Utilizing Big Data to Understand Disparities in Cancer Care Across South Florida

Leonard Kalman, MD

Disparities are one of the most pervasive issues in modern healthcare, according to COTA, Inc. For oncologists, there is a need to improve their understanding of demographics among patients with cancer, and the disparities they might face. Miami Cancer Institute (MCI) and COTA aim to enhance their understanding through a partnership.¹

MCI will utilize COTA’s real-word data system, which includes de-identified electronic health records (EMRs) and claims data, to uncover the breadth of cancer disparities impacting patients who are treated at MCI and how these disparities may impact patient outcomes.

“What makes it unique is that they can extract information from the EMR, and cohort patients, and that's very important. Then you can ask a panoply of questions about how they're being treated, explained Leonard Kalman, MD, in an interview with Targeted Oncology™.

Another important aspect of cancer care is cost-effectiveness. COTA’s real-world data system allows financial and clinical information to be linked to provide the best insights.

“We can cohort any group of patients you want to talk about. We can identify the patients with a code of real-world analytics [RWA] and what we're doing is trying to take our financial system and wed it with the RWA’s clinical information, so we can understand better the charges, the reimbursement, and the cost of those patients because we are concerned about being cost-effective, said Kalman, the executive deputy direction and chief medical officer at MCI.

During the interview, Kalman, continued to discuss how real-world data will improve the understanding of patients with cancer at MCI and the information about how the business runs overall.

TARGETED ONCOLOGY: How do you think lack of diversity impacts clinical trials?

Kalman: There is a great disparity in clinical trial enrollment, and certain many underserved populations do not have any exposure to clinical trials at all. Also, very often, clinical trials are the best option for a patient. So, there's a great deal of work to be done to identify those populations, get in, educate them, screen them, and also make treatment options available even in the underserved area itself. By using navigators that are from the underserved area, so the patient is comfortable. And of course, involving a lot of community organizers and local people is important, so that the community that's underserved, feels that the institute that offers clinical trials is coming to them, and working with them in their neighborhood and not always pulling them out to our institution. When a patient enrolls in the trial, they will have to see a physician or institution, but physicians have to embed themselves in the underserved are, to prove their credibility and ultimately. And obviously, the more patients you see, there are more options for clinical trial enrollment.

Considering some of the limitations of clinical trial enrollment, how do you think real-world research can narrow the gap when we talk about diversity in clinical trials?

Miami Cancer Institute has partnered with COTA because they are what I call a patient cohorting company at its core. They basically remove information from the EMR, and they have some proprietary intellectual property that allows them to cohort like-minded patients. So, I turned to COTA and their RWA database, which is another part of their intellectual property, and aske the question, tell me about all of the locally advanced breast cancer patients that we have seen an MCI in the last 2 years or 3 years, then what we can do is de-identified all to protect patient privacy. Then, we can then start to match those local events often indicate that the patient has ignored their symptoms, or perhaps didn't have access to care. And we can cross-reference that with other demographic data that we have and start to see for instance, whether certain geographic areas have upstaging. That means a certain patient in a particular geographic area that we're concerned about being underserved, indeed does have breast cancer patients who present are in a higher stage rather than a lower stage.

What else makes this real-world data tool unique?

What makes it unique is that they can extract information from the EMR, and cohort like patients, that's very important, then you can ask a panoply of questions about how they're being treated like is the treatment consistent? We hope to use it on all of our patients who are going to be treated with systemic therapy or evidence-based regimens. We assume that we have a system in place where the patients within a certain cohort are getting a certain treatment. Well, when you query the RWA and ask the question whether that cohort was treated that way, no surprise, you find out that certain patients weren't treated exactly the way you hoped they would be.

Now, there are many reasons for differences in treatment. Occasionally, the physician does not necessarily make the choice that we had agreed upon ahead of time. So, it's very useful in that circumstance. Again, to have the consistency of treatment to make sure people are being treated the way you say you're treating them is very important for quality.

Are there any other real-world analyses planned that you're using this RWA platform for?

We have 2 projects that come to mind right away. We have a proton, we're the first center in South Florida to have proton therapy. Protons are a very special form of radiation. There are very precise. It supposedly limits the damage to normal tissue more than conventional photon radiation. And we had promised, we had decided to price protons at the same price as sophisticated photon therapy. And we want to see whether we were doing that. So, we took a certain type of patients with left-sided breast cancer who are eligible for proton therapy, but we wanted to see whether we truly can we identify with the left side of breast cancer patients who got protons who got photons? And then say, do we truly charge the same? So, we were able to prove that?

Another thing I’ll mention is that the question remains whether risk payment, which Medicare is very interested in, is going to be adopted by the commercial carriers. So, I think it's very important both for the Medicare population and commercial populations to really understand your charges, what you're paid, and what your expenses are in any given situation. We can cohort any group of patients you want to talk about. We can identify the patients with a code of RWA and what we're doing is trying to take our financial system and wed it with the RWA’s clinical information, so we can understand better the charges, the reimbursement, and the cost of those patients because we are concerned about being cost-effective.

We need to stay in business even though we're not for profit. But we are very concerned about keeping costs controlled, and that wedding of financial and clinical information will be very useful?

_REFERENCE:

_{Miami Cancer Institute takes action to address inequities in cancer care with expanded COTA, Inc. collaboration. New release. COTA, Inc. May 18, 2022. Accessed June 23, 2022. https://bit.ly/3A7E4LU}