The U.S. spends 86 percent of its healthcare dollars on chronic disease. Health IT is just beginning to loosen the tight hold these conditions have on the healthcare system. We take a closer look at the effect technology is having on the top three: heart disease, cancer and diabetes. In Part I of a three-part cover story series from our February 2015 issue, we highlight heart disease. Part 2, here, focuses on cancer. Part 3 on diabetes will run on Thursday.

Over the past 10 years or more, information technology has markedly changed treatment and care cancer patients receive today. While a cure for cancer remains elusive, patients are living longer, going into remission more often and, in treatment, they are becoming partners with their physicians, making informed decisions about the course of care.

IT permeates most aspects of cancer care today. Research increasingly offers the promise of personalized medicine.

Doctors at Levine Cancer Institute in Charlotte, N.C., recently employed IT to establish their own clinical pathways that ensure clinical teams at disparate offices will provide consistent treatment and care, regardless of the location.

Technology has been an essential piece of the national pilot MyJourneyCompass, run by Georgia Tech and funded by the Office of the National Coordinator for Health Information Technology.

At Moffitt Cancer Center in Tampa, Fla., researchers are working with Oracle on an informatics platform that will help make cancer care more targeted, more personal.

As Mark Hulse, RN, senior vice president and CIO at Moffitt, put it back in 2011 as the platform was being rolled out, it will "enable us to surmount two fundamental health science informatics challenges – data integration and analysis – to identify predictive biomarkers that will lead to more personalized treatments for our patients."

There are thousands of examples of similar initiatives taking place across the country on the cancer front.

Cancer by the numbers

While unprecedented work is occurring in cancer research, data analytics, treatment and care, the cancer numbers would take anyone aback.

The Centers for Disease Control and Prevention place cancer as the second leading cause of death in the U.S. Heart disease is the first.

Critical work in progress

"Healthcare delivery has barely begun to apply communications technology – but the time is now and the means are at hand," Richard Antonelli, MD, medical director of integrated care at Boston Children's Hospital and assistant professor of pediatrics at Harvard Medical School, urged in a white paper published in June 2013. "The beneficiaries of this innovative work will be children and adolescents with chronic conditions, as well as their families and caregivers."

Antonelli champions better care coordination. "In my care coordination work," he says, "I'm trying to find ways of how information gets tracked from the patient to the primary care provider, getting the right information to that specialist in the community or an academic center. So when the family goes from point to point they know that the information they have sanctioned to be able to share is following them across the care continuum. That is the ideal outcome for coordination of care."

Edward S. Kim, MD, chairs the Department of Solid Tumor Oncology and Investigational Therapeutics at Levine Cancer Institute. He is known as a top lung cancer doctor. He specializes in thoracic oncology and head and neck cancers.

"I do believe that our goal is to convert cancer so, No. 1, we cure it or convert it to a chronic disease, so that people can maintain on treatment and also live a meaningful life on a day-to-day basis."
                                                                                                                                                                                           Edward Kim, MD

"Information technology crosses many boundaries in medicine and in our daily life," Kim told Healthcare IT News.

As Kim sees it, the way IT plays out in cancer treatment is a microcosm of how technology has changed everything in all the other sectors of the economy and in day-to-day life.

"It's great that patients, their family members or just interested parties can have access to information that exists. I think it keeps everyone's guard up a little better as far as recommendations and thoroughness."

In the world of medicine, Kim has "straddled both sides of the fence," as he put it. Before joining Levine, he was at MD Anderson Cancer Center in Texas for 12 years. There he spent about 40 percent of his time seeing patients and 60 percent of his time on research, both clinical and translational research.

Levine Cancer Institute is part of the Carolinas HealthCare System a not-for-profit system with 41 hospitals, serving communities in North and South Carolina. There, Kim is helping build the fledgling cancer institute.

"I do believe that our goal is to convert cancer so, No. 1, we cure it or convert it to a chronic disease so that people can maintain on treatment and also live a meaningful life on a day-to-day basis," Kim said.

Phil Lamson, a Georgia Tech healthcare consultant on the national pilot MyJourney Compass, an initiative that supplied women in Rome, Ga., who had been diagnosed with breast cancer, a tablet they could use to manage their disease.

A symptom tracker application developed at Georgia Tech and loaded on each tablet allowed patients to provide frequent feedback to healthcare providers when necessary. For a patient prescribed a new pain medication, for example, the app may ask for updates several times a day to help the doctor judge whether the drug is doing what’s needed.

The pilot is over, and Lamson has pronounced it successful.

"There were some specific goals that we were testing and one of them was using a transfer protocol called Direct, which was getting the patient's medical record from the doctor to the patient for inclusion in a personal health record," Lamson explained. "We were able to do that."

The pilot was also charged with providing a method by which the participants could also send information – back to their providers. Also completed, Lamson said.

Small steps and big steps have been taken to improve cancer treatment and care, and many of those steps have helped move cancer from death sentence to closer to chronic disease.

Over the past 10-20 years, Lamson has observed a change in focus from curing cancer to managing it as a chronic disease.

That change in focus makes perfect sense, Lamson said. "That's my lay opinion because I'm not a physician, but I've been around cancer – oncology – for a while as a demonstrator and program manager. You see patients living longer and longer even when diagnosed with grim prognosis," he said.

It makes sense to Kim, too. But, in cancer care, he's observed a tendency to give up too easily.

"From a healthcare provider perspective – we suffer quite a bit of this in cancer – is that stigmata that 'oh, once you have cancer, and it's Stage 4, we should just give up,'" Kim said. "That's not the case. We as a caretaker, being physicians, need to be very positive in how we try to help folks. We don't want to indiscriminately give them therapy, but we want to balance that with appropriate, quality advice."

With Stage 4 cancer, he's noticed a tendency for some providers to give up too easily, to go light on treatment.

"I don't believe that. I think that's really up to the patient and the caretaker – that physician. I've had patients that are treated for Stage 4 lung cancer that have lived five, seven, 10 years when people would say their one-year survival is 50 percent."