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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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

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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