Cancer care is experiencing an explosion of innovation in terms of diagnostics and treatment, but physicians need data and help from technology to process it all.
During a May Becker's Hospital Review's webinar sponsored by Flatiron, a cancer software and data company, four healthcare leaders discussed how a data and technology infrastructure focused on genomics can improve cancer care. The panelists were:
- Alan Braly, senior director, data and insights delivery, Foundation Medicine
- James Hamrick, MD, vice president, clinical oncology, Flatiron
- Jerry Mitchell, MD, director, field medical oncology, Foundation Medicine
- Murat Sincan, MD, director, health informatics, Flatiron
Four key insights were:
- Data and technology are transforming cancer care. The common thread is precision medicine, with a transformation happening at three levels:
- At the point of care: Data generated through routine clinical care can identify patients with targetable genomic alterations. Physicians can use this data to select the best treatment or the most promising clinical trial; decision-support tools built into EHR workflows can "nudge" doctors in the right direction.
- At the population level: Real-world data can augment traditional methods of evidence generation through randomized controlled trials, can help design smarter trials and can detect inequities in who is not getting screened.
- At the data infrastructure level: Datasets that are standardized and harmonized for high quality, completeness and interoperability can enable more stakeholders to access useful data with a high degree of confidence.
"Cancer is offering us a glimpse into what all branches of medicine will look like as precision medicine takes hold," Dr. Hamrick said.
- The right data infrastructure can power precision oncology by embedding genomics insights. Precision oncology depends on molecular profiling and interpretation of tumors' genomic alterations — competencies that are beyond the knowledge scope of physicians without a PhD in genomics. To enable insights at the point of care, a system is needed that can sequence the tumor and generate genomic interpretation of the data (Foundation Medicine), then standardize and incorporate the findings into clinical workflows (Flatiron). "We are moving from a world where things are faxed or mailed to a place where things are recallable at clinicians' fingertips when needed," Mr. Braly said.
- GPS-like decision-support tools can take the guesswork out of cancer care. With new cancer research and therapies coming out continuously, it is difficult for oncologists to keep up with all the knowledge being generated while also providing routine care. Decision-making tools that integrate into the EHR can guide them by sending clinical "nudges" about treatment options, including newly approved ones that may not be top of mind yet, that match the genomic profiles of their patients' tumors.
"We use stethoscopes to improve our ability to hear, we use microscopes to enhance our ability to see beyond our physical capabilities. Technology is similarly enabling us to enhance our cognitive capabilities without having to memorize all 8,000-plus clinical scenarios that the National Comprehensive Cancer Network publishes," Dr. Sincan said.
"The pace and complexity of change have gotten so great that we must have technological assistance to be able to give the right therapy at the right time," Dr. Mitchell added.
- Precision oncology technology provides clues to addressing health inequities. Genomic and clinical data can be combined to fuel precision medicine and also reveal health disparities. Such signals can be inferred by overlaying socioeconomic data about who is getting tested and treated, thereby visualizing gaps in access to care, patient outreach or quality metrics. With GPS-like automated prompts, oncologists and health systems can further address disparities by reducing variation in treatment.
Integrating genomics into everyday cancer care has the power to improve health outcomes, reduce costs, move the needle on the patient and provide experience — and democratize the practice of medicine so these benefits are available to all patients.
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