For years, men coming to Johns Hopkins for treatment of prostate cancer relied upon the experience and intuition of their providers to help them navigate the best options. But with a new partnership between the Johns Hopkins Individualized Health Initiative (inHealth), a personalized medicine program, and the Johns Hopkins University’s Applied Physics Laboratory, clinicians can add sophisticated computations of similar patients’ histories into their decision-making through the Precision Medicine Center of Excellence for Prostate Cancer.
Since January 2017, nurse navigators with the center have fielded more than 500 phone calls, says Kenneth Pienta, center co-director. About 30 percent of callers have been referred directly to providers at Johns Hopkins, and 50 percent of those have been seen in the precision medicine center.
There, clinicians assess each patient’s cancer grade using lab tests, biopsies and imaging results, then combine those measurements with family histories and symptoms to determine the right level of treatment. For some patients with low-grade cancers, this might mean active surveillance requiring careful follow-up but no current treatment. On the other end of the spectrum, a clinical trial of a potentially curative treatment for men with metastatic disease has enrolled over 40 participants.
“We develop a partnership with patients to provide them longitudinal care,” Pienta says. Patient satisfaction is “extremely high,” he says. “We have a high participation rate in clinical trials, and over 90 percent of participants give us permission to collect data and biospecimens. It’s a win for everybody.”
Clinicians traditionally use their expertise to place patients within subgroups they think will best be managed by one treatment or another, says Antony Rosen, vice dean of research for Johns Hopkins Medicine and co-director of Johns Hopkins inHealth. “In some cases, you get it right; in other cases, you don’t get it right immediately, so there’s this trial-and-error element.” Humans have only a limited capacity to factor in clinical information and patient histories. “Even though we can be highly intuitive and wise, we are challenged by processing all this data,” he says. Computer analysis tools can crunch all the data efficiently, helping providers determine which subgroups their patients belong to, and thus what treatment is needed.
Although the focus here is individualized health, computational tools help place patients into more homogeneous subgroups who behave and look alike, putting forth patterns that help define treatments for these patients as part of a learning health system, says Mary Cooke, co-director of Johns Hopkins inHealth and vice president of the Johns Hopkins US Family Health Plan: “It really does help to identify the most appropriate therapy more quickly and eliminate unnecessary costs.”
A second precision medicine center of excellence, for multiple sclerosis, opened in April 2017. Six more centers—in scleroderma, arrhythmia, myositis, neurofibromatosis, pancreatic cancer and bladder cancer—will launch soon, Rosen says.
It’s feasible that, eventually, every patient encounter could occur in the context of a precision medicine center, Rosen says: “The use of measurement and the sophisticated analysis of data is going to change the face of medicine as we know it, across the entire continuum of health.”