Patient Life Span Navigation

SPECIAL FOCUS: Pilot Efforts to Connect Across Agencies: What's Next to Further Open Data Science

Cancer is not merely an acute event but a chronic condition.

Patients want results that enable a better life across the continuum.

forecast forecast across similaracross similarpopulations populations

accurately diagnose the disease

precision across socioeconomic spectrum

precision precision across across ethnic ethnic diversitydiversity

Patient Life Span Navigation

A. Individual patient’s health along the continuum of life.

B. Forecast disease progression with similar patients.

C. Precise (reproducible) and accurate (meaningful) diagnosis and monitoring of the disease.

D. Navigation with equal precision and accuracy across socioeconomic spectrum and ethnic diversity.

individual individual patientpatient’’s s

healthhealth

CSI - Cancer

A: Patient Health: NCI/DoD

C: Disease Status: fNIH/Pharma IndustryAnalytical

tools for the objective measurement of human performance

B: Patient Forecasting:NCI/VA

• Big-data scientist training enhancement program

• Mathematical models to accurately represent specific patient cohorts

HD single cell analysis

Rare cell morpho- proteo-genomics

Therapy, drugselection

X: Navigator:Provide patients and physicians more relevant, accurate, and actionable information to improve treatment options.

Patient Cohort

Life Span Navigation: Step by Step

THE PATIENT AND

QUANTIFIED HEALTH DATA

HEALTH

DATAPALOOZA 2016

Jeannine WalstonIntegrative Cancer Care for the Whole Person and Healing Focus

4

My Cancer Story

5

Radiation

Feb-March 2014

6

Oral Chemotherapy –

Temodar

February & March 2014

7

Immunotherapy with a Dendritic Cell-Based Vaccine

May & June 2014

8

Integrative cancer care for the whole person addresses the physical body, mind-body connection,

spiritual vitality, social support, and a cleaner environment.

9

Self-Careis

Essential

Cancer Patients Experience Challenges and Complications

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My brain tumor journey–

Problems before and after treatment

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Cancer impacts too many people–

1,685,210 people will be diagnosed with cancer in 2016–

14.5 million people were living beyond a cancer diagnosis in 2014 and it’s expected to rise to almost 19 million by 2024

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Other cancer patients and survivors –

Cancer types, stages, ages, health issues, socioeconomic factors, education, culture, and support infrastructure

–

Stories

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What are some key strategies to address challenges and complications?

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Better communication with doctors, nurses, other providers, and directly to patients

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Support to the whole person and not just cancer–

Recognize patients as people

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Improved patient-centered care, personalized medicine, and precision medicine

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Help outside of appointments when necessary

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Track cancer patients real time

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ATOM-HP Delivers Major Benefits

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Qualitative supportive status

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Real time –

24/7

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Sensors and Patient Reported Outcomes

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Acute therapy and long-term follow-up

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Goals to improve quality of life and survival

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Helps people with cancer, clinical trials, pharma and bio companies, FDA, practitioners, health insurance, and much more

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ATOM-HP: Patient Health•Quantifying Patient Health to improve therapeutic decision making

Why DoD and NCI? Why Warfighters and Cancer Patients?

• Always wants to be ready for mission. • Performance Status (PS) impacts survival.

• Fatigue induced during exercise • Short term studies only

• Always wants to be ready for next therapy/trial.• Performance Status (PS) impacts survival.

• Fatigue results from therapy.• Clinical trial enrollment is routine. • Fatigue impacts ability to accept treatment and

therefore affects survival.• Long term longitudinal studies possible

Patients from ECOG 1594

Overall Response Rate

(%)TTP (months) Median OS

(months)1 year survival

(%)

PS 2 14 1.5 3.9 19PS 1 18 3.5 7.1 30PS 0 23 4.3 10.8 42

PS 0 = normal activityPS1 = minimally symptomatic, nearly fully ambulatoryPS2 = in bed sometimes during daytime hours but less than 50%PS3 = in bed greater than 50% of daytime hoursPS4 = bedridden

Problem #1: Are you sure that Mr. Smith will benefit from chemotherapy?

Problem #2 Patient-Physician Disagreement is associated with a 16% increase in

the risk of death

(Schnadig et al. 2008 Cancer 113:8)

60 60 PPatient atient CClinical linical TTrialrial

Primary Objective:

• Identify predictors of Hospitalization / Urgent interventions/ Dose Delays (Mission Failure)

Secondary Objectives:

• Identify predictors of performance status score

• Identify predictors of fatigue score

60 Warfighter Trial60 Warfighter Trial

Primary Objective• Identify predictors of performance

• Physical tasks• Cognitive tasks• Mixed tasks

Pathway to a Solution: Clinical Trial at USC and US Navy Human Performance Laboratory

Analytics for Patient Performance AssessmentUsing Routine Activities and translating them into Quantitative Performance Measures.

Data Driven Performance Level from Kinect Data

RED: fast/high performance

BLUE: slow/low performance

Real World Data: http://tinyurl.com/atomhp

Patient Reported Outcomes across Diversity Spectrum

eHealth app designed for daily patient symptom reporting from cell phone

• Daily ratings of fatigue & appetite• Weekly ratings of:

– Physical activity, sleep disturbance, fatigue • Daily body weight• “Selfie” photo

Available in multiple languages to capture diverse patient sample• English• Traditional Mandarin• Spanish

Quantified and Applicable: Designing solutions that mimic human decision making

Patient factors

Patient factors

Environment factorsEnvironment factors

Disease/

Disease/

situational factors

situational factors

ImprovedOutcome

Patient: I am a 53 year old female diagnosed with stage 1 triple-negative breast cancer in 2011 who has now metastasis in the bones: what does that mean?

• Navigator: This happens to about 30% of patients like you. Go here for more data.

Physician: Previous standard of care applied to all triple negative patients but what do we know about the next metastasis?

• Navigator: TNBC to bone is likely followed by lung or liver. Trials exist in PARPi.

Scientist: TNBC patients seem to fall into two groups of short term survivors and long term survivors. I wonder how they differ?

• Navigator: Here are progression pathways, the survival curves and the newest proteogenomics data.