Humanities and Social Sciences Program - Innovation in Oncology
Innovation in Oncology
Innovation in oncology faces challenges that are not just biomedical but also fall within the social sciences and humanities. Gustave Roussy hosts a set of research teams with various disciplinary backgrounds that bring their own contributions in the common ultimate aim to improve the management of the disease.
Our research program revolves around two axes: therapeutic innovation and innovation in patient health care during and after cancer. It gathers research in Health Economics, Health Management, Philosophy, Psycho-Oncology, Public Health, Sociology
Health Economics: Economic evaluation of therapeutic innovations
Innovation in healthcare improves outcomes but also generally increases costs to the community. The healthcare systems face financial limits that require to make choices for the different stakeholders: the regulators, the payers, the providers of care (hospitals in particular) and the patients. Economic evaluation is a tool to inform decision-making. In oncology, the sustained dynamic of innovations is a challenge for rigorous evaluation and accumulation of knowledge and evidence-based medicine. Meanwhile, new sources of data such as claims databases are now available in the current era of big data.
One of the challenges for health economics research is to make use of these new sources of data while continuing to collect its own material when necessary. A second challenge is that the breadth of possibilities, requests and expressions of interest for this type of research is growing.
Philosophy: Analysis of the conceptual and theoretical foundations of therapeutic innovation
Therapeutic innovation relies on scientific progress in the understanding of cancer biology. Fuzzy concepts and hidden assumptions hinder scientific progress and delay translation into clinical success. Our aim is to alleviate these obstacles through critical assessment of the key scientific concepts and the theoretical foundation on which innovative therapeutic strategies lay (e.g. the clonal evolution model and the development of precision medicine and adaptive therapies; the cancer stem cell model and the search for cancer stem cell targeting therapies; the tumor microenvironment and the multiple afferent therapies).
Sociology: study of access to therapeutic innovations and associated social inequalities in health
A better understanding of cancer has led to the creation of numerous therapeutic innovations in recent years (immunotherapies, targeted therapies). Patients still mainly access to these therapeutic innovations through clinical trials. It is important to understand how issues at stake in therapeutic innovation might sometimes be remotely related to care (international competition, etc.). It is also crucial to study the way in which the question of patient access to therapeutic innovation becomes an integral part of clinical research activity (e.g. identifying the right patient profiles, organizing cross-referencing systems of patients). Our aim is to study therapeutic innovations through patient access routes and to assess the new forms of social inequalities in health resulting from these access routes.
Innovation in health care before, during, and after cancer
Health economics: study of long-term costs in survivors and modeling of potential cost reductions associated with the use of innovative therapeutic tools
Our research projects often involve long-term follow-up of patients. The longitudinal dimension and a long time horizon are two inherent components of economics. The use of data from the national health data system (SNDS) will make it possible to study the trajectories of patients through the healthcare resource use in a comprehensive manner and at nationwide.
Long-term iatrogenic effects following treatment can result in significant long-term health costs. Our objective is to assess the total additional cost of health expenses and to model the possible reduction of this cost through the use of innovative therapeutic tools such as proton therapy.
Health care management: Improving the patient pathway through the implementation and assessment of a remote monitoring patient system
Remote Patient Monitoring Systems (RPMS) based on e-health (including algorithms enable to treat massive data) and nurse navigators can improve patient follow-up and have a positive impact on quality of care (by limiting non-adherence and toxicities effects; improving patient experiences) and costs (by reducing readmissions). However, the extent of this impact depends on effective implementation which is often restricted, and a robust assessment of its impact. A program (Capri-Gustave Roussy) develops a RPMS with the aim to demonstrate its impact and to understand the management activities required to promote a better coordination at each steps of the patient pathway (between Gustave Roussy oncologists, ambulatory care professionals, and patients). It also explores new ways for translating scientific advances in precision medicine into personalized care.
Psycho-oncology: Psychological dimension at the heart of innovation and personalization of care
Therapeutic advances in oncology are associated with important changes in health management and care pathways. The Psycho-Oncology unit has developed its research activity closely tied to the issues related to these transformations. Taking into account the emotional, relational and cognitive dimensions contributes to advances in precision medicine. It helps to personalize care and to promote their adoption by patients, from prevention to survivorship, for the benefit of the greatest number and with particular attention to the most vulnerable.
This research activity focuses on two main axes:
- Identifying the psychological, relational and cognitive processes, in the short and long term, involved in the adjustment of patients to cancer, in the preservation and improvement of their quality of life, as well as in the engagement for changing health behaviors;
- Evaluating innovative interventions intended for psychotherapeutic, rehabilitation or support purposes for patients, relatives and providers.
Sociology and Public Health: evaluation and management of the long-term physical and psychosocial impact of treatments
Currently, thanks to therapeutic advances, the majority of patients treated for pediatric, breast, colorectal or prostate cancer will be cured of their disease. Yet, cancer related treatments can cause serious long-term side effects, including limitations in mobility, cognitive impairment, fatigue, weight gain, infertility, depression, sexual dysfunction. These long-term side effects impact overall quality of life, social function (difficulties with regard to professional insertion or returning to work, isolation,), and treatment adherence which can result in an increased risk of relapse. Our groups aim to evaluate the long-term impact of cancer treatment, but also to design innovative interventions to prevent and manage these long-term effects.
Sociology and Public Health: Study of health risk behavior patterns in survivors of childhood cancer
The health risk behaviors of some patients cured of pediatric cancers may increase the incidence of long-term complications following treatment. The co-occurrence of several risk behaviors can magnify these adverse effects. Our objective is to characterize the different patterns of health risk behaviors, taking into account their interactions, and to identify the determinants of these patterns in order to advocate for more targeted interventions in this population.