The World Health Organisation reports 9.6million cancer related deaths globally in 2018. The rising incidence of cancers across the globe are due to a multitude of risk factors and carcinogens -physical, chemical and biological. Lung, Breast, Prostate, Stomach, Liver cancers showing the highest incidences in the last year with all other types of cancers still contributing 59.4% of the total. The total annual economic cost of cancer in 2010 was approximately US$1.16trillion.
High powered Medicine by combining Human and Artificial Intelligence Improving the number of physicians and infrastructure is still just a limited solution to tackle this global giant. Therefore, an intelligent system needs building by not just using Artificial intelligence technologies but also with a backbone of the knowledge provided by medical professionals who have been involved in fighting cancer over several decades.
“When we have the tools to fly .. if you prefer to crawl, then that is your choice” -RG. The advancements in the field of medicine lags behind that of the technology and its a slow catch-up. At the same time, technology built for medicine is lacking insight into the intricacies of healthcare including its methods of working, the visions for future and even its ethics. Therefore, we are building AI products headed by the best in medicine. Solutions we provide are built based on good clinical practice and customised to individual healthcare system requirements.
A.I. – the escape from Time Warp of Cancer Treatment Pathways
Every disease ever known to the mankind has challenged us humans to find a cure. Research has helped us understand the patterns of them diseases but the early diagnosis and treatment is still a race against time. Failure to do so leads to significant morbidity and mortality. Patients put their trust in doctors and the system to help solve their problems. The human capabilities can only be pushed to a certain limit under constraints of budgets and the targets set by the system which is backed only by outdated research. The healthcare systems across the globe are under immense pressures to beat the clock especially when it comes to cancer. Efficiency of hospitals are measured by achievements against the cancer treatment waiting times. As an example, the current 62-day cancer treatment target introduced in 2013 has pushed the NHS, UK to treat all cancer in this set target time and is achieved in 72.5% of the cases. However, the published results are far from reality because of the underreported patient experiences in this journey. Patients now are using the Internet blogs to express their views and concerns about the true waiting periods they face whilst being allocated slots for investigations, to get the results of tests performed and appointments in specialist review clinics. However, this internet savvy group only represents the tip of the iceberg of a much deeper problem. A national review of radiology reporting within the NHS in England by the Care Quality Commission(CQC) published in 2018 describes the key performance indicators (KPI) that tended to be longest were for routine, outpatients and GP requests. Most hospitals aimed for urgent/fastracked to be done at 2-5 days and routine requests in 7-21 days. However, this is not always achievable due to the work load, staffing and IT issues.
The recognisable delays that can be quantified are the waiting times to access clinic time slots in GP clinics (2-4days) limited consultation times (10-13mins) investigations scheduling/reporting (2weeks) MDT slots (2weeks) and the wait for definitive treatment of cancer(4weeks). The unquantifiable time which could be in several weeks or months is lost whilst the patient actually recognises the symptoms thus adding a bigger challenge for doctors in treating a much more advanced disease. The Cancer MDT does help deliver a structure to management of cancer pathway. However, the current frequency of MDT meetings trigger actions in once-a-week only fashion. It is an impossible task to increase the frequency of these meetings with the current level of funding and staffing in the healthcare systems across the globe. Thus, needing an intelligent AI system that can generate customised plans for cancer patients which will be evidence based, prioritised and person centred.
Artificial Intelligence when applied to various steps of the patient journey will double the efficiency of the healthcare systems. Self-referral of patients with worrying symptoms for their initial investigations, that could rule out sinister conditions, could be a possibility with the help of symptom analysing AI. This not just saves several days of waiting for GP appointments but also filter out unwanted tests for patients. Image analysing AI can be used to improve the pick up rate of small cancers on radiological imaging and also early reporting. Natural Language processing (NLP) will help interpret letters, reports and suggest the next action to be taken in the management of cancer patients. The future of AI in Healthcare will see its application into human lives at the very beginning of their journey. It will study every lifestyle choice made, environmental factors and even the data from social media feeds to decipher it’s correlation to human diseases. Thus, helping detect diseases in its earliest stages and limit its progression since we all do know that Prevention is definitely better than Cure. Dr Rohith Govindraj(United Kingdom)
Early Cancer diagnosis: the patient, the doctor or the government – who’s responsibility is it?
The surmounting pressures on the system and lacking funds is enough to break the infrastructure that has survived for years like the NHS as an example. The apathy from the governments to address the pleas of doctor and nurses over the years will only cause irreversible damage to the system especially by pushing the potentially treatable medical conditions into the a no-go zone whilst they wait for a medical review or investigation. However, can we blame just the system for this? The delays in cancer diagnosis are noted at a variety of stages; from patient recognizing the symptoms needing urgent review, recognition of red flags by their first contact in the healthcare, waiting times for investigations, reporting errors, pressures on cancer MDTs, delays in definite treatment etc . Pushing the already understaffed medical and nursing teams in order to review more and more patients in the limited time slots will only lead to missing vital informations and missed diagnosis. Also, the mammoth job of reporting millions of radiological images is now being outsourced to other countries. The errors in reporting leading to missed diagnosis of cancer are possible in in-house as well as in the outsourced reporting structures because of the sheer pressure of the number of images needing reporting. Cancer treatment has been the focus of the government over the last decade. Although Introduction of 62-day targets to treat cancer has increased the rate of curative treatment but it still is way below the desired outcome we wish to see in the vision of a healthy planet. A well funded Infrastructure would alleviate the pressures that influence errors or delays in patient management. Prioritisation of healthcare by government organisations is imperative to the early diagnosis and effective management of medical conditions.
Worldwide Cancer Mortality 2018 The Medical fraternity also has a major responsibility on their shoulders. The system picks the best individuals and trains them with skills that are intended not just to serve the immediate purpose but also to further the knowledge and improve the system. The research and innovations in medicine thus far have answered many questions, opening up our mind to a million new puzzles for us to solve. Is early surveillance of disease or education of the population what can help detect the diseases at its earliest stage? If this were to be possible for all types of cancers pushing the numbers awaiting treatment, would that not need an infrastructure that can withstand the pressure ? The answer to that question isn’t simple yet we can say that the responsibility now lies in all the parties involved to steer the culture into the direction of a healthy nation because the progress of a society is not measured by the wealth accumulated or the rankings of its GDP but by the social well being of its elements.