Scientists at The Christie NHS Foundation Trust in Manchester together with colleagues from Maastricht University in the Netherlands and other international partners have pioneered a new approach to research using specialist software that could enable doctors to learn from every patient treated.
A recent experiment has shown this can be achieved by rapidly analysing the data of patients treated in different hospitals around the world. Crucially this was done without sharing any patient data between hospitals, placing confidentiality at the centre of the approach, and ensuring that patients’ privacy is protected and strict data protection legislation is complied with.
The research team successfully undertook the first large scale demonstration of new technology which enabled them to learn from the data of more than 20,000 lung cancer patients across eight institutions in five countries in just four months.
Using routine treatment data will complement clinical trials, which are the gold standard of medical evidence. However clinical trials are often conducted on patients whose health and demographics are not representative of the general population, and therefore do not help to decide on the best course of treatment for every individual.
Rather than taking all the data from different hospitals in different countries to one place to allow scientists to work on it - 'taking the data to the learning' - they instead 'take the learning to the data'. Using this new 'distributed learning' approach, no patient data ever leaves a hospital or is even seen by researchers, ensuring patient information remains secure. Instead, the scientists send software that codes the relationships they wish to test to each participating hospital in turn where it learns on the data there before moving to the next site, learning from each in turn.
Clinical scientist at The Christie, Gareth Price said: “This exciting work can make medical research much more inclusive. If doctors are able to look at what happened to all of the patients treated in hospitals they can gain a greater understanding of how different patients respond to different treatments.
“We used lung-cancer patients for this particular experiment but in principle this technique can be used across the whole spectrum of cancer treatment, or indeed any medical condition. The theory is that if our medical evidence is calculated from everyone, then it should apply to everyone. The problem, though, is that unlike clinical trials, the data from routine treatments is not carefully controlled so the best way to guard against the risks of incorrect findings is to cross-check them with information from many hospitals.”
Prof. Corinne Faivre-Finn, clinical oncologist specialising in lung cancer at The Christie added:” One of the aims of modern medicine is to be able to predict which is the right treatment for each individual patient. Traditionally this evidence comes from randomised clinical trials. Our work paves the way for safely and rapidly learning from every patient’s treatment. This means that the evidence we use to help decide which treatments are the best for which individuals includes everyone, not just those selected for clinical trials. Quite rightly we need to protect patients’ privacy but this makes 'learning from every patient' difficult. This marks the first large scale demonstration of the infrastructure we have developed to overcome this barrier which is very exciting.”
This recent work won the Varian award at the largest European radiation oncology conference, ESTRO, which took place in Milan from 27-30 April 2019. The work was funded by Cancer Research UK, The National Institute of Healthcare Research and the Dutch NWO institute.
The Christie NHS Foundation Trust has been ranked ‘Outstanding’ by the health regulator the Care Quality Commission (CQC) which referred to it as ‘exceptional’ and ‘a leader in its field’. It not only commended the Trust for its effectiveness and care, but highlighted its work in shaping the future of cancer care and noted the reach and influence of its clinical research projects. The CQC also rated The Christie the best specialist trust in the country, and one of the top three trusts overall in England.