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Targeting the right treatment

Oncospace data warehouse project aims to improve cancer treatment outcomes
Posted September 10, 2014

We live in a world of data.  Each swipe of the credit card leaves a digital footprint detailing our personal preferences and customer characteristics.  Retailers analyze this data to drive consumer decisions with personalized book recommendations and customized coupons printed at check out.  Similarly, every visit to the doctor results in data about weight, blood pressure, temperature, medication, and more. The adoption of electronic medical records has allowed the capture of patient data, but, unlike your online bookstore or neighborhood grocer, the full potential for using that information to drive decision making and personalize healthcare is still on the horizon for many areas of medicine.

Johns Hopkins Radiation Oncology is moving toward that goal with a program dubbed “Oncospace” — a complex data warehouse that provides the precise information doctors need to create an optimal radiation treatment plan for each patient. Oncospace is considered one of the first demonstrations of how complex patient data — information on anatomy, treatment side effects, and radiation dose distribution to specific organs — can be collected from previously treated patients, stored in data warehouses, processed, and presented to physicians in a meaningful way so that they can make treatment decisions for each patient based on that patient’s unique characteristics and preferences.  It is also one of the first demonstration projects in the multidisciplinary Hopkins Individualized Health Initiative (Hopkins inHealth) that brings together experts from across the university and medical system to harness data to improve health and healthcare.

Theodore DeWeese, MD, Director of the Johns Hopkins Department of Radiation Oncology and Molecular Radiation Sciences, explains Oncospace with the analogy of Mrs. Jones. “When 75-year-old Mrs. Jones comes into my office with a new cancer diagnosis, I use standard protocols to determine a course of care, but I also rely on my own experience seeing other patients in a similar category to make assumptions on the likelihood that she can be cured,” he says.  “But what if I had access to patient outcome data for other patients, like Mrs. Jones, seen by other Johns Hopkins physicians, or other patients treated at other institutions? There may be 100 people just like Mrs. Jones in the universe of patients with her diagnosis, and wouldn’t it be nice to know that 80% of those people had a heart attack on the third cycle of treatment? I would now be better informed on how we might avoid that heart attack in Mrs. Jones by altering the care we provide.” Oncospace can provide that information to doctors and patients.

The program is already being used to collect data. An Oncospace iPad app prompts prostate cancer patients to report on treatment side effects, storing that information to be quickly retrieved and analyzed by care teams at each visit, eliminating the need for additional paperwork. Additionally, Oncospace is being used to automate the radiation planning process for head and neck cancers, resulting in a condensed planning process and allowing the teams to adjust for the risks of radiation side effects based on patient concerns. Radiation to the head and neck range can cause symptoms ranging from dry mouth to swallowing issues to speech impairments. Dry mouth might be devastating for a chef who relies on his taste, while a speech delay could be life-altering for a radio announcer.

Similarly, Oncospace will soon allow teams to be predictive in their treatment plans. “Historically, head and neck cancer patients received a PEG tube prophylactically so nutrition wasn’t compromised if the swallowing process was disrupted by radiation.  But a large portion of patients may not actually need that tube,” says DeWeese. “We hope to use Oncospace to see who will need a tube, and who will not need it.”

The next phase of the project will see increased partnerships with other medical institutions in the hope that Oncospace will transform patient outcomes for other cancers, such as lung and pancreatic. “That will take additional computer scientists and researchers,” DeWeese says. Getting those boots on the ground will be possible only through private philanthropy. “With support from donors, we can bring Oncospace capabilities to more patients facing more types of cancers, give patients more informed advice. It’s the right thing to do.”