L.I.S.A. set to transform children’s cancer care

Doctors swamped in a baffling array of complex information can now turn to a new friend for therapeutic advice.

Cancer Research UK scientists have developed a sophisticated web-based system called LISA (Leukaemia Intervention Scheduling and Advice) to support doctors’ decision-making in the treatment of childhood leukaemia.

The system will help doctors and nurses judge the dose of chemotherapy required for individual patients and allow medical staff responsible for administering treatment at different hospitals to share up-to-date information on the child’s treatment and progress.

Researchers believe the system will help ensure drug dosage decisions are accurate, improve patient safety and ease the burden for doctors dealing with complex information.

Scientists at Cancer Research UK’s Advanced Computation Laboratory, based at the charity’s London Research Institute, have developed LISA to help with the management of Acute Lymphoblastic Leukaemia (ALL) – the commonest childhood cancer affecting over 300 children in the UK each year.

The disease requires a long period of ongoing treatment that can last up to three years and is shared between a large regional treatment centre and a network of smaller local units easily accessible to the patient.

The mainstay of treatment during this period is regular administration of two oral chemotherapy drugs, one given daily and one weekly.

Doctors and nurses decide the dosage to give patients based on the child’s most recent blood count as well as the blood counts and chemotherapy tolerated in the previous twelve weeks.

They also have to make modifications to treatment as new information on the patient’s response and side-effects emerge.

The LISA system can hold all patient information including blood counts, responses to treatment and previous dosages prescribed and is programmed to provide accurate advice on adjustments to drug dosages.

The team behind the technology believe having a computerised, web-based record of this information, which can also provide help with decision making, will simplify an otherwise complex and time consuming task for doctors.

One of the researchers developing the system is Professor Vaskar Saha, Head of the Cancer Research UK Children’s Cancer Group at the Royal London Hospital. He says: “The treatment of childhood leukaemia is a long and complex process involving different organisations across the country. Chemotherapy doses have to be continually adjusted to ensure the best outcome for the patient, as there is a great deal of individual variation in response and both under-treatment and over-treatment can have serious consequences.

“The wrong dosage can lead to a condition called severe marrow depression – where the production of essential parts of the blood and immune system are slowed down – making the patient susceptible to infection. If this happens cancer treatment may have to be interrupted while the patient recovers. So a computer system that can assist doctors with drug dosage decisions will be extremely useful.”

The developers say as well as helping doctors in their treatment decisions, the system will also make it easier for those involved in caring for the child to share information.

Prof Saha says: “Following a complex treatment protocol is difficult, especially when care is shared between different centres. At present patient information is recorded on paper and is sent between sites using fax and telephone. A web-based computer system will help enormously with accessing patient data quickly and accurately at the click of a mouse.”

The researchers have piloted the system in a small number of clinics across the UK and have received positive feedback from doctors. They will be incorporating this into a national trial to evaluate the system next year.

Prof Saha adds: “Doctors really liked LISA and found it helped them in their decision-making and eased their workloads.”

Richard Palmer, Vice Chair of the National Alliance of Childhood Cancer Parents Organisations, says: “Although the treatment of childhood ALL has a very high success rate, the length and complexity of treatment has a big impact on the health and on the quality of life of the child and their family. This puts an enormous strain on them all.

“This new system offers parents the potential of ensuring optimal dosing, when their child is being treated at different hospitals and is very ill. It also ensures good information flow between the care teams, which will reassure the parents and patients, and ease the strain on them at such a difficult time. Such advances in the treatment of our children will be welcomed by all parents of these children”.

Professor Robert Souhami, Director of Clinical and External Affairs at Cancer Research UK, says: “This innovative computer system will help doctors to provide a consistently high standard of care that is crucial in the treatment of childhood leukaemia, which can last months or even years.

“Systems like LISA also have applications in the management of other cancers and any disease where treatment is prolonged and requires co-ordinated input from medical teams in different parts of the country. In the future I expect they will be a normal part of patient care, reducing the chance of clinical error and improving patient safety.”

ENDS