Big Data and the Promise of Precision Medicine in Cancer
The promise of CancerLinQ is, at its core, the promise of precision medicine. More than ever, our nation is expecting us to deliver on this promise.
—Peter Paul Yu, MD, FACP, FASCO
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– John Smith, MD
Precision medicine—and its promise to revolutionize how we understand disease and care for our patients—is a concept that oncology has understood and embraced for well over a decade. But millions of Americans recently heard about the concept for the first time when President Obama announced a high-profile Precision Medicine Initiative during his annual State of the Union address in January.
The President has called on Congress to allocate $215 million in federal funds in the next fiscal year to back this effort. The lion’s share of the funding would be used to establish a new research cohort of a million or more people and to increase research on the genetic mechanisms that lead to cancer and other diseases.
Broader Innovations Needed
The President’s proposal is hugely welcome, and ASCO hopes that it will find bipartisan support in Congress. Federal research financing has driven extraordinary medical progress, and these new investments could yield important new knowledge.
Along with new research, however, broader innovations are needed. In fact, the full potential of precision medicine will be realized only if we rethink how we collect, analyze, and learn from all of the cancer care that patients receive, whether at major clinical trial sites or in small oncology practices across the country. It will require creating digital health systems that support population health; the identification of special populations of cancer patients based on clinical and molecular characteristics and aggregation of data across such populations.
We all recognize that too few of our patients participate in clinical trials—just about 3%, in fact. That pool of patients is not just small. It’s also not representative of many of the patients we see in our practices every day—patients who are often older or less healthy than the people who are eligible for trials.
Meanwhile, most cancer doctors already find it difficult, if not impossible, to constantly review and interpret new research findings and rapidly incorporate this knowledge into day-to-day care. Over time, the President’s new initiative will produce even more information for physicians to track, understand, and apply.
Put simply, cancer doctors need more: We need more information to inform the care of our patients, and we need more support to make sense of it all.
CancerLinQ Will Transform Cancer Care
That’s why ASCO is building CancerLinQ™, an ambitious “big data” initiative to transform cancer care and improve patient outcomes through the generation of new knowledge based on real-world patients and learning tools that aid in the application of that knowledge to patient care. When complete, it will seamlessly and securely aggregate and analyze data from electronic health records and other sources in order to do three things:
CancerLinQ will provide clinical decision support to help physicians choose the right therapy at the right time for each patient. This functionality will draw on published guidelines from ASCO and other expert groups and eventually on conclusions drawn from real-world patient care.
The system will provide rapid, quality feedback to allow providers to compare their care against guidelines and against the care of their peers. We will be able to see, right away, if there are ways to improve the care we’re providing and to monitor that care in real time as we work to close those gaps.
CancerLinQ’s analytic tools will help improve care by uncovering hidden patterns in patient characteristics, treatments, and outcomes. These kinds of insights will generate strong new hypotheses for clinical research and help us improve trial designs.
Rollout Later This Year
Building this system will take several years and require substantial, ongoing investments. But I believe that CancerLinQ is well on its way to becoming the platform of choice for oncologists by the end of this decade.
We recently announced that CancerLinQ will be built on a big data software platform developed by SAP, a leading data processing and database management company. This technology, known as HANA, is already being used by thousands of institutions worldwide, including many health and medical organizations.
With the technology platform selected, we are on a fast track to roll out the first version of CancerLinQ by the end of this year with at least 12 oncology practices nationwide, which collectively serve about 500,000 cancer patients. Insights from this first phase will allow us to develop smarter, more advanced versions, which will ultimately be available to all oncology practices in the United States, no matter their affiliations or choice of electronic health record systems.
As excited as we are about CancerLinQ’s progress and potential, important challenges lie ahead. For one, CancerLinQ is an extremely ambitious and complex technical project. We will need to overcome a host of technological challenges as we seek to build a platform that is powerful, versatile, and easy to use. Like any health data initiative, CancerLinQ will need to guarantee the security and privacy of patient information. We are deeply committed to doing so and have engaged patient advisors and other experts to make sure we maintain patients’ trust every step of the way.
Fulfilling the Promise of Precision Medicine
There are also a number of other health data initiatives competing for oncologists’ attention and patients’ data. As the only nonprofit, physician-led initiative in this arena, I believe CancerLinQ is well positioned to succeed. But its impact on patient care will ultimately depend on the participation of ASCO’s members and other physicians nationwide.
In the coming months, we will have exciting news and updates to share as we continue to bring CancerLinQ from vision to reality. I invite you to visit our newly revamped website, CancerLinQ.org, for more information.
More important, I ask my fellow oncologists to join us as we roll out CancerLinQ in the years ahead. The promise of CancerLinQ is, at its core, the promise of precision medicine. More than ever, our nation is expecting us to deliver on this promise. ■
Disclosure: Dr. Yu is the President of ASCO for 2014–2015.
Dr. Yu is President of ASCO for 2014–2015 and Director of Cancer Research at Palo Alto Medical Foundation in California.