Breast cancer patients and clinicians benefit from technological developments

The Cognitive Science and Systems Group (COSSAC), comprising a team from the Department of Engineering Science at the University of Oxford and London’s Royal Free Hospital, has developed a number of software technologies to help clinicians decide how to treat their breast cancer patients based on techniques from mathematical logic. One of these has reached the point at which applications are being made available within the NHS, and in the not too distant future, individual patients will also be able to access the software to get personalised healthcare advice.

Tallis, an application platform developed with funding from Cancer Research UK, ‘applies medical reasoning to assess patients’ circumstances and recommends appropriate care. Clinicians add data to a patient profile, from test results to images and current treatment regimes.  The software then analyses the current situation against clinical guidelines to suggest the most suitable course of action’.

Web version of CREDO MDM
The CREDO clinical decision support system. This picture shows the Web version of the CREDO-MDM software. Its purpose is to support evidence-based and transparent decision making in breast cancer management. CREDO-MDM is being installed for use by the Breast Cancer team at the new Cancer Centre in Oxford, and a number of other applications are now in development with clinical collaborators at the Centre.

The team’s flagship clinical research programme started in 2006 and is called the CREDO project. It aims to show that advanced informatics can make a substantial contribution to the quality and safety of clinical decisions ‘throughout the cancer journey’ (including risk assessment, detection, diagnosis, treatment and other decisions), while also being welcomed by clinicians. CREDO draws on techniques from computer science and Artificial Intelligence.

Professor John Fox, who heads the Oxford Group, said: “It was Sir Muir Gray, Chief Knowledge Officer to the NHS, who in 2008 said, ‘knowledge is the enemy of disease; the application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade’. My team’s research has shown that clinical decision support technology can make a major contribution to making sure knowledge is properly applied: reducing medical errors, avoiding over-use and under-use of specialist tests and investigations, and making better use of resources”.

A major trial of the CREDO technology started at the Royal Free Hospital in 2009 and routinely supports its breast cancer team, led by Mr Vivek Patkar, Surgeon and Clinical Research Fellow in Professor Fox’s Group and Mr Mohammed Keshtgar, who heads up the breast cancer team at the Royal Free Hospital. The system has so far been evaluated with 2,000 breast cancer patients and demonstrated a number of benefits.  The first phase of an Oxford trial at the John Radcliffe Hospital has now started.  The COSSAC group is also working on applications in colon and lung cancer, and in other clinical areas.

Acknowledgements: COSSAC, CREDO; Cancer Research UK; Oxford Cancer Centre.

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