Artificial intelligence, digital therapeutics, telehealth, biometric monitoring: the terms alone are enough to suggest that cancer care is entering a new age, one characterized by tools and practices based on technologic innovation. To explore the impact of these new tools, the National Comprehensive Cancer Network® (NCCN®) convened a Policy Summit, bringing together clinicians, patient advocates, researchers, administrators, and other experts to share perspectives, not only on the promise of the tools, but also on the challenges they pose.
Robert W. Carlson, MD
“Innovations in technology hold both great promise and many challenges,” noted Robert W. Carlson, MD, Chief Executive Officer of the NCCN, as he opened the meeting. “We recognize there are tremendous opportunities in leveraging technology to close gaps in our health-care system to provide better care, reduce physician burnout, and control costs for people with cancer. At the same time, we have to worry about unintentionally exacerbating existing problems and creating new areas of bias or inequity.”
“We convened this summit,” he continued, “to share diverse perspectives—on both policy and practice—for what can be done and, more important, what should be done.”
Keynote: Cancer Imaging
One of the most prominent of the new technologies is artificial intelligence (AI), a tool used in the analysis of cancer imaging.
Janet Eary, MD
“An image is a picture of a disease and one of the most important tools in cancer,” said keynote speaker Janet Eary, MD, Associate Director of the National Cancer Institute’s Clinical Imaging Program (CIP). The program maintains a large imaging data archive as a public research resource, which promotes new imaging and data analyses. “With 147 data sets and more that 741,000 subjects (human, mouse, and canine), the archive is an engine for innovative research,” she said.
Asked about possible concerns that CIP data could reflect disparities in patient access to care and in patient outcomes, Dr. Eary noted that the data sets with their clinical metadata are collected from diverse populations. “Researchers can apply innovative imaging research and data analysis approaches to these reference examples,” she said, “and that diversity allows analyses that can be used to address issues concerning the equity of care delivery.”
Although AI is one of the most frequently used new tools, others are “integrating into our daily lives,” observed Edmondo Robinson, MD, MBA, Senior Vice President and Chief Digital Officer at the Moffitt Cancer Center. Speaking in the first panel discussion of the day, he noted that “health policy is increasingly recognizing these opportunities, from telehealth to AI and beyond. There is much more we can do to truly harness the power and potential of digital tools to prevent and cure cancer.”
Edmondo Robinson, MD, MBA
Clifford Goodman, PhD
That perspective was shared by other participants who see tools being used to improve both patient experience and outcomes. In presentations and in panels moderated by Clifford Goodman, PhD, Senior Vice President of The Lewin Group, participants discussed the new tools and their impact on practice and policy.
Technologies to Reduce Risk, Improve Quality, and Address Psychosocial Needs
One way technology is being used is to provide support and guidance for both providers and patients. Clinical decision support systems, for example—computer-based programs that analyze data within electronic health records—are designed to help physicians use the data to make imaging decisions.
“We know there is unwarranted variation in imaging, which is potentially a marker of poor quality,” said Jonathan Darer, MD, MPH, Chief Medical Officer, Medicalis. “Diagnostic episodes can be rife with errors and communication breakdowns. [Clinical decision support systems] are aimed at quality improvement by assisting in decision-making.”
Another tool to improve care is machine learning. Panelist James Hamrick, MD, MPH, a medical oncologist at Flatiron Health, described its “risk-stratification solution” to improve quality and reduce preventable high-cost episodes. Its goal, he said, is to find patients who may end up in the emergency room and to reduce their risk.
Diagnostic episodes can be rife with errors and communication breakdowns. [Clinical decision support systems] are aimed at quality improvement by assisting in decision-making.— Jonathan Darer, MD, MPH
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“We use machine learning to proactively identify patients at risk for an adverse clinical event and surface these insights directly in clinical workflows to help care teams better direct resources to patients who need them most.”
The tool is designed also to help prevent disparities in care. “As part of this investment,” Dr. Hamrick said, “we built a rigorous model monitoring an analytic solution to mitigate the very real risk of reproducing real-world disparities in machine learning algorithms.”
Technologies can also improve the overall quality of care. “A cancer diagnosis can be overwhelming,” observed panelist Kjel Johnson, PharmD, Vice President for Specialty Strategy and Client Solutions at CVS Caremark. “What makes it even harder is that the treatment journey is fraught with breakdowns—from getting patients diagnosed in a timely manner to making sure they get onto the most appropriate regimen for their specific diagnosis as quickly as possible.” CVS is using a digital infrastructure to help “get patients on the right treatments faster, mitigate adverse events, and prevent unnecessary admissions.”
Tools to help patients with cancer manage the psychosocial stress that many experience is another emerging use of technology. “The inevitable stress that accompanies a cancer diagnosis often leads to anxiety and depression,” said panelist Laura Chavaree, LCSW, MSW, Head of Patient Engagement at Blue Note Therapeutics. “We aim to make mental health care available to any patient with cancer at any time by merging deep scientific and clinical expertise, neuroscience, and digital innovation. Unfortunately, cancer care teams have limited resources and time to provide psychosocial care, and cancer-related distress can go undertreated or even unrecognized.”
Ms. Chavaree continued: “Blue Note is committed to addressing this unmet need as we leverage clinically validated, digital technology to provide greater access to the full suite of care for cancer-related distress that is available in top cancer centers.”
Supporting Patient Engagement
Tools that encourage patient engagement and communication with providers are also playing an increasing role in cancer care. The use of telehealth during the COVID-19 pandemic created interest in more such tools, observed panelist Vanessa Cramer, Director of Policy at the Ovarian Cancer Research Alliance.
“Among patients with ovarian cancer, who have no early diagnostic tool and no low-risk confirmatory test, interest in more information and patient engagement are very high,” she said. Moreover, the deluge of information found online can often be overwhelming, and patients need help sorting through it.
Among patients with ovarian cancer, who have no early diagnostic tool and no low-risk confirmatory test, interest in more information and patient engagement are very high.— Vanessa Cramer
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Overall, panelists seemed to agree that the interest in patient engagement is driving a need for digital tools including those that patients themselves can use to find expert information.
“Data by itself are not particularly helpful,” said Dr. Robinson. “It needs to be filtered by expertise and turned into information and actionable insights. Patients need digital channels they can use to search for this kind of expert information, from home and on their own time, 24/7.”
Interest in patient engagement is also high at PhRMA, said Jocelyn Ulrich, MPH, Deputy Vice President, Medical Innovation Policy at the pharmaceutical association. The industry has been looking at ways to reach patients and is working with the U.S. Food and Drug Administration on various issues, she said, such as patient-reported outcomes and medication labels.
A patient-specific approach can also encourage and support patient engagement, said Tim Foley, MBA, Vice President, Oncology Solutions, for Optum, a pharmacy benefit manager and health-care provider. “We place lots of value on providing clinical information for patients,” he said. “Clinicians at Optum are able to become familiar with individual patients’ cases and can be ready to advise and respond to calls. Patient support is available 24/7.”
Does encouraging patient engagement raise any concerns regarding safety and security or equity of care? That question from the audience drew emphatic replies:
- “It is necessary to have experts in house who can address security to keep data protected,” said Dr. Robinson. “It is a constant effort and absolutely necessary.”
- “Regarding equity, the same constant vigilance is required,” said Ms. Ulrich. “Paying attention to issues of equity takes steady awareness.”
- “If you don’t have a dedicated and disciplined eye regarding equity,” added Dr. Robinson, “you are going to make our already disparate health-care system worse.”
Note: More information about the NCCN’s Policy Summit on new technologies, as well as other oncology policy summits—past and upcoming—is available at NCCN.org/policy.
DISCLOSURE: This NCCN Summit was supported by Adaptive, ADC Therapeutics, AmerisourceBergen, Apobiologix, Astellas, AstraZeneca, BeiGene, Bluebird Bio, BMS, Boehringer Ingelheim, Eisai, EMD Serono, EQRx, Exelixis, Foundation Medicine, Genentech, GSK, Helsinn, Heron, Incyte, Janssen Oncology, Kite Pharma, Lilly, Merck, MorphoSys, Pharmacyclics, QED Therapeutics, Regeneron, Sanofi, Sun Pharma Oncology, and TG Therapeutics. Dr. Carlson is Chief Executive Officer of the NCCN. Dr. Darer is Chief Medical Officer of Medicalis. Dr. Johnson is Vice President for Specialty Strategy and Client Solutions at CVS Caremark. Ms. Chavaree is Head of Patient Engagement at Blue Note Therapeutics. Ms. Cramer is Director of Policy at the Ovarian Cancer Research Alliance. Ms. Ulrich is Deputy Vice President, Medical Innovation Policy, PhRMA. Ms. LaRussa is Director, Patient Education and Web Content at the Leukemia & Lymphoma Society. Dr. Eary, Dr. Robinson, and Dr. Haddad reported no conflicts of interest.
