasize quality of life and functionality; this is how we define responsible care”
PAIN
(cancer induced & nosiplastic)
Development Program: NanaBis, see progression
Over the past decade, chronic pain has shifted from a clinical challenge to a macro-economic headwind in the United States. New federal data show not just high prevalence, but a clear upward drift—especially in pain that routinely limits daily life and work. When you factor in cancer-induced pain and the growing recognition of nociplastic pain (pain arising from altered nociception without clear tissue or nerve damage), the pattern is unmistakable: pain is a public-health and productivity crisis hiding in plain sight.
In 2016, about one in five US adults reported chronic pain. By 2023, that figure had climbed to 24.3%—roughly 1 in 4 Americans—with 8.5% experiencing high-impact chronic pain that limits life or work activities “most days” or “every day.” Women and older adults shoulder a disproportionate share, and the burden is highest outside large metro centers. This isn’t a niche problem; it’s the leading reason adults seek medical care and a driver of anxiety, depression, opioid exposure, and unmet mental-health needs.
That rise is not a blip. CDC surveillance across 2019–2021 showed chronic pain affecting 20.9% of adults (≈51.6 million) and high-impact pain affecting 6.9% (≈17.1 million). The subsequent 2023 jump underscores a worsening trajectory as the population ages and post-pandemic musculoskeletal and mental-health factors interact.
Chronic pain isn’t just clinically costly—it’s economically corrosive. Analyses projecting to the national level from 2022 healthcare data estimate the annual economic burden of managing chronic pain at roughly $725 billion, even before counting broader productivity losses; excluding direct surgical costs, the burden still lands near $447 billion. Acute pain adds a comparable order of magnitude, illustrating how peri-operative and injury-related pain feeds into persistent costs. Patients who receive opioids incur higher costs, highlighting the interplay between pain severity, treatment patterns, and spend.
Cancer survivorship is rising—and so is the visibility of cancer-related pain. A nationally representative analysis found about one-third of US cancer survivors live with chronic pain, with ~16% experiencing high-impact chronic pain—nearly double the rate seen in the general population. That translates to ~5.4 million Americans, many of whom are of working age.
Meta-analytic data across disease stages show how entrenched cancer pain remains despite therapeutic progress: ~55% of patients report pain during active treatment, ~39% after curative treatment, and ~66% in advanced or metastatic disease. In other words, cancer pain is not just an acute, treatment-linked phenomenon; it often persists into survivorship, eroding quality of life and employability.
Beyond nociceptive (tissue-damage) and neuropathic (nerve-injury) pain lies nociplastic pain—a mechanism recognised by the International Association for the Study of Pain (IASP) to capture conditions where altered nociceptive processing drives pain without clear peripheral pathology. It underpins disorders such as fibromyalgia and overlaps with centrally sensitized subgroups in low back pain, migraine, temporomandibular disorders and irritable bowel syndrome. Recognizing nociplastic pain matters: patients often cycle through investigations and procedures with low yield, while evidence-based non-pharmacological and targeted multimodal approaches are under-utilized.
ASP’s 2021 clinical criteria and guidance push practice toward precision pain medicine—matching mechanism to treatment and shifting expectations away from cure-by-procedure toward function-first, multi-domain care (sleep, mood, movement, graded exposure, education, and judicious pharmacology). As healthcare systems catch up, better recognition of nociplastic drivers should reduce low-value care and redirect spend to approaches with durable benefit.
References:
Centers for Disease Control and Prevention (CDC) National Center for Health Statistics 2024, Chronic Pain and High-Impact Chronic Pain in U.S. Adults, 2023, NCHS Data Brief no. 518, November. Available at: https://www.cdc.gov/nchs/products/databriefs/db518.htm (accessed 25 August 2025). CDC
Dahlhamer, J., et al. 2023, ‘Chronic Pain Among Adults — United States, 2019–2021’, MMWR. Morbidity and Mortality Weekly Report, 72(15), 393–398. Available at: https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm (accessed 25 August 2025). CDC
Jiang, C., Hesser, J., et al. 2019, ‘Prevalence of Chronic Pain and High-Impact Chronic Pain in Cancer Survivors in the United States’, JAMA Oncology, 5(8), 1221–1223. Available at: https://jamanetwork.com/journals/jamaoncology/fullarticle/2736363 (accessed 25 August 2025). JAMA Network
van den Beuken-van Everdingen, M.H.J., Hochstenbach, L.M.J., Joosten, E.A.J., Tjan-Heijnen, V.C.G. & Janssen, D.J.A. 2016, ‘Update on Prevalence of Pain in Patients with Cancer: Systematic Review and Meta-Analysis’, Journal of Pain and Symptom Management, 51(6), 1070–1090. Available at: https://cris.maastrichtuniversity.nl/en/publications/update-on-prevalence-of-pain-in-patients-with-cancer-systematic-r (accessed 25 August 2025). Maastricht University
Fitzcharles, M-A., Cohen, S.P., Clauw, D.J., Littlejohn, G., Usui, C. & Häuser, W. 2021, ‘Nociplastic pain: towards an understanding of prevalent pain conditions’, The Lancet, 397(10289), 2098–2110. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00392-5/fulltext (accessed 25 August 2025). The Lancet
Schoenfeld, A.J., Morlando-Geiger, J., Princic, N., et al. 2024, ‘Economic Burden of Managing Acute and Chronic Pain in the United States: National Estimates from 2022 Data’, Value in Health (ISPOR 2024 abstract/poster EE359). Available at: https://www.ispor.org/docs/default-source/intl2024/ispor24morlandogeigeree359poster136819-pdf.pdf (accessed 25 August 2025). ISPOR.org
ISPOR Presentation Record 2024, ‘Economic Burden of Managing Acute and Chronic Pain in the United States (EE359)’, ISPOR Presentations Database. Available at: https://www.ispor.org/heor-resources/presentations-database/presentation/intl2024-3898/136819 (accessed 25 August 2025).
“1 in 3 of cancer survivors”
“This translates to ~5.4 million Americans living with cancer-related chronic pain”
“Survivorship-realted chronic pain driving long term economic burden”
“Nociplastic pain estimated population ~20M”
“Economic burden estimated $200B+”
CHEMOTHERAPY INDUCED NAUSEA AND VOMITING (CINV)
Development Program: NanoCBD, see progression
Chemotherapy-induced nausea and vomiting (CINV) remains one of the most feared and clinically important toxicities of cancer treatment. Even in an era of modern antiemetics, CINV persists as a common and costly problem—reducing quality of life, interrupting treatment, and setting off a cascade of secondary health problems that add meaningful expense to the US healthcare system.
Recent clinical summaries and guideline updates report that a substantial fraction of patients still experience CINV despite prophylaxis. Contemporary reviews estimate that, depending on the chemotherapy regimen and how strictly guideline prophylaxis is followed, roughly 20–40% of patients receiving emetogenic chemotherapy experience clinically meaningful nausea and/or vomiting episodes, with higher rates in inadequately managed cases.
Poorly controlled CINV drives measurable healthcare utilization. Analyses of US datasets and hospital studies show that CINV contributes to emergency presentations, unscheduled IV fluid administrations, and hospital admissions—many of which are potentially avoidable with guideline-concordant antiemetic care. One analysis found CINV-related events constituted a non-trivial share of avoidable post-chemotherapy admissions in Medicare patients and highlighted the potential for large cost savings if guideline compliance improved.
Beyond hospital costs, older and more recent economic evaluations have documented measurable productivity loss among working-age cancer patients and incremental outpatient/hospital costs attributable to uncontrolled CINV. Real-world comparative studies of antiemetic regimens also show that more effective prophylaxis can reduce downstream visits and costs—evidence that spending more on effective prevention often reduces later health-system spending.
CINV is not just an acute discomfort—when uncontrolled, it can precipitate secondary and longer-term problems that worsen oncologic and gastrointestinal health:
Malnutrition and weight loss. Recurrent nausea and vomiting reduce oral intake and can accelerate cancer-associated cachexia, undermining functional status and tolerance of further therapy. This worsens prognosis and increases resource needs for nutritional support.
Dehydration and electrolyte derangement. Severe or prolonged vomiting commonly requires IV rehydration or inpatient care—adding acute costs and introducing risks that complicate chemotherapy scheduling.
Treatment delay, dose reduction, or discontinuation. When CINV is inadequately controlled, clinicians may reduce doses or delay cycles to protect patient safety—actions that can compromise curative intent or long-term disease control and thus produce downstream oncologic costs.
Psychological and anticipatory effects. Repeated poorly controlled nausea fosters anticipatory nausea and anxiety, which are difficult to treat and can reduce adherence to oral anticancer regimens and clinic attendance.
Over the past ten years the oncology community has made important advances: new antiemetic agents and updated guideline recommendations (ASCO, NCCN, MASCC/ESMO) have improved prevention frameworks for acute, delayed, and anticipatory CINV. However, real-world studies repeatedly show a gap between guideline recommendations and routine practice—this implementation gap is a main reason CINV remains an economically meaningful problem in the U.S.
Comparative real-world economic evidence from the early to mid-2020s indicates that some newer combination regimens are associated with fewer nausea/vomiting visits and lower downstream healthcare resource use—suggesting that correcting under-use of optimal prophylaxis is both clinically and economically sensible. Nevertheless, national aggregate cost estimates remain fragmented because CINV costs are spread across outpatient oncology clinics, emergency departments, and inpatient care, making a single consolidated national price tag elusive but significant.
Calling CINV a “growing epidemic” reflects several converging trends: increasing numbers of cancer survivors exposed to repeated systemic therapies, the proliferation of multimodal regimens with variable emetogenicity, persistent real-world under-prophylaxis, and the cumulative economic burden of repeated, preventable resource use. Each year that guideline-discordant practice continues, the U.S. health system and patients absorb avoidable costs—financially and in quality of life.
References:
National Cancer Institute (2025) Nausea and Vomiting Related to Cancer Treatment (PDQ®). Available online. Cancer.gov
Navari, R. et al. (2023) “Real-World Treatment Outcomes, Healthcare Resource Use, and Costs for CINV Regimens”, Adv Ther (article summary). SpringerLink
Centers for Medicare & Medicaid Services / Value in Health analysis (2016) — evaluation reported: “Hospital admissions for chemotherapy induced nausea and vomiting represent a share of avoidable admissions” (Value in Health summary). Value in Health
Hesketh, P.J. (2018) “Strategies to Improve CINV Outcomes in Managed Care”, The American Journal of Managed Care. AJMC AJMC
Olanzapine prophylaxis/meta-analyses and clinical impact (2015) — evidence linking uncontrolled CINV to dehydration, malnutrition and compromised treatment adherence. SpringerLink
“An estimated 80% of patients with cancer will experience chemotherapy-induced nausea and vomiting (CINV)”
““Clinical studies have shown that despite administration of antiemetic agents, 35% and 13% of patients still suffer from nausea and emesis induced by chemotherapy””
“Acute CINV: 42.7% of patients
Delayed CINV: 76.4% of patients”
ANTI-AGING
Development Program: NC-ACI and NC-SER, see progression
Over the past decade, anxiety has shifted from a background concern to a defining feature of America’s health and productivity story. It’s now the most common class of mental disorders in the U.S., touching roughly one in five adults in any given year (NIMH, 2024). Beyond personal suffering, anxiety carries real economic weight—dragging down labor force participation, productivity, and overall healthcare efficiency. (NIMH, 2024).
While clinical prevalence has hovered around ~19% annually, population symptom data reveal how anxiety surged during the pandemic and then settled at a persistently elevated “new normal.” CDC’s Household Pulse Survey shows the share of adults reporting anxiety and/or depressive symptoms spiked above 40% in 2020–21, with ongoing monthly trackers indicating rates that remain far above pre-2020 baselines and continuing to fluctuate alongside economic stressors (CDC/NCHS, 2020–2025). Unmet need for care also climbed in the same period (Vahratian et al., 2021; CDC/NCHS, 2024).
Multiple analyses converge on the same conclusion: poor mental health is economically expensive. U.S. estimates suggest mental health issues cost >$280 billion annually in reduced productivity and related impacts (Columbia Business School, 2024). Claims data analyses demonstrate why: people with any behavioral health condition (including anxiety) account for a disproportionate share of total health spending, largely due to higher medical/surgical (not behavioral) costs when anxiety co-occurs with physical conditions (Milliman, 2020). Investing upstream is not just humane—it’s fiscally rational.
Why this matters to the wider economy: anxiety fuels absenteeism and presenteeism, depresses innovation capacity, and increases turnover. Macro evidence links better mental-health access to stronger economic performance; global studies estimate depression and anxiety drain US$1 trillion in productivity annually—an indicator of what’s at stake if U.S. rates remain elevated (WHO, 2016; WEF, 2023–2024).
Anxiety rarely travels alone. Robust longitudinal evidence shows anxiety and depression are bidirectional risk factors, with anxiety often preceding later major depression. Anxiety also elevates the risk of substance use disorders and suicidal behavior, particularly when symptoms are unrecognized or untreated (Jacobson & Newman, 2017; Kauffman & Zvolensky, 2020; Bentley et al., 2015; Miloyan & Van Doorn, 2019). Clinically, once comorbidity develops, costs and disability rise faster than with a single diagnosis—amplifying the economic signal noted above.
References:
Bentley, K.H., Franklin, J.C., Ribeiro, J.D., Kleiman, E.M., Fox, K.R. & Nock, M.K. (2015) Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Psychological Bulletin. Available at: https://nocklab.fas.harvard.edu (accessed 25 August 2025). nocklab.fas.harvard.edu
Columbia Business School (2024) Mental Health and the Economy—It’s costing us billions. New York: Columbia University. Available at: https://business.columbia.edu (accessed 25 August 2025). Columbia Business School
Kauffman, B.Y. & Zvolensky, M.J. (2020) Directional effects of anxiety and depressive disorders with substance use. Current Addiction Reports, 7, 460–469. Available at: https://link.springer.com (accessed 25 August 2025). SpringerLink
Milliman (Davenport, S., Gray, T. & Melek, S.) (2020) How do individuals with behavioral health conditions contribute to physical and total healthcare spending? Seattle: Milliman. Available at: https://www.milliman.com (accessed 25 August 2025). Milliman
Miloyan, B. & Van Doorn, G. (2019) Longitudinal association between social anxiety disorder and incident alcohol use disorder. Social Psychiatry and Psychiatric Epidemiology, 54, 469–475. Available at: https://link.springer.com (accessed 25 August 2025). SpringerLink
National Institute of Mental Health (2024) Any Anxiety Disorder. Bethesda, MD: NIMH. Available at: https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder (accessed 25 August 2025). National Institute of Mental Health
U.S. Centers for Disease Control and Prevention (CDC) (2021) Symptoms of anxiety or depressive disorder and use of mental health care among adults: August 2020–February 2021. MMWR, 70, 490–494. Available at: https://www.cdc.gov/mmwr (accessed 25 August 2025). CDC
U.S. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (2024) National Health Statistics Reports No. 213: Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 pandemic. Hyattsville, MD: CDC/NCHS. Available at: https://www.cdc.gov/nchs (accessed 25 August 2025). CDC
U.S. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (2025) Household Pulse Survey: Anxiety and Depression Indicators. Washington, DC: CDC/NCHS. Available at: https://data.cdc.gov (accessed 25 August 2025). CDCData.CDC.gov
WHO (2016) Investing in treatment for depression and anxiety leads to fourfold return. Geneva: World Health Organization. Available at: https://www.who.int (accessed 25 August 2025). World Health Organization
“An estimated addressable market of 170M adults over 40”
“Emerging market and next GPL-1”