In the 1980s computing shifted from room-sized mainframes to personal computers that could easily fit on the desktop. For most users, there was no more need to submit batch jobs to a queue, wait hours for a printout, and walk down the hall to pick it up. All of that could now be done in short order from the comfort of one’s swivel chair. Today cancer care is undergoing a similar transformation, as researchers advance new technologies designed to shift the action away from large, specialized facilities and toward smaller, local clinics and patients’ homes—and return test results within minutes rather than days. It’s a trend that promises to considerably reduce the costs, complexities and inconveniences of cancer care, make treatment available to more patients in low-resource settings, and achieve better health outcomes for patients in the US and around the world.
To effect this transformation will require a deft combination of biomedical engineering and clinical expertise, and that’s exactly what the Center for Future Technologies in Cancer Care (CFTCC) at Boston University brings to the table. Launched in July 2012 through a five-year, $10 million grant from the National Institutes of Health (NIH), the Center identifies, prototypes and provides early clinical assessment of innovative point-of-care technologies designed to treat, screen, diagnose and monitor cancers. One of three institutions within the NIH/National Institute of Biomedical Imaging and Bioengineering (NIBIB) Point-of-Care Technologies Research Network (POCTRN), CFTCC is the only POCTRN cancer center and one of the only engineering-focused cancer research centers in the nation.
Largely a virtual center that supports researchers around the country in the development and clinical assessment of emerging point-of-care (POC) technologies and the training of clinicians and other potential stakeholders in their use, CFTCC operates two prototyping facilities on the BU campus. One, located on the fifth floor of the BU Photonics Center, is used for early-stage prototyping; the other, housed at the Fraunhofer Center for Manufacturing Innovation, produces more advanced prototypes. As they draw upon these prototyping facilities and the Engineering Product Innovation Center to advance technologies from the lab bench to the marketplace, Center researchers are guided by the NIH’s ultimate aim of lowering healthcare costs while improving the quality of care.
“We’d like to see a shift from a lot of high-cost imaging studies and resource-intensive, late-stage cancer care to early care, smarter care and prevention. In the future, we hope that the kinds of technologies our researchers are developing will become the standard of care,” says Professor Catherine Klapperich (BME, ME, MSE), who directs the CFTCC. “We’re trying to give inventors—scientists, engineers and clinicians—a springboard to get their technologies to a place where they can become marketable products.”
Accelerating Innovation from Bench to Bedside
In its first three years, the Center has funded 12 projects, two of which have produced devices that are now being commercialized. Among the most promising new POC technologies to emerge from the Center are a noninvasive chemotherapy monitoring device, a mobile app that provides cancer patients with easy access to medical information and support, and a screening test for melanoma.
Assistant Professor Darren Roblyer (BME) has used CFTCC funding and prototyping facilities to advance a noninvasive optical device that monitors the effectiveness of chemotherapy at the point of care for breast cancer patients. Wearable by the patient or handheld by a clinician, the tumor-tracking “imaging pad” that Roblyer is developing transmits near-infrared light that penetrates deep inside cancer tissue. Some of the light is absorbed within cancer tumors and some is scattered back to a detector on the pad. Based on the pad’s continuous optical measurements of the absorption and scattering of light within a tumor, a clinician could, in real time, determine rapid changes in the tumor’s structure and metabolism that indicate its resistance to current treatment. A new course of treatment could then be implemented.
Now in production at the Fraunhofer Center and suitable for clinical testing, Roblyer’s device sharply reduces the size, cost and response time of existing chemotherapy monitoring technology so it can be more easily applied at the point of care.
“This is a technology that used to be the size of a refrigerator just about a decade ago,” says Roblyer. “Because we’re using new digital technologies to both synthesize our signal and to measure, we can reduce the size of the device to that of a briefcase and the cost by an order of magnitude.”
Another CFTCC-funded project that’s poised to enter the marketplace is the Personal Health Network, a mobile app that enables cancer patients and their family members to communicate more effectively with care coordination nurses, oncologists and other specialists. Spearheaded by Dr. Katherine Kim, assistant professor at the Betty Irene Moore School of Nursing at University of California-Davis, in collaboration with Tiatros, a digital health technology company based in San Francisco, the app functions like a confidential social network. Once logged onto that network, patients can interact with health providers through video chat and email, and view their plans of care, appointment schedules and a library of medical and self-management information.
“Support from the Center makes possible the optimization of this technology for patients,” says Kim. “We hope to be part of the growing movement that asks how technology can fill the gaps patients experience in the coordination of complex care. Our goal is to bend the cost curve and at the same time improve health.”
University of Texas-Austin Biochemistry Professor Andrew Ellington and BU School of Medicine Professor and Chair of Dermatology Dr. Rhoda Alani used their CFTCC grant to develop an integrated microfluidic platform that tests for cancer biomarkers (it functions like a diagnostic paper test-strip), and a handheld electronic reader that can wirelessly transmit test results. Focusing initially on detecting the recurrence of melanoma, the researchers designed the platform to detect cancer biomarkers in circulating nucleic acid (CNA), which consists of extracellular genetic material (DNA and RNA) that moves freely in the blood. These information-rich molecules could be used to indicate the status of remote tumors, possibly circumventing the need for costly tissue biopsies. Through their novel platform, currently contained within a plastic cartridge, Ellington and Alani aim to transition molecular diagnostic testing to the point-of-care setting.
“The beauty of this is that it’s extremely cheap and easy to use,” says Klapperich. “In three years, it’s gone from Andy and Rhoda meeting through the Center to a working device that’s being prototyped by a commercial entity.”
Streamlining Cancer Care
The melanoma biomarker test is one of a number of CFTCC projects that may enable a clinician—and, ultimately, the patient—to administer a rapid test and report the results via the Internet. With that goal in mind, Klapperich is currently working on a microfluidic test that screens for HPV (human papillomavirus, which can lead to cervical cancer) and returns results within minutes rather than days. Other projects, including an app Professor Christos Cassandras (ECE, SE) is co-developing, aim to boost the numbers of people in high-risk, low-compliance populations who get screened for colon and other cancers.
One of the greatest potential benefits of POC screening is to enable clinicians and patients to quickly and easily distinguish between nonaggressive cancers and those likely to spread rapidly and cause illness. Using molecular diagnostics to accurately detect cancer biomarkers in body fluids, such tests could do everything from eliminating unnecessary surgery for nonaggressive tumors to replacing the mammogram with a blood test.
“What are the early molecular changes, and how can we detect them most efficiently? Those are the kinds of questions we try to focus on at the Center,” says Klapperich. “How can we assist clinicians not just in identifying tumors, but by querying the cancer and quantifying the level of risk to the patient? In the last 10 years, exciting tools have emerged that allow us to quantify biomarkers in blood in new ways.”
Even as researchers develop faster, better and cheaper screening technologies, they must also find ways to sell those disruptive technologies to the clinical community.
To overcome potential resistance to the innovations they’re advancing, CFTCC engineers, clinicians, public health practitioners and technology transfer experts spend considerable time on assessing clinical needs. Their collective goal is to determine what technologies will have the biggest impact on improving the healthcare delivery experience for both physicians and patients.
“When you get a diagnosis of cancer, you’re basically entering a years-long healthcare odyssey where you see an array of different providers, take an insane number of tests and endure uncomfortable procedures,” says Klapperich. “If we can mitigate some of those stress points along the way, that’s really our goal.”
See video for an overview of the Center for Future Technologies in Cancer Care.