Floridas Cancer Burden

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Floridas Cancer Burden

• Latest American Cancer Society statistics predict
  that more than 97,000 people in Florida will be
  diagnosed with cancer and more than 40,000 will
  die.
• Florida ranks 2nd in the US for total cancer
  incidence and mortality.
• Cancer has surpassed heart disease as the top
  killer of Americans under age 85.
• The African-American population bears an
  increased burden of cancer.

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Moffitt History

• The Florida Legislature established the Moffitt
  Cancer Center in 1982, with funding to come from
  the states cigarette tax.
• Moffitt opened on October 26, 1986
• Moffitt has one priority fighting cancer through
  patient care, education and research.
• Moffitt became a NCI designated Comprehensive
  Cancer Center in 2001.

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National Comprehensive Cancer Network
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Legislative Intent
Chapter 90-56, Laws of Florida (SB 1498) stated
that.. it is the intent of the Legislature
that the H. Lee Moffitt Cancer Center and
Research Institutebe organized in such a fashion
that will consolidate and focus cancer-related
research efforts and further, that the center
is to be a statewide research institute. Chapter
93-167, Laws of Florida (SB 1600) stated
that .it is the intent of the Legislature that
the H. Lee Moffitt Cancer Center and Research
Institute.strive to become .a statewide
research institute, a national resource for basic
research and clinical research and further, that
the Institute is performing a statewide function.
Statutory Authority, Chapter 1004.43, Florida
Statutes
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Moffitt Total Cancer Care

• A New Approach to Cancer Care Delivery

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Proposal Moffitt Total Cancer Care

• Goal To develop a platform that supports the
  elimination of death and suffering due to cancer
  in Florida and beyond.
• Approach Create a delivery system that will
  integrate new technologies into the standard of
  care and develop evidence-based guidelines for
  treatment of cancer throughout the state.
• Create an alliance between Moffitt, statewide
  affiliates and patients
• Delivery system integrates technology into the
  community

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Barriers

• Lack of platform/grids for development and
  exchange of information
• Create eco-system for discovery and data
  generation
• Fragmentation of information/ Need Integration of
  datasets
• Need for real-time access of information
• Need for clinical outcomes analysis/affect of
  intervention
• Lack of standards
• Performance of assays
• Databases
• No common lexicon

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Barriers

• Lack of collaboration and inter-disciplinary
  approach
• Create cross-culture environment
• Improve entrepreneurial culture in academia
• Gap between the Ivory Towers and the point of
  impact the community where vast majority of
  patients are treated

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The Future of Medicine

• Where we are today Sequencing of the human
  genome has dramatically improved molecular
  technology and our understanding of disease
• The potential is HUGE! New technology will
  ultimately improve molecular diagnosis, identify
  new targets for therapy, create personalized
  therapies, and identify populations at risk of
  disease, especially cancer.
• The Challenge How do we translate new molecular
  technologies into clinical benefits for our
  patients?

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Total Cancer Care ApproachIntegration of
Technology
Risk Factors Genetics Screening Prevention Nutriti
on Life Style
Functional Genomics Imaging Modalities Nanotechn
ology
Populations at Risk
Diagnosis
Health Outcomes
Prognosis
Cancer Patient
Molecular Oncology Functional Genomics
Cancer Control Prevention Outreach to
the Community
Behavioral Oncology
Treatment
Relapsed Disease
Primary Therapy -Multimodality
Post Therapy -Surveillance -Consolidation
Salvage Therapy -Phase I program -Drug Discovery
Behavioral Research Palliative Care
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How Total Cancer Care Can Help Closing the Gap
Between Innovation and Care

• In partnership with the community we will
• Integrate new technologies into standard cancer
  care
• Measure health outcomes patient survival and
  quality of life measurements
• Increase access to Moffitts expertise and
  technology
• Analyze cost savings
• Develop evidence based guidelines for cancer care
• Develop network information systems for real-time
  access to guidelines and recommendations

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Moffitt Affiliation ProgramBasic Concepts

• Our 14 affiliated sites impact over 20 of the
  Florida cancer cases
• Targeted affiliations will get to about 3540 of
  cancer cases in Florida
• Philosophy is based on the Right Care in the
  Right Place at the Right Time
• In partnership, we work to improve cancer care
• Each affiliation agreement includes
  collaborations in
• Clinical
• Research
• Education
• Prevention Screening
• Outreach

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Moffitt Affiliates
(Savannah, GA)
14 affiliates in Florida
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Example of a Patient in MTCC

• Newly diagnosed breast cancer patient from
  Altamonte Springs, FL

• Patient offered enrollment in TCC Protocol
• Patient has surgery in her community, and tumor
  sent to Moffitt for molecular profiling.
• Molecular profile data deposited in a single
  database repository
• Clinical information placed in an internet-linked
  database by community affiliate physician.
• Patient enrollment in TCC allows tracking of
  patients throughout life and will determine the
  value of intervention and new technology
• Single database repository allows queries to
  correlate molecular profile data, imaging, and
  clinical interventions with clinical outcome.
• Creation of evidence-based guidelines to improve
• overall cancer care.

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Two Translational Roadblocks on the Way Toward
Improved Public Health
whereas the National Institutes of Health has
been consistently targeting the bench-to-bedside
block, no one is taking responsibility for the
second, which is integrally tied with the funding
of the health care delivery system
JAMA. 20042911120-1126
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The Approach

• Data?Information?Knowledge?Wisdom?
• Improved medical practice
• Demonstration projects will focus on early
  diagnosis and prognosis of specific cancers using
  molecular diagnostic techniques.

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The Total Cancer CareConsent Form

• Enroll new patients Front Door Policy
• Seeking permission to
• Collect tissue (Tissue Consent Process)
• Perform molecular profiling on patient specimens
• Follow patients longitudinally regarding
  diagnosis, long-term follow-up, and satisfaction
• Network Affiliates will enroll new patients
  involved in the Demonstration Projects.

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Demonstration Projects

• Focus Lung Cancer
• Increase access to molecular analysis technology
  for select community partners (2-3 of current
  13).
• Utilize Internet and Telemedicine technology to
  create network information systems
• Determine impact of molecular analysis on
  diagnosis, prognosis and potential treatment
  strategies
• Take advantage of scale for analysis of outcomes
  on standard of care in community
• Increase number of affiliates involved over time
• Develop treatment guidelines based on evidence

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Solution Design (Phase 1 and beyond)
Phase 1 Foundation
Analytical View
The proposed solution design will be iterative
by building on an initial BI foundation that will
span to integrate clinical/genomic/image
information in a multi-dimensional environment.
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Future Demonstration Projects

• Emphasis on Quality Improvement and Patient
  Satisfaction
• Two Projects Colon Cancer and Myeloma
• Collaboration with Network Partner
• Morton Plant in Clearwater
• Develop system for sharing health information
  relevant to patients enrolled in demonstration
  projects.

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Critical Success Factors for Moffitt Total Cancer
Care

• Scientific Research applying cutting-edge
  molecular technology to specific cancers to
  improve prevention, diagnosis and treatment
• Affiliate Network critical to closing the gap
  between innovation and care
• Information systems developing an integrated
  data management platform

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Future Outcomes of this Initiative

• Physicians will have real time access to patient
  information
• Development of Diagnostic/Therapeutic Bundles
• Personalized treatments based on molecular
  diagnostic profiling
• Reduce medical errors
• Community is involved earlier in this
  revolutionary approach to medical care critical
  for optimal development
• Outreach to community to reach underserved
  populations
• Emphasis on health outcomes analysis will result
  in more cost efficient health care
• Starting with cancer will provide a model system
  for all health care needs
• Real-time health information available in case of
  disaster
• Contribute to knowledge based economy by creating
  and attracting companies

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Summary - Major Costs
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• Thank You For Coming!

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Example of Moffitt Total Cancer Care in Action
Newly Diagnosed Breast Cancer Patient from
Lakeland

• Patient offered enrollment in MTCC Protocol
• Patient has surgery in her community, and tumor
  is sent to Moffitt for molecular tests
• Results of molecular testing are deposited in a
  database
• Community affiliate physician places clinical
  information in an Internet-linked database
• Enrollment in MTCC allows patient to be tracked
  over time so that new discoveries can be offered
  to the patient sooner and not when it is too late
• Creation of this information system allows
  physicians, scientists, and even patients to
  query the database and gain information to
  improve outcomes
• Creation of evidence-based guidelines to improve
  overall medical care

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Quote from the Council of Scientific Advisors,
2003

• This extraordinary initiative serves dual
  purposes utilizing clinical expertise of the
  Moffitt Cancer Center for the good of cancer
  patients throughout Florida and creating a
  network that, if properly utilized, could improve
  the quality of care and provide enormous
  opportunities for health outcomes research
  including research in quality of care and
  cost-effectiveness.

Quote from David Brailer MD, Presidents
Consultant on Health Information Systems, 2004
this needs to happen, and it needs to happen in
Florida
Quote from Anne Barker MD, Deputy Director of
NCI, 2005
you have just seen a glimpse into the future of
medicine, and the way it needs to be