OBJECTIVES: Understanding a patient journey is essential for patients’ decision-making and improvement in the care process for better patient outcomes. Electronic Health Record (EHR) is a promising data source reflecting diverse treatment pathways in oncology. However, EHR is still underutilized for secondary use due to limited standardization in Japan. We conducted this feasibility study using EHR for patient journey mapping to investigate the remaining challenges in ovarian cancer (OC).

METHODS: 544 patients with a definite diagnosis of OC between May 2013 and October 2020 at National Cancer Center Hospital East in Japan were identified using EHR. Demographic information, stage, performance status, surgery, regimen for chemotherapy, dose of drugs, reasons for dose reduction and discontinuation, and adverse events were extracted and anonymized for analysis. To map out a patient journey, 107 patients who received chemotherapy for OC at the hospital were selected, and the medical oncologist validated the patient journey.

RESULTS: 85 patients received paclitaxel and carboplatin combination (TC) therapy as the front-line treatment, e.g., TC and dose-dense (dd) weekly TC regimen. Gemcitabine, doxorubicin, and topotecan were additional options for recurrent OC. Regarding the front-line treatment, Sankey diagram revealed the changes in initial regimen or early discontinuation in 47% and 25% of the patients by the end of six cycles of TC and dd weekly TC regimen, respectively. Also, 22% and 60% of patients experienced dose reduction in both regimens. The common grade 3 or higher adverse events were hematologic toxicity (neutropenia, leukopenia, anemia, n=4), followed by ALT/AST increased and nausea (n=1) during front-line treatment.

CONCLUSIONS: There were several challenges for a more comprehensive patient journey mapping, e.g., missing data, unstructured data, and information linkage among hospitals. However, the real-world evidence above suggested room for improvement in patient outcomes. Further research will focus on applying the developed algorithm for patient journey mapping to more hospitals.