The evolution of digital decision support in cancer care

As cancer care becomes more sophisticated and more personalized, oncologists and the entire care team face growing time pressure – including the daunting task of sifting through a staggering amount of information. More than a million medical papers are published each year, with nearly 100 clinical trial reports and reviews added every day.1 In 2018, more than 1,000 new cancer drugs were being studied in clinical trials or awaiting FDA review.2,3 When patients are facing a potentially life-changing diagnosis, they need confidence that their healthcare providers are considering all the relevant data and making the best possible diagnostic and treatment decisions in a timely fashion.

Taken on their own, vast amounts of health data and information do not automatically add up to improved patient outcomes. Few clinicians have the time to delve deeply into the latest and increasingly complex research and prepare all patient diagnostic information for review with other experts to make a confident decision about the right therapy for each individual patient.

The challenges in harnessing health information today are so complex that no one player can tackle them alone. When companies with complementary expertise in healthcare and technology form partnerships, they can provide clinicians with much-needed clinical decision support tools. By using technology to gather complex information, pull out clinically relevant data and streamline the management of patient information, these tools enable clinicians to make more confident, timely decisions throughout the course of care. In a multidisciplinary tumor board, for example, having a comprehensive view of each patient through a technology-enabled “dashboard” can help specialists use the limited time they have to review all necessary patient data and align on the best possible treatment plan. This process is an important step in delivering more personalized care to patients with a life-threatening disease like cancer.

“It’s extremely important to have an accurate diagnosis, which means we need all the information about what is going on with the patient – from all the studies, all the radiology reports, all the lab tests,” according to Richard Hammer, MD, Vice-Chair of Clinical Affairs, University of Missouri School of Medicine. “We need to have that all present in one place to make an accurate diagnosis and decide what the best treatment is.”

Improving access to essential information

Many new clinical decision support tools employ cloud-based software, which means that participating clinicians on a care team do not have to be in the same room anymore. Instead, they can login remotely to upload, review and discuss patient information from any place, which further supports easier, more informed and timely decision-making by oncology care teams.

One of the critical venues for this collaboration is the tumor board, or a multi-disciplinary team meeting that brings together oncologists, radiologists, surgeons, pathologists, nurse navigators and other specialists that play a key role in cancer care. In under 90 minutes, a typical tumor board needs to review all the clinical perspectives required to fully understand a cancer patient’s disease4 and determine the best possible individual treatment plan. As such, tumor board discussions represent some of the most important minutes in a cancer patient’s life.

But running a tumor board is both time- and labor-intensive, and tumor board participants have demanding caseloads. Coordinating meetings, getting all the experts in the same room and organizing patients’ medical information – laboratory tests, medical imaging files, medical history, biomarkers, tumor information and more – can be challenging.

With cancer care becoming increasingly complex, oncology care teams need a more streamlined approach to clinical workflow and information management. New clinical decision support solutions enable experts from various disciplines in cancer care to upload their patient records in the same dashboard from wherever they are. These digital solutions make virtual tumor boards possible, bringing flexibility to meeting logistics and allowing oncology experts to connect to a broader network for consultation, second opinions and knowledge sharing. Having all of the relevant clinical information available in one place for review by the entire team and not having to switch between systems saves time. It also “facilitates our discussions and leads us to make the best decision regarding therapy for the patient,” Hammer said.

Searching databases for actionable insights

Oncology decision support software can also provide automated access to external databases to bring timely and relevant patient-specific actionable insights to treatment decisions. For instance, integrated software applications can pull in the latest National Comprehensive Cancer Network (NCCN) or other clinical practice guidelines for a tumor board discussion, measure and document guideline adherence or variance, and record patient diagnostic and treatment paths. This can also reduce inefficiencies in payer reimbursement and hospital accreditation.

Other available apps can find the latest, sponsor-agnostic clinical trials to help the care team explore patient treatment options. Using patient-specific data, the software can automatically search the largest international trial registries to find relevant, local clinical trials with convenient locations and identify home institution options. These programs search in real time, deliver results in seconds, and provide unbiased results to match patients to available trials independent of sponsorship.

Another type of oncology decision support app can search trusted, curated publication databases in real time to discover up-to-date relevant medical literature within seconds. Using embedded instructions, it can automatically query thousands of medical and research publications to receive clinically and therapeutically relevant articles in seconds, expanding the care team’s knowledge with current medical literature.

Database query apps can perform these functions without sharing sensitive patient information, which is hosted on a secure cloud infrastructure and encrypted in transmission.

Using data to bring patient confidence

The ability of digital decision support tools to offer remote access, enhanced workflow and automated data management can help oncology teams improve the quality of care, provide more timely answers for patients, and potentially include more patients in tumor boards. Research shows that patients reviewed in a tumor board are more likely to be enrolled in clinical trials, yielding benefits for both current and future patients.5

Today’s decision support tools can help give patients the certainty that they are getting the best possible diagnosis and the best possible treatment course, and that it all happens in a timely fashion. While the diagnostic and therapeutic decisions are still made by healthcare providers, clinical decision support tools can help them make the decisions in a more accurate, personalized and timely manner.

References

  1. Landhuis, E. Scientific literature: information overload. Nature. 2016 July 21; 7612:457-58.
  2. Food and Drug Administration, Center for Drug Evaluation and Research: Advancing Health Through Innovation: 2017 New Drug Therapy Approvals. January 2018. https://www.fda.gov/downloads/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ReportsBudgets/UCM591976.pdf. Accessed October 1, 2020.
  3. Statista. The Statistics Portal: Number of cancer drugs in development in the United States in select years between 2005 and 2018. Pharmaceuticals Products & Market. May 2018. https://www.statista.com/statistics/268805/number-of-cancer-drugs-in-development-since-2005/. Accessed October 1, 2020.
  4. World Health Organization. https://www.who.int/diagnostic_imaging/en/ and https://www.who.int/cancer/prevention/diagnosis-screening/en/.
  5. Basse C, Morel C, Alt M, et al. Relevance of a molecular tumor board (MTB) for patients’ enrolment in clinical trials: experience of the Institut Curie. ESMO Open. April 2018. https://esmoopen.bmj.com/content/esmoopen/3/3/e000339.full.pdf.

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