CHOS-WG Scenario: Oncology

• Introduction:
• Oncology is a domain in which collaborations are very critical because many stakeholders are involved. These stakeholders work normally in different location and have usually difficult to meet each other.  
• The purpose of this scenario is to identify:
• How far the generic requirements of the CHOS project are valuable and sufficient in the context of oncologic situations?
  
• Which "additional" informatics requirements are necessary in case of oncology?
   
  
• Typical scenario:
• Stakeholders:
• Primary Care:
• The GP see many patients with many complaints and has to identify the few cases which could be related to a beginning oncologic issue.
• The GP should recommend the patient to follow health screening schema, e.g. breast screening for women > 50.  The GP should be kept informed of the results.
• The GP has a global view on the patient health.  The GP should maintain a global problem list available at any time,  including past history, i.e.  previous problems considered as closed, although being still a low risk factor to take account of.
  
• In this scenario, the GP can ask specialized help for the problem of a suspicion of tumor, as described below.  Nevertheless the GP remain the global coordinator of any other health issues the patient could have. 
  
• At any time the GP should have access to information related to the evolution of the oncologic problem.
  
• Health screening:
• Low cost mass detection and identification of a short list of cases who should go through more comprehensive diagnostic procedures.  The scope of health screenings is not limited to oncology.  Their organization will be discussed in a specific chapter.  Anyway there are here also communication needs.
  
• Organ specialist:
• Wherever the tumor could be located, the specialist of the anatomic domain will confirms the diagnose, whoever it may be e.g. gynecologist, urologist, pneumologist, etc...
  
• Invasive diagnostic test may be necessary.
  
• Pathology:
• A critical step to get a confirmation and to identify the exact type of tumor and the expected evolution, from very slow growing benign tumors to very invasive cancers.
• In answer to every sample received the pathology lab with provide a report.
  Moreover a small lab could need to ask advice over images, to a remote specialists as for example in the case of telemedicine provided by the iPath network.
  
• Oncologist:
• The oncologist has a coordination role about oncologic issues.  A central role in the choice of the treatment and the follow-up.
• Depending of the type of tumor, treatments are usually planned according to predefined schema's.
• Software requirements:
• The oncologist needs at least to share access to the general purpose patient record, as the other stakeholders hereabove.
  
• Maybe with a different presentation of the screens, more directly focusing on the tumor and related issues.
  
• The principle is that a group of activities are ordered, see the generic activity scenario, ../ActivityManagement.html , which may need here to be extended in function of oncology plannings.
• The oncologist contribute to the maintenance of the "Problem List", which should remain available at any time for the oncology team as well fo for all other partners in charge of the patient.
  
• ..... ???
  
• Surgery:
• The tumor may need to be removed.  See the generic schema about surgery.  Surgeon are usually organ oriented, e.g. thorax surgeons, neurosurgeons, etc...
  
• During surgery material is normally sent again to the pathology lab.
• Software:
• See the activities related to workflow of surgery.
  
• Radiotherapy:
• Standard appointment procedures, but here with the need of series of repetitive appointments.
• Software requirements:
• The radiotherapy scenario need a set of specialized software dealing with 3D image processing and planning of the volume to be irradiated, while preserving as far as possible the surrounding.
  
• This is not included in the basic common software, but could well be shared as open source inside the international radiotherapy community.
  
• Chemotherapy:
• A careful control of the hematologic situation is required. 
  
• Appointments as above.
• Often requiring the planning in a "one-day-care" in hospital.
• Software:
• Here again at least the generic patient record software as for the other clinicians, maybe with a presentation focusing on hematologic parameters.
• Specific software can help for the monitoring of the evolution and the computing of appropriate doses of chemotherapy.
  
• Home care, palliative medicine:
• Collaborations with the GP and nurses going at home.
  
• Research:
• A domain in which data collection for research is very active.  The technical procedure are similar to what is necessary in other domains of clinical research, e.g the need of anonymisation, of statistical analysis tolls, etc...
• ....