Abstract
Background:
All UK cancer patients undergo required assessments by a full Multidisciplinary Tumor Board (fMTB) at key treatment decision points, placing a resource burden on the healthcare system. Watson for Oncology (WfO) is a decision-support system that presents therapeutic options to cancer-treating clinicians. This study is an initial phase of an evaluation at Guys and St. Thomas’ NHS Hospital (GSTT), designed to explore the extent to which WfO can be used by the fMTB to triage less complex patient cases and ultimately reduce workload and time pressures currently experienced by fMTBs. We conducted a concordance study with two minimal MTB teams (mMTB) for Stage I-III breast cancer patients.
Methods:
Breast cancer cases (N=63) treated from 2017-2018 at GSTT were evaluated by 2 independent mMTBs, blinded to each other and previous fMTB decisions rendered prior to this study. Each mMTB consisted of a senior medical oncologist and surgeon; GSTT’s 12+ member fMTB is comprised of oncologists, surgeons, radiologists, pathologists and others. mMTBs were shown options that were either listed as ‘recommended’ or ‘for consideration’ by WfO and given the opportunity to revise prior decisions. The combined 4-person minimal MTB (cmMTB) consisting of both 2-person mMTBs provided a current consensus best-practice plan and systemic therapy recommendations for discordant cases. We evaluated the concordance of WfO’s systemic therapeutic recommendations and mMTBs, as well as concordance with the cmMTB. Previous decisions by the fMDTB were also compared to decisions by the cmMTB. Univariate logistic regression explored characteristics predictive of concordance with the cmMTB.
Results:
For treatment plans, WFO’s therapeutic options had higher concordance with cmMTB decisions than either mMTB alone (concordance 93.7% vs. 92.1%) or the previous decisions by the fMTB (87.3). For systemic therapy decisions, the WfO-cmMDTB concordance was 70.2%; however, adjusting for non-NICE approved drugs and the common practice of Carboplatin use in the UK, concordance increased to 91.5%. Previous decisions by the fMTB had the lowest concordance with the cmMTB (87.3%). Adjusting for the UK-practice related use of Carboplatin, WfO had slightly higher concordance with cmMTB systemic therapy decisions than either mMTB alone (89.4% and 87.2%). Univariate analysis with this limited sample revealed non-significant trends in association between mMTB’s concordance with WfO and stage of cN at diagnosis, HER2 status, tumor location and grade. For example, mMTBs concordance with WfO tended to improve when tumor grade was high. Non-significant trends were also identified in the association between WfO-treatment concordance and tumor location, where treatment concordance increased with medial tumor location.
ConclusionIn:
this small cohort study, a clinical decision-support tool demonstrated better agreement with UK best practice treatment than a 2-person mMTB and may have a role in triaging breast cancer cases in the UK.
All UK cancer patients undergo required assessments by a full Multidisciplinary Tumor Board (fMTB) at key treatment decision points, placing a resource burden on the healthcare system. Watson for Oncology (WfO) is a decision-support system that presents therapeutic options to cancer-treating clinicians. This study is an initial phase of an evaluation at Guys and St. Thomas’ NHS Hospital (GSTT), designed to explore the extent to which WfO can be used by the fMTB to triage less complex patient cases and ultimately reduce workload and time pressures currently experienced by fMTBs. We conducted a concordance study with two minimal MTB teams (mMTB) for Stage I-III breast cancer patients.
Methods:
Breast cancer cases (N=63) treated from 2017-2018 at GSTT were evaluated by 2 independent mMTBs, blinded to each other and previous fMTB decisions rendered prior to this study. Each mMTB consisted of a senior medical oncologist and surgeon; GSTT’s 12+ member fMTB is comprised of oncologists, surgeons, radiologists, pathologists and others. mMTBs were shown options that were either listed as ‘recommended’ or ‘for consideration’ by WfO and given the opportunity to revise prior decisions. The combined 4-person minimal MTB (cmMTB) consisting of both 2-person mMTBs provided a current consensus best-practice plan and systemic therapy recommendations for discordant cases. We evaluated the concordance of WfO’s systemic therapeutic recommendations and mMTBs, as well as concordance with the cmMTB. Previous decisions by the fMDTB were also compared to decisions by the cmMTB. Univariate logistic regression explored characteristics predictive of concordance with the cmMTB.
Results:
For treatment plans, WFO’s therapeutic options had higher concordance with cmMTB decisions than either mMTB alone (concordance 93.7% vs. 92.1%) or the previous decisions by the fMTB (87.3). For systemic therapy decisions, the WfO-cmMDTB concordance was 70.2%; however, adjusting for non-NICE approved drugs and the common practice of Carboplatin use in the UK, concordance increased to 91.5%. Previous decisions by the fMTB had the lowest concordance with the cmMTB (87.3%). Adjusting for the UK-practice related use of Carboplatin, WfO had slightly higher concordance with cmMTB systemic therapy decisions than either mMTB alone (89.4% and 87.2%). Univariate analysis with this limited sample revealed non-significant trends in association between mMTB’s concordance with WfO and stage of cN at diagnosis, HER2 status, tumor location and grade. For example, mMTBs concordance with WfO tended to improve when tumor grade was high. Non-significant trends were also identified in the association between WfO-treatment concordance and tumor location, where treatment concordance increased with medial tumor location.
ConclusionIn:
this small cohort study, a clinical decision-support tool demonstrated better agreement with UK best practice treatment than a 2-person mMTB and may have a role in triaging breast cancer cases in the UK.
| Original language | English |
|---|---|
| Pages (from-to) | PS8-22 |
| Journal | Cancer Research |
| Volume | 81 |
| Issue number | 4 Supplement |
| DOIs | |
| Publication status | Published - 1 Feb 2021 |
