Title: Translating Science into Improved Health Care: Cancer as a Model
1Translating Science into Improved Health
CareCancer as a Model
- William S. Dalton, Ph.D., M.D.
- Center Director
- H. Lee Moffitt Cancer Center Research Institute
2The Future of Medicine
- Where we are today Sequencing of the human
genome has dramatically improved molecular
technology and our understanding of disease - The potential is HUGE! New technology will
ultimately improve molecular diagnosis, identify
new targets for therapy, create personalized
therapies, and identify populations at risk of
disease, especially cancer. - The challenge How do we translate new molecular
technologies into clinical benefits for our
patients?
3The Scenario
- The Answer Develop a new approach to deliver
cancer care that integrates research at every
step of a patients journey dealing with cancer,
and create alliances with academia, the cancer
care community, and patients. - The Opportunity Develop a novel delivery system
to incorporate new technologies and define their
value in the care of cancer patients.
4Barriers
- Lack of platform/grids for development and
exchange of information - Create eco-system for discovery and data
generation - Fragmentation of information/ Need Integration of
datasets - Need for real-time access of information
- Need for clinical outcomes analysis/affect of
intervention - Lack of standards
- Performance of assays
- Databases
- No common lexicon
5Barriers
- Lack of collaboration and inter-disciplinary
approach - Create cross-culture environment
- Improve entrepreneurial culture in academia
- Gap between the Ivory Towers and the point of
impact the community where vast majority of
patients are treated
6Two Translational Roadblocks on the Way Toward
Improved Public Health
whereas the National Institutes of Health has
been consistently targeting the bench-to-bedside
block, no one is taking responsibility for the
second, which is integrally tied with the funding
of the health care delivery system
JAMA. 20042911120-1126
7The Future of Medicine
- The future of medicine is based upon new
molecular insights into cancer and other
diseases. - Current Model of Delivery develop technology at
research institutions and carry the tablets to
the masses or build it and they will come. - Proposed Model of Delivery early involvement of
the community in assessing the value of new
technologies. Capitalize on economy of scale and
real world experience from the beginning.
8From Vision To Reality Cancer as a Model
9The Vision
- The right treatment, for the right patient, at
the right time and the right place
10The Requirements
- Enrollment of large patient populations in
prospective efforts to collect clinical histories
and molecular data - Expansion of information technology
infrastructure to integrate large data sets from
multiple sources - Experienced multi-disciplinary research teams to
perform data-mining and modeling - New healthcare networks capable of reducing new
methods to standard practice - Federal, State and private health insurance
payers to embrace new health care models.
11The Challenges Cost
- Infrastructure cost
- Bio repositories
- Large integrated and interoperable databases
- Human Resources
- Researchers, clinicians, biostatisticians,
bioinformaticians - Clinical trials staff, IRB, consenters,
abstractors - Public-private partnerships needed
12The Challenges Patient Understanding
- Patient participation in clinical trials
- Consenting patient survey logistics
- Understanding timing of developing personalized
cancer care - Overcoming concerns
- Tissue use Honest Broker system
- Tissue data ownership
- Privacy
- Genetics
- Access by collaborators (NFP FP)
13Challenges Data Collection
- Interoperability - limited
- Robust data collection without interfering in
clinical care process - Precious little data available in a discrete
format - Few electronic sources of data for direct access
- Data often manually abstracted retrospectively
- Data may be in the MDs office paper chart rather
than the hospitals electronic medical record - High investment in capital
- Navigating HIPAA Human Subject Research
requirements
14Other Challenges
- Reimbursement
- Conducting the research
- Integration into clinical practice
- Training future clinicians and researchers
15The Approach
- Data?Information?Knowledge?Wisdom?
- Improved medical practice
- Create a delivery system that will integrate new
technologies into the standard of care and
develop evidence-based guidelines for the
treatment of cancer.
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17Total Cancer Care
- Will provide an approach to identify the best
treatment for individual patients based on
clinical and biological characteristics of a
patients cancer. - Integrates new technologies into the standard of
care in an evidence-based fashion to personalize
treatment and improve individual outcomes. - Addresses cancer as a public health issue and
seeks to improve access, affordability and
quality of care by creating an information system
to assist in making clinical decisions based on
outcomes and comparative effectiveness. - Creates a network of health care providers and
researchers who contribute and share information
from individual patients to ultimately improve
care of patients from Florida and beyond.
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20Progress
- Total Cancer Care Protocol
- 33k consented patients
- 9500 tissues collected since 20066500 profiled
- 17 contracted consortium sites contributing 70
of tumors - Database data collection enhanced
- Data Warehouse
21Total Cancer Care The Future
- Further expansion of TCC Consortium Sites (FL,
US, Internationally) - Development of a dynamic information-learning
system - Integrated model for personalized medicine
- Personalized Health Record
- Cancer Biomarker Drug Target Discovery
- Patient Treatment Matching
- Comparative Effectiveness Research
22Why Personalized Medicine?
- when doctors can truly prescribe
- the right treatment, to the right person, at the
right time, we will have a new level - of precision and effectiveness that will provide
the knowledge-driven power that - is necessary to achieve our highest goals in
healthcare reformincluding more - effective disease prevention and early disease
detection. - HHS Secretary Kathleen Sebelius
- Written testimony given during Senate
confirmation hearings, April 2, 2009