As a practising radiation oncologist with a special interest in prostate cancer, I always knew this question was coming. Eventually, we would get there. The patients in this story have a new diagnosis of prostate cancer, and this was their final question of our consultation. It was a ‘loaded’ question for both of us. I didn’t like this question because, in a way, it was a moment of temptation for me. If I answered with the treatment option that I offered myself (often though not invariably, the one I thought was correct), I was open to the nagging doubt I had a vested interest here. Was I conflicted? Not only through a potential financial interest but also my ego and prestige in the programme amongst my peers. In a way, we all like to be considered the busiest doctor. It’s a compliment – let’s face it. The question generally came after the more balanced part of the meeting with the patient. The part where I explained the diagnosis was early prostate cancer, with a high likelihood of cure. The part where I explained there were a number of management options open to the patient, from close observation, through to radical surgery, with many different techniques of radiation also in the mix. There was the same chance of being alive 10 years later with all of them. But, there were quite different risks from each patient’s point of view. Some risks were common and mild. A few (rare, thankfully) could be more difficult to deal with in terms of quality of life, some emerging even years after the treatment.
So, how did I answer?
Before I tell you – let’s unpick the reason for this question. What is the patient really seeking? What they want is help choosing the best option for them. Generally, in a patient with cancer, this means the one with the best chances of survival, but in this instance, thankfully, the chances of survival are high irrespective of the choice of therapy. However, each option carries different risks in terms of quality of life, and each carries a small chance of a serious long-term side effect. This is where it really gets difficult. How does a patient weigh a <1% risk of serious urinary incontinence after surgery, for example, with a <1% risk of a serious bowel injury after implantable radiotherapy (brachytherapy)? The same small chance of a long-term problem, but very different problems. Like comparing “apples to oranges”, as they say.
Difficult.
Next, they need to weigh up the risk figure, “<1%”. From where does that information come? Usually, it’s from the published medical literature. That means papers, reports and articles, best if they are from “peer-reviewed” journals. But, and here’s the but, unless the patient is sitting in the very institution from which that study was done, then how do they know that the quoted risk would be the same in the institution where they are seeking their care? Unless the doctor actually conducted the treatment on the study… they don’t. What they really want to know, then, is the real risk number in the clinic in which they sit. “Real world evidence” is the new buzzword in medicine. To answer this, the actual results from every clinic should be available. Here’s the problem, they are not. Not usually, that is. Why? Because most of the doctors are too busy doing the actual clinical work to write up their own results. Another reason given is that it is too costly to collect the data. Sometimes the stated reason is because the health records are not accessible either manually or electronically. There are a million reasons given. And until now, this was the case. Worldwide, over 80% of cancer patients are treated in the real world. By this, I mean non-academic or non-teaching hospitals. These are often referred to as community hospitals, and the treatment results from these hospitals have not generally been available until now.
Whyze Health has developed a state of the art software platform which every hospital can install, and now collects this very data. They can share the real outcome data expected from their own doctors, performing these treatments in their own hospitals. They can use the Whyze Health Platform to curate the same information to screen patients and gain access to clinical trials. So even when standard treatment options are no longer successful, patients can be offered new options only available in research studies. Whyze Health platform uses machine learning (ML), artificial intelligence (AI) and novel blockchain technologies to safely report the data that patients really want useful data so they can make their own best choices. These are informed choices. this will eliminate the need for the question, “What would you do yourself, Doctor”
So how do I answer it? I answered by showing the real-world outcomes from the last 1000 patients treated by me over the proceeding decade. If the results are acceptable to the patient sitting with me, then they may well choose that treatment. If they are still in doubt, at least they now have a real-world benchmark with which they can compare other options open to them.
Then, together with Frances Abeton, I co-founded Whyze Health!
Prof Frank Sullivan
CMO Whyze Health