Cancer Care Engineering: A Collaborative Transformational
Project
Indiana University School of Medicine
Purdue University
Cancer Care EngineeringProject Leaders:
Stephen Williams, MDHH Gregg Professor of OncologyDirector, IU Cancer CenterAssociate Dean of Cancer ResearchIndiana University School of Medicine
Bradley Doebbeling, MDDirector VA CIEBPIU Cancer CenterDirector (RI, RCHE)Indiana University School of Medicine
Joseph Pekny, PhDProfessor of Chemical EngineeringDirector, e-Enterprise CenterFounder, Regenstrief Center for Healthcare EngineeringPurdue University
Marietta Harrison, PhDProfessor of Medicinal ChemistryDirector, Oncological Sciences CenterAssociate Director Purdue Cancer CenterPurdue University
VA/IU Center for Implementing Evidence Based Practice, RI/IU
Center for Health Services & Outcomes Research
Vision: Goal-oriented cancer research
Approach: “Systems Analysis” for cancer prevention, detection, treatment and care delivery & project management
Team: Over seventy physicians, caregivers, engineers, scientists and staff drive the CCE vision
Cancer Care Engineering
CCE Strategy
Indiana Cancer Care
UnderstandGoal Oriented Improvement
Model, Analyze,
Communicate
System Awareness
Decision Support Tools
CCE Hub
Animal Models
CCE Pillars & Hierarchy
The Integrated Pillars
Mathematical Models
Patient OMIC Analysis
Health Services Research
Cancer as a Managed Disease
Cancer Care System Projects
The Integrated Hierarchy
Cancer Care Best Practice Projects
Physician Tools Projects
OMICS Projects
CCE Enablers
Modeling the Indiana Cancer Care System: A What-If Tool for the Big Picture
Regulatory Agents
Organizational & Regulatory
Agents
Patient Agents
CRC Care System
Indiana Cancer Care System Indiana Cancer Care Model What If Questions
validate
data
What is the impact of screening rate improvement?
Caregiver Agents
What is the best strategy for using OMICS
advances?
What is the best strategy for colonoscopy
screening?
How can all patients with colonoscopy orders to
follow-up get them? What resources are required?
Indianapolis CRC Quality Improvement Initiative
• Implementing evidence-based practices, including psycho-social services, and guidelines to deliver high quality care and outcomes – last step in translational research
• Within CRC care, screening, treatment, and surveillance tests after treatment are studied within primary and specialty care
• Interventions within two healthcare systems with well-integrated EMRs: Wishard / IUMG and VA (links to VA national initiative)
• Main project components and outcomes:– Cancer prevention and care process maps– Quality reports for Indianapolis clinics – Application of implementation research methods– Building a Cancer Care – Technical Assistance Program
(CC-TAP), patterned after RCHE Healthcare TAP, to help implement best practices in one or more clinics
– Understanding the barriers to best practice care
Connecting Research to Practice: Mechanistic modeling of polyp & CRC development
• Methods– Mutation network– Stochastic cell growth
• Predictions– Likely incidence with age
• Growth characteristics• Transformation rates
• Applications– Adaptive modeling to individual patients
• Connection to “omics” measurements
– Decision tree hypothesis testing– Identification of heterogeneous sub-populations
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data1 model
Personalizing Cancer Care: Data Driven Prevention/Treatment, “Omics”, & Measurement Driven
Medicine
Genetic Information
Proteomics and metabolomics
Normal Trajectory
Cancer Trajectory
malignancy
What markers presage cancer?
What markers are present with cancer?
What markers indicate risk?
Develop markers based on all information – integrated omics, clinical data
What markers differentiate people?
What resolution is possible?
On which patient groups does Drug X work?
Patient groups are indistinguishable with respect to treatment
What dosage is best?
Patient Blood
• Genomic Analysis
• Lipidomic
• Metabolomic
• Glycoproteomic
CCE Predictive Molecular Signatures
Personalizing Cancer Care: Data Driven Prevention/Treatment, “Omics”, & The Role of Dog Models
Genetic Information
Proteomics and metabolomics
Normal Trajectory
Cancer Trajectory
malignancy
What markers presage cancer?
What markers are present with cancer?
What markers indicate risk?
What markers differentiate dogs?
What resolution is possible?
Well understood & controlled lineage
Companion animals get care & study registration typical
IT infrastructure prototype usable for humans
Rapid knowledge acquisition cycle
Insight to more genetically diverse humans, established animal model
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CCE Milestones
10/08
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Cancer Care EngineeringCurrent Funding Initiatives
Walther Cancer Institute Foundation
Engineering the Cancer System (R-CCE)
Funded: $1.35M Regenstrief Institute 7/1/07-2009
Focused on Health Services Research
• Cancer Care Delivery, Modeling & Data Visualization, CCEHub
Warfighter CCE (W-CCE)
Funded: $2.4M DOD, 12/1/07-2011
Focused on Prevention, Molecular Signatures
•Sample Acquisition, OMIC Analysis, Data Modeling, Data Visualization, Literature Mining
Funded: $0.2M 2007-2009
Dog-CCE (D-CCE)
Regenstrief, PCC, DP, Engineering, Vet School
Funded: $0.2M 2007-2009
CCE Future
• Harvest CCE Seed Projects– First Wave of Results Papers & Proposals
• Present Status & Plans to Indy Foundations– Presentation Proposal (August 14)– Presentation (Fall 2008)
• Take Results to Foundations & Expand Partnerships
• Iterative Refinement• Evolve According to Results & Funding• Realize Results in Care System