May 2013, Vol 2, No 3
The MHealth Factor: A Bioinformatics Platform for Arming the Oncology Personalized Medicine RevolutionThe Last Word
Personalized medicine (PM) applied to cancer diagnosis and treatment is really all about information: discovering it, synthesizing it, analyzing it, translating it to cancer pathophysiology, and finally sharing it with those who need to know what is going on inside the tumors. The rise of PM skill sets, as I remarked in one of my first articles for Personalized Medicine in Oncology, relates to this matter of information – which forms the subject at hand in this piece. I therefore quote a paragraph from that article, “Cancer Care Personalized Medicine and Value:
The Strength of Science Fulfilling Innovation,” as a starting point for this column on mobile health technology:
A core focus of this research, and a source of the plethora of information involved in the PM process, is the ongoing “…marked rewiring of the signaling networks that determine the behavior of the cancer cell and patient outcomes. High throughput technologies generate incredible masses of data showing many potential aberrations and connections and allowing visualization and integration of the data into testable hypotheses.” This has led to the several “omics” technologies – genomics, proteomics, and metabolomics – “…that interrogate tumors at the DNA, RNA, protein, and metabolomics level…[but which] has not been paralleled by improvement in cell biology approaches to understand the consequences of these changes on cellular, organ, and organismal outputs.”
The question at hand now is the most translational utilization imaginable concerning the sharing of cancer disease state information: mobile health, or MHealth. What do Dick Tracy’s telephonic wrist watch and the telephonic sharing of various disease states information in third world countries have in common with the application of MHealth in PM? At the 10th Annual World Health Care Congress, there was no direct answer to this burning question (of course, America is no longer perched on the edge of its seat wondering when Dick Tracy’s futuristic wrist watch phone will become a reality). But there was a clue. For MHealth was discussed as a real-world technology uniting physicians with patients in remote third world areas, and the implications for oncology PM are profound.
What is becoming evident in examining the use of MHealth to transmit patient health photos, lab results, and other diagnostically relevant information from patient location to physician location is the potential to transform smartphones into personalized medicine portals with nearly limitless applications for remarkable information technology apps that guide patients through their treatment pathway in cancer PM. The development of the software now in place suggests amazing possibilities for helping oncology PM information needs via a bioinformatics tool with the compactness and immediacy of a smartphone – and a very smart phone it will be when it is developed to full potential. Its value rests in its ability to provide a platform for linking cancer patients with their providers who can monitor and transfer data seamlessly. This would give PM a much needed technological boost to achieve the 3 points of value: cost, quality, and access.
This MHealth technology is already fully operational in many countries and is now making its appearance more prevalent in the United States in 2013. It offers the advantages of telemedicine while overcoming the limitations imposed by ponderous, high-maintenance operating systems. Its methodology would use smartphones to deliver information while educating a new workforce, thus supplementing a shrinking oncologist workforce. Already used in cardiology and several other disease states, MHealth has reduced congestive heart failure hospital emergency department admissions by about two-thirds through point-of-care assessment that facilitates diagnosis and treatment by enabling remote physicians to advise on-site nurses, health workers, or caregivers. By sharing information on a patient’s status immediately, the software allows physicians to prioritize care, preventing deterioration of a patient’s condition and so head off disease progression.
This track record suggests a myriad of possibilities that aggressive software development in this bioinformatics platform holds for PM in cancer, which is so dependent on informatics and personal counseling to achieve its treatment goals. Consider as a case in point 2 articles on prostate cancer risk factors that happened to appear in the same May 2013 issue of Cancer Epidemiology, Biomarkers & Prevention: “Sleep Disruption Among Older Men and Risk of Prostate Cancer” and “Obesity and Future Prostate Cancer Risk Among Men After an Initial Benign Biopsy of the Prostate.” The advantages of monitoring patients for exacerbation of either risk factor for prostate cancer speak volumes to the potential of MHealth to oncology PM. It also speaks to the issue staring oncology square in the face: finding the economies needed for the advance of PM informational sharing – whose complexity is suggested with all the subtlety of a sledgehammer in that first paragraph quoted at the beginning of this article. The cancer tumor/disease progression information updates that the oncologist, nurse, or pharmacist needs to receive is well suited to the MHealth bioinformatics platform. With apps developed relevant to the informational needs of practicing oncologists, MHealth can deliver on the promise of PM, which relies on an enriched patient population. The problem facing PM is trying to write this new chapter in the conquest of cancer using informational technology on the order of a clay tablet and stylus. It is time oncologists had technological weaponry equal to the complexity of the information they depend on in the PM arena.
The breadth of functions that MHealth innovation can provide underscores the long list of tasks that oncology PM must satisfy. This bioinformatics platform can be outfitted with patient-oncologist contact and access capabilities appropriate to changes in a patient’s condition and signal oncologists, nurse navigators, pharmacists, hospitals, or any appropriate member of the treatment team/system to respond in a timely fashion. Alternately, an app could monitor adherence to treatment regimens or other ongoing trends affecting a patient’s condition. The patient in turn could reach out to the treatment team with questions or concerns. Either way, the flow of information is the essential PM linchpin for timing appropriate interventions – and this is the key to avoiding waste and achieving the pinpoint precision that PM requires.
The benefits of MHealth to PM’s uptake are legion: timely responses, avoiding needless hospitalizations or ensuring quick hospitalization when needed, and the simple sharing of queries between patients and their providers to assuage fears and help keep patients and physicians clear on the goals of treatment. In short, a telemedicine platform has emerged with the potential to help PM deliver premier quality care while avoiding waste in resource allocation like never before.
It is curious that information mobility could play so significant a part in bringing this about – but there it is: MHealth is a tactical element essential to bringing cost, quality, and access under control, and the data already exist, albeit in other disease states, to support this claim. A smartphone app that puts patient needs into clear and immediate focus, regardless of whether the patient or provider is at work or at the opera…now that’s a game changer. Dick Tracy, eat your heart out.
The cancer apps for this tool appear certain to be written, and quickly. It will be interesting to see their order of progression. This will be an MHealth marvel worth watching. It appears we are ready to write that new chapter in the history of PM in cancer…with materials considerably more current than a clay tablet and stylus.
Robert E. Henry
Dr Stintzing is currently a postdoctoral fellow of the German Cancer Aid at the University of Southern California/Norris Comprehensive Cancer Center. Dr Stintzing’s research focus is on predictive and prognostic factors in the treatment of metastatic colorectal cancer. Dr Lenz is the Associate Director for Clinical Research and Co-Leader of [ Read More ]
The American Association for Cancer Research (AACR) 2013 Annual Meeting was held in Washington, DC, April 6-10, 2013. Following are selected highlights of early studies presented at the meeting. The hope is that these encouraging preliminary findings will be confirmed by larger studies and lead to advances in cancer care. [ Read More ]