Disruptive technologies making cancer care more patient centred

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Neil Bacon, chief executive and founder of iWantGreatCare, a cloud based technology platform that allows patients to review doctors, hospitals, and medicines, told the conference: “Patients are used to going online to find information about restaurants and hotels, but try looking up information about a neurosurgeon who is going to operate on your child. It is very difficult. Our children will look at us and laugh that healthcare has taken so long to catch up. It is happening, but not fast enough.”

He added: “There is a shift of power towards patients. There is always resistance to change, but the walls will tumble. Citizens won’t accept a lack of transparency anymore.”

The NHS Cancer Vanguard programme, which was established in 2015 to test new models of cancer care, has now partnered with iWantGreat Care. The system is being used by 45 NHS organisations in London and Manchester to collect real time patient feedback at key points in the cancer care pathway. The aim is to use this feedback when redesigning services, putting patient experience at the heart of service improvement. “If we do not listen continuously to patients and their caregivers, we will never learn and improve the standards of cancer care,” says Bacon.

Bacon says patients trust the views and opinions of other patients. He dismisses those who worry about negative reviews, saying that most reviews are positive and that his organisation uses technology to stop fraudulent reviews. He says there should be more pressure on doctors to be patient centric. “When doctors are rated their morale goes up,” he adds.

England’s national cancer strategy, Achieving World Class Outcomes, published in 2015, said that patient experience should have the same importance as clinical effectiveness and safety.2 It called for patients to be properly informed and empowered to be equal partners in their care. “We have the opportunity to revolutionise the way we communicate with and the information we provide to cancer patients, using digital technologies,” it said, pointing out that more than two thirds of adults own a smartphone and that patients could benefit if all information shared with them during consultations was made available to them electronically.

In its implementation plan published in 2016, NHS England pledged to put patient experience on a par with other patient outcomes.3 There has been some progress on this with the Cancer Patient Experience Survey and the Cancer Dashboard, an online resource to help identify priorities for improvement. NHS England says it is also working on its wider digital revolution programme to ensure that all patients have online access to all test results and other communications with secondary and tertiary care providers by 2020.

Apps in the NHS

Recent years have seen a sharp rise in the number of health apps available for smartphones, several of which are being tested in the NHS. Trials of apps such as myCOPD, for example, have shown that they can help patients manage their conditions with less reliance on general practice and hospital appointments. The conference heard about another app, Andaman7, which allows users securely to store their health records and share them with family members and doctors. Vincent Keunen created the app after he developed leukaemia and his son had bone cancer. It is being tested at CHU-Liège, a university hospital in Liège, Belgium, where any patient can receive documents from the hospital to their smartphone. He told the conference that being able to share his medical data with his doctor improved communication and speeded up diagnosis.

In September the health secretary, Jeremy Hunt, said that every patient in England should be able to access their medical records, book an appointment with a GP, and order repeat prescriptions through an app by the end of 2018. The scheme is being piloted in several practices countrywide.4

Advances in informatics can help to improve communication between various departments on the cancer pathway. Varian Medical Systems manufactures medical devices, including for proton beam therapy, but it has also developed tools that connect hospital or clinic data, records, and patient information through a single platform. Sukhveer Singh, vice president of oncology continuum solutions at Varian, said that this has many advantages. “We treat patients as users of our platform alongside doctors and nurses, allowing real time communication. Lots of patients want to be able to keep an electronic diary and be able to share it with doctors, so how a patient is feeling can be looked at alongside the numbers.”

Technology proponents see a healthy future for the use of artificial intelligence (AI) in healthcare. For example, IBM Watson Health is using a supercomputer with artificial intelligence to digest massive amounts of data from doctors’ notes, research studies, and clinical guidelines and claims it can identify cancer treatments personalised to each unique patient. Dusty Majumdar, vice president of the company, said it was a myth that such technologies will replace doctors but said it can help tackle the huge variability in cancer care. “There is a buzz out there that AI will replace doctors, but that’s not our belief. We will instead offer radiologists the chance to put joy back into their jobs. And to get better outcomes. AI won’t replace radiologists, but radiologists who use AI will replace radiologists who don’t use AI,” he told the conference.

Advances in screening

To improve early diagnosis the NHS is moving more cancer screening out of the doctor’s surgery and into the community. A pilot scheme that offers smokers and former smokers computed tomography scans in supermarket car parks quadrupled the early diagnosis rates for lung cancer in Manchester.1 The scheme is being rolled out throughout north Manchester, and some other cancer alliances, charged with local implementation of strategy, are following suit.

The NHS is also planning to introduce faecal immunochemical testing (FIT) into the bowel screening programme next year.5 The home testing kit will be sent to everyone aged 60 to 74 years every two years. The FIT test is easier for people to carry out at home because it requires only one faecal sample rather than the six needed for faecal blood testing. It remains to be seen how acceptable the public finds the test, but NHS England expects it to increase the take up of bowel screening by about 7%.

However, Corrie Drum, policy adviser for Cancer Research UK, argues that expansion of screening programmes must be matched by a commitment to increase the diagnostic workforce. “It’s vital that there are enough staff in the NHS to carry out and interpret tests for cancer, including more staff who do colonoscopies, if we’re to make FIT even better in the future.”

In the future non-invasive, more user friendly tests may have an even greater role. Owlstone Medical has developed a breath test to measure volatile organic compounds that are biomarkers for cancers. The NHS is funding the LuCID clinical trial with 4000 patients at 26 sites to evaluate the diagnostic accuracy of the test for lung cancer. Billy Boyle, cofounder of the company, told the conference, “The nature of the test matters. For example, patients don’t like colorectal screening. A big advantage of a breath test is its patient acceptability.”

Sometimes new technology adds to a GP’s workload but produces only limited benefits. A recent pilot study into one form of electronic consultation, eConsult, found that most patients still wanted to see their GP in person after an online consultation.6 Helen Stokes-Lampard, chair of the Royal College of GPs, said, “Innovations must be implemented in the best interests of patients as a whole—and in ways that alleviate pressures across the NHS, not potentially add to them. It's a myth to say that because we are making greater use of technology that we must be saving resources.”

Some commentators argue that the NHS hasn’t yet mastered even basic technological advances. Ali Stunt, chief executive of the charity Pancreatic Cancer Action, said communication between doctors and patients and between different parts of the cancer care system was a major problem. “Why in 2017 are doctors still having to write to each other? Why not email? Technology has moved on.”