Cancer ranks as a leading cause of death and is an important barrier to increasing life expectancy in every country of the world.1 Interruptions in cancer care can change the course of care, increase the potential for deviation in care as well as increase the overall costs of care, despite the advances in medicine, technology, and cancer treatments.2
Under normal circumstances, cancer care is complex and can be inconsistent for various reasons. Delayed or missed treatments due to the COVID-19 pandemic resulted in exacerbated levels of interruption of usual care in many health care facilities. This exposed already vulnerable patients with cancer to additional health risks.
Reducing the time between the appearance of symptoms, diagnosis and treatment of cancer is a priority for the healthcare industry. However, leaders across the healthcare industry, government institutions and patient groups have joined forces to propel new thinking and collaborative efforts to transform the design of care and care pathways. With novel approaches to map the evolution of disease and use of imaging data technology in innovative ways, healthcare providers can begin to facilitate information sharing and collaboration of patient care, bringing research into clinical practice and promoting better understanding of the physiology of tumors. These advances enable better integrated cancer care and help to overcome the challenges of fragmented care delivery with more consistent treatment and clinical practice.
Overcoming Fragmentation in Cancer Care
According to the International Agency for Research on Cancer, there were an estimated 19.3 million new cases of cancer detected in 2020. Because of the distribution of these patients and the varied health systems across the globe, many individuals are not getting consistent care for the same diseases. Differing practice methods and providers' knowledge of the most current treatments vary by location, meaning patients may get different tests done in different locations as well as interact with many different care givers along their treatment paths. Moreover, patients in particularly isolated or rural areas may not have access to the same quality of treatment, technology or latest in care that can be accessed at larger facilities or even in research hospitals. To complicate the already complex situation, there is often a lack of coordination among care providers and the patient is often left on their own to collect all the relevant information and try to understand their care path.
Better integration of care and avoiding the failures of care delivery is top of mind for industry leaders. Richard Gilbertson, MD, who serves as the Li Ka-shing Chair of Oncology, Head of Department of Oncology and Director of the CRUK Cambridge Centre at the University of Cambridge says that overall, cancer care in developed countries, such as the US and the UK is good, but specific challenges lie in the integration of that care. According to Dr. Gilbertson, there are three areas of fragmentation: fragmentation in terms of access, fragmentation in the different levels of care, primary, secondary and tertiary, and fragmentation between research and clinical practice.
"If you look at the UK, as well as many other countries,” explained Dr. Gilbertson, “when you travel 50 miles in any direction, your likelihood of surviving a specific cancer can change as you move from one region to the next. There are complex reasons for that, but largely, it's because there is disparity in healthcare. We're very aware of that. And that's inevitable because of regionalization and expertise, access to different aspects of healthcare, and access to research opportunities within those centers. The National Health System (NHS) has recently outlined its goals for earlier cancer diagnosis and treatment in the UK, which is partially dependent on making improvements in access to care."
Because the NHS is a single party payer system, it has the unique opportunity to create a more clearly delineated path to improve access, integrate and deliver optimal care. In the NHS long-term plan, it outlines its goals for earlier cancer diagnosis and treatment in the UK, which would potentially result in 55,000 more patients by the late 2020s who would survive an additional five years after their cancer diagnosis. According to the NHS, these ambitious goals will be achieved through improving national screening programs, giving people faster access to diagnostic tests, investing in cutting edge treatments and technologies, and making sure more patients can quickly benefit from precise, highly personalized treatments as medical science advances.3 Dr. Gilbertson believes this shift in early diagnosis will happen in primary care and that better integration of care will be essential for this to be achievable.
Improving early diagnosis with data integration and advances in intelligent imaging
Beyond the radiology images visible to the radiologist's naked eye lies the higher dimensional data and quantitative mapping of radiomics. Radiomics tools use automated data extraction from medical images to provide comprehensive assessments and modeling of many image features that relate to specific diseases. Bringing together patient data, imaging data, predictive algorithms and radiomics tools can advance a more holistic view of patient care, according to Claire Bloomfield, DPhil. Chief Executive Officer of the National Consortium of Intelligent Medical Imaging at the University of Oxford.
"We're bringing partners together from the different components of the healthcare ecosystem," Dr. Bloomfield explained, " the NHS, plus academics, plus industry, plus patient groups, to try and tackle the issues and bridge some of the gaps and bring the right people together even if they're geographically split, or technically split. We've been using that model--particularly recently with some work that GE, Roche, and some of our other partners have been involved in--to try to embed research into the lung health check program that has been launched in the UK to improve lung screening programs."
The work involves collecting 150,000 patients' clinical questionnaire data, CT, PET/CT data, blood biomarkers and digital pathology to integrate the different types of information and potentially generate new insights that will help at different points of the care pathway.
Particularly, Dr. Bloomfield mentioned, PET/CT and biopsy digital pathology data being integrated to generate new artificial intelligence (Al) radiomics solutions that could potentially remove the need for surgical biopsies.
"If you remove those [biopsies] globally," she explained, "it has a significant impact on care and on mortality, but also just making care ‘more caring’ in the way we're delivering it. It's about how you can embed research along that pathway of care rather than artificially trying to insert things in a non-integrated manner. And that's why I think imaging is fascinating, because it's an existing, broadly available technology that you can reverse engineer to enhance with Al or multimodal information without fundamentally altering the technology itself."
Improving clinical information and driving better insights with enhanced imaging outputs and data integration
Part of Dr. Gilbertson's research at Cambridge is also focused on data integration. In the Integrative Cancer Medicine program, teams are prospectively collecting patient data from clinical trials and addressing the mathematical problem of how to integrate them. Imaging data, imaging digital pathology, liquid biopsy ribonucleic acid (RNA) and whole genome sequencing are the types of data they are working with. One example that has great potential, according to Dr. Gilbertson, is understanding the biochemistry of a tumor with hyper-polarized imaging.
"The reason this has so much potential value," Dr. Gilbertson explained," is for example, when we're looking at tumor response, we're still requiring patients to go through two or three cycles of a drug before we can get a readout. But hyper-polarization can literally give you a biochemical readout of the impact of a drug study in one cycle of a drug-so that's a really powerful aspect."
Dr. Gilbertson's teams are also using radiomics and imaging to build three-dimensional tumor models using 3D printing. Cross referencing the tumors with the imaging and habitat genomics can help access detailed information to make more effective treatment decisions, and correlate high-tech solutions with day to day operations and can even affect resource planning.
"It's not uncommon in many hospitals to suddenly find out we need an upper gastrointestinal (GI) surgeon on a case of ovarian cancer. The kind of radiomics approaches that the team is developing here can actually predict not just the location of the tumor and where it might be heading from a progressive perspective, but also work out what you'll need for the management. And that's really exciting because it has workforce implications."
Enhancing the outputs of existing medical imaging with new tools and cutting-edge Al is an opportunity for the radiology community to help drive decision making for care pathways.
Democratizing these insights is equally important in driving accessibility for all and facilitating consistency in care.
Empowering clinicians and improving patient care with meaningful innovation and holistic collaboration
With the end goals of earlier diagnosis, better care integration and improving health equity in care, both Dr. Gilbertson and Dr. Bloomfield agree that the best cancer care is delivered as early as possible in the disease and without the need to travel far from home. Using existing imaging networks to deliver these innovations is key.
"I think it's very important that individuals have absolute confidence in their local healthcare. We can ensure local and regional experts have the ability to deliver exceptional care at that level by using technology and tools that are democratized for ubiquitous access. For example, integrating imaging AI can be done now. We have the technology to support software deployment across imaging networks, and that ensures new innovation generated in a center of excellence is deployed across the broader population."
To engage every local healthcare provider in the adoption of these new tools, Dr. Gilbertson said, there needs to be ownership at every level and there needs to be input from the clinicians and radiologists who are delivering patient care.
Co-creation and collaboration in the development of these new tools and solutions is key for both Dr. Gilbertson and Dr. Bloomfield. Cross functional partnerships are bringing together organizations like GE Healthcare and The National Consortium of Intelligent Medical Imaging, and the University of Cambridge, to create novel approaches and intelligent new tools.
"Bringing together colleagues in radiology with research and industry like GE is the philosophy we're using," said Dr. Gilbertson. "In Cambridge, what we're doing is bringing the concept of product to the academic process. The balance is to allow the freedom and research to produce that creation, but also to learn from the philosophy of companies that there has to be a product at the end of this that means something. And that is a really exciting aspect of research biotech partnerships-bringing those philosophies together to create something really impactful for patients."
1 Bray F, Laversanne M, Weiderpass E, Soerjomataram I. The ever-increasing importance of cancer as a leading cause of premature death worldwide. Cancer. In press.
2 https:/ / acs journals.onlinelibrary.wiley.com/do i/ full/ 10.1002/cncr.32336