Wednesday, October 2, 2013

Adding Prognosis to Cancer Screening Decisions: The ePrognosis Cancer Screening App



The goal of cancer screening is to identify asymptomatic cancer well before it causes symptoms or death.  This means that there is a long “lag time" before a patient sees a benefit from these screening tests.  This is in direct contrast to harms, which often occur rather immediately with these screening tests.  It would make sense then for us as health care professionals to focus cancer screening on those most likely to benefit from these medical interventions, and conversely, avoid screening in those who are unlikely to live long enough to see a benefit but will be exposed to immediate harms.  The problem is that as health care professionals, we aren't very good at this.

Multiple GeriPal posts have documented the health care systems proclivity at performing cancer screening in indivudals with a poor prognosis.  For some egregious examples, just take a look at these posts about cancer screening in those with dementia (here and here) and those with unresectable cancer (here and here).  It got so bad that back in 2010 Alex Smith wrote the following challenge in a post about "Dumb Medicine":
We need to train providers to have these difficult conversations, create health systems that flag patients with limited life expectancy who are receiving potentially harmful tests and interventions of little benefit, and educate the public about the harms of overtesting and overtreatment.

Well, Alex and a bunch of us GeriPal’ers took this challenge to heart by creating a free ePrognosis: Cancer Screening decision support app to help guide conversations with elderly patients of whether to start, stop, or continue breast cancer and/or colorectal cancer screening.   You can download it here for iPhones and iPads to try it out, or continuing reading to get a brief overview of what it does.

Overview of the ePrognosis Cancer Screening App 


ePrognosis home screen

When you start the app you’ll see the start screen asking you whether you are interested in screening for colorectal cancer, breast cancer, or both. Once you make a selection the app runs you through 15 health related questions including age, gender, BMI, symptoms, and functional impairment to calculate a mortality risk to estimate life expectancy.


Based on the response to these questions, you will be shown a speedometer like image that can help inform whether cancer screening is more likely to help or harm a patient.  You can also click on the "harms" or "benefits" buttons to learn more about what these may include.



Lastly, you can also click the learn more button, which will run you through a series of pictographs (each pictograph is of 1,000 squares where each square represents one person).  These pictographs visually display information on harms and mortality benefits from cancer screening, as well overall mortality risk at 10 years.

Overall mortality pictograph

Feedback

So give the ePrognosis app a try and tell us what you think.  What works well?  What can we do better?  Comment below!

by: Eric Widera (@ewidera)


Here is the full link to the app: https://itunes.apple.com/us/app/eprognosis-cancer-screening/id714539993?mt=8 



7 comments:

sky list said...


Today I can finally tell you something about one of the big things
that we've been working on home care
.This is something I'm tremendously
excited about -- we're rethinking commenting on home care
to be about building communities among both viewers and creators. The blog

Joshua Uy said...

I don't have the app in front of me, but when I've been communicating information, I've been trying to be flexible. Some patients think quantitatively but many think in value oriented terms and it is not obvious to some patients how to take the numbers and translate them into values. Sometimes it helps just to say them out loud. So for example, a colonoscopy is preventative measure that gives you no benefit now, takes years to see any benefit and the benefit is small. Many other interventions I have discussed with you are more likely to make an impact on your life, comfort and function now. It is reasonable to want to decline a colonoscopy. If you want to pursue it, the risk of harm may be just as great as the chance of benefit but the most likely thing that will happen is just an annoying day of diarrhea. If you care enough about wanting to avoid cancer to the point you are willing to undergo a useless/harmful intervention then it is a good idea for you. If not, don't do it.

In other words, maybe some questions on values could help the app decide if it is a better fit.
Goals (longevity, comfort, function), treatment preferences (curative, therapeutic, palliative, preventative, resuscitative). And the conclusion could have some recommendation of fit. Not sure if you want to get into that legally though.

Akon said...

As we already now health Screening is the premise identification of unrecognized disease The main aim of screening, to be sure that as few as available with the disease get through undetected and as few as possible without the disease are subject to further diagnostic tests.

Elizabeth J. Neal said...

Specifically a THC-containing drug called Marinol is FDA approved though it does not come close to effectiveness of natural cannabinoids. treat cancer

Stephen Montamat said...

Is an Android or PC-based calculator available?

Stephen Montamat said...

Is there an Android or web-based calculator for cancer screening available?

Eric Widera said...

We are working on it. Turns out that it costs a whole lot of money to develop apps for each operating system. Planning to use more of a web based system to avoid this.