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Translating Science into Improved Health Care: Cancer as a Model

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Federal, State and private health insurance payers to embrace new health care models. ... use Honest Broker system. Tissue ... Improved medical practice ... – PowerPoint PPT presentation

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Title: Translating Science into Improved Health Care: Cancer as a Model


1
Translating Science into Improved Health
CareCancer as a Model
  • William S. Dalton, Ph.D., M.D.
  • Center Director
  • H. Lee Moffitt Cancer Center Research Institute

2
The 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?

3
The 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.

4
Barriers
  • 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

5
Barriers
  • 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

6
Two 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
7
The 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.

8
From Vision To Reality Cancer as a Model
9
The Vision
  • The right treatment, for the right patient, at
    the right time and the right place

10
The 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.

11
The 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

12
The 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)

13
Challenges 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

14
Other Challenges
  • Reimbursement
  • Conducting the research
  • Integration into clinical practice
  • Training future clinicians and researchers

15
The 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.

16
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17
Total 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.

18

19
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20
Progress
  • 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

21
Total 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

22
Why 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
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