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Advances in Cancer Care Management: Insights from the caBIG® Clinical Information Suite Expert Meeting

The caBIG® Clinical Information Suite Expert Meeting held at the West Michigan Cancer Center on October 27-28, 2010, focused on crucial updates in cancer therapeutics, diagnostics, and chemotherapy management. Key discussions included changes in chemotherapy administration processes, cancer staging methodologies (AJCC 7th Edition), and enhancements in electronic health records for cancer data management. Participants examined intricate details of treatment planning, the importance of accurate staging, and future prospects in cancer care. This meeting set the stage for improved patient outcomes and innovative models in oncology care.

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Advances in Cancer Care Management: Insights from the caBIG® Clinical Information Suite Expert Meeting

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  1. caBIG® Clinical Information SuiteWest Michigan Cancer CenterDomain Expert Meeting Oct 27-28, 2010

  2. Announcements, Introductions, & Updates Wednesday, October 27, 2010 Announcements, Introductions, and Updates

  3. Topic Agenda Wednesday October 27

  4. Topic Agenda Thursday October 28

  5. caBIG Clinical Information Suite – Therapeutics Chemotherapy Management

  6. caBIG Clinical Information Suite Domain Analysis Model

  7. DAM Changes Review • Outcomes Models • Encounter • Changes to Treatment Plan • Concerns • Allergies • Cancer

  8. Outcomes

  9. Encounter

  10. Treatment Plan

  11. Concern (Problem List)

  12. Allergies

  13. Cancer Concerns

  14. Modeling Chemotherapy Activities • There are three activities normally associated with an administration activity: • The Order • The Supply • The actual Administration • “Normal” prescriptions make the order and supply explicit but the administration is implicit and assumed. • We assume because you picked up your Crestor that you are actually taking it as told • Immunizations have an explicit administration with an implicit supply, but not very often an order • We have international use cases for an immunization order • Chemotherapy? • My first guess: an Order and an Administration with an implicit supply

  15. caBIG Clinical Information Suite – Diagnostics Cancer Staging

  16. Cancer Staging Discussion • AJCC 7th Edition 1. ‘Staging Group’ = ‘Anatomic Stage/Prognostic Groups’ • Anatomic Stage (Stage IIIB) • Prognostic Factors (HER2 status . . .) 2. Subtle but important changes on rules! 3. EHR cancer staging vs. Cancer Registry • Summary Staging? 4. Generalization back to Breast Cancer model

  17. AJCC 7th • Some changes in TNM • Changes in terminology (6th Staging Group, in 7th is Anatomic Stage/Prognostic Group)

  18. Breast Cancer Example AJCC 7th Edition

  19. Anything missing? • Method used for staging (clinical vs. pathologic) • Histologic is pathologic, not clinical • Imaging stuff is clinical, not pathologic • Not consistent which has more information • Both will be recorded • Laterality – where would it come from? (ICD-9-CM); quadrant on breast seems to be important for billing, as well as proximity to nipple; does not actually affect actual stage • With neo-adj, may get pathology after chemo • ypT, ypM, ypN

  20. Need a “field” for “Mitotic rate” • Duke (for colorectal)? Don’t support using? • Siewert? Sounds like it is used to figure out which body site to use for AJCC • Need a capability to add new staging systems in the future, but it needs to have controls to prevent tweaking AJCC • How to model current RI to support such future extension?

  21. Disease/Stage Systems that fit the same model

  22. All sarcomas use “grade” in staging • Gyno has FIGO, but it’s been mapped to AJCC • Substaging for various areas, but still AJCC • Gestational trophoblastic tumors are not staged exactly the same way as other areas, as the relay on some clinical lab results; also age, antecedant pregnancy, others • Whitmore-Jewitt is Bladder (very old?); use AJCC • CNS – Glioma has no staging (diffused or focal); some have WHO system (grade 1-4); rely on pathology report, other standard reports • Genetic markers? Not ready to go there • Lymphoma - there are masses that can be measured, as well as liquid; TNM doesn’t work the same (you don’t use it); AJCC has taken over Ann Arbor staging system (A and B) • IPI – Int’l Prognostic Indicator

  23. Leukemia – non-solid (skip)\ • Present DE group don’t practice pediatric oncology • Will look at vetting with larger SEG group • St. Judes may be a good contact

  24. Cancer Staging Discussion • Source report traceability– expand on topic • What would be useful? • As long a particular document or image can be selected to link back to staging data (possibly T,M, or N separately), that would be ideal • Reporting needs • Report to problem list • Auto-populate in notes • Referrals • Scope statement document in progress

  25. Topic: “restaging” • AJCC 7th supports a restaging concept with “r” prefix (cancer returns after disease-free state); will this really be used? Not sounding like it, would be fine with an indicator • Other issue: disease progresses (i.e., spreading to other organs/sites)

  26. caBIG Clinical Information Suite – Therapeutics Chemotherapy Management

  27. Next Steps? • Planning for next steps • Questions? • Big Thank you!

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