A Pilot Project Proposal for the Implementation of a Geographic

Information System for Immuno-Oncology in Italy

Rosa Marina Donolo

, Paolo Collarile

, Ilaria De Maria

, Marta Donolo

, Enrico Filippi

Maria Rizzo

and Domenico Spagnolo

Le Belle Imprese S.r.l., Rome, Italy

Public Health Care, Unit n.3, Prevention Department, Gemona del Friuli, Italy

San Giovanni Addolorata Hospital, Complex Operating Unit, Oncology Department, Rome, Italy

LUISS University, Management and Enterprise Department, Rome, Italy

Comenius University, Faculty of Mathematics, Physics, and Informatics, Bratislava, Slovakia

Council for Agricultural Research and Economics, Research Centre for Forestry and Wood, Trento, Italy

National Superior Institute of Public Health, ISS, National Centre of Chemicals, Rome, Italy

Keywords: Spatial Data Science, Geographic Information System (GIS), Health GIS, Immuno-Oncology (I-O), Clinical

Epidemiology, Clinical Governance.

Abstract: The purpose of this project is to exploit the potential given by the connection of two fields apparently distant

in which research is recently making very rapid progress: Immuno-Oncology (I-O) and Spatial Data Science.

The connection of these two fields has led the research group to propose the building of an I-O Geographic

Information System. In section 1 of this paper, we explain the advantages of linking I-O and Spatial Data

Science, in section 2, we explain the purposes and the objectives of the project, in section 3, we describe the

phases of the Geographical Information System (GIS) implementation and in section 4, we indicate some

main issues and future perspectives. In particular, in section 3.1 we describe some preliminary steps in the

building of the project’s database such as the collection of the Italian I-O Network Projects and the I-O

excellence centres.

1 INTRODUCTION

The idea of building an Immuno-Oncology

Geographical Information System was born from the

connection of two fields apparently distant in which

research is recently making very rapid progress:

Immuno-Oncology (I-O) and Spatial Data Science.

The ingredient that launched the project was the

intuition that the connection of these two fields could

have a great role and potential in the dissemination of

cancer-related information to doctors and patients,

and in particular in the improvement of the Italian I-

O Information System.

1.1 Immuno-Oncology

Immuno-Oncology is a science which is rapidly

evolving worldwide, and is in charge of identifying

innovative treatments in the fight against cancer.

https://orcid.org/0000-0003-2899-7319

Immunotherapy is currently indicated as the “fourth

way” in therapeutic treatments against cancer after

surgery, chemotherapy and radiotherapy. Some

immuno-therapeutic drugs have been authorized in

Italy and in the EU. For melanoma, lung cancer, and

other types of cancer, there are Immuno-therapeutic

drugs which are officially approved and already

available in the Italian National Health System. There

is also a lot of experimentation on Immuno-therapy

for other types of cancers. Moreover, I-O is a

fundamental topic in Translational Oncology which

is also a rapidly developing approach in oncology

research. This approach promotes the integration

between preclinical and clinical practice, through the

design and execution of multidisciplinary research

projects among groups of researchers for the

development of new therapeutic approaches,

including personalized ones. In particular,

translational oncology promotes basic, applied and

Donolo, R., Collarile, P., De Maria, I., Donolo, M., Filippi, E., Rizzo, M. and Spagnolo, D.

A Pilot Project Proposal for the Implementation of a Geographic Information System for Immuno-Oncology in Italy.

DOI: 10.5220/0009818301350139

In Proceedings of the 6th International Conference on Geographical Information Systems Theory, Applications and Management (GISTAM 2020), pages 135-139

ISBN: 978-989-758-425-1

135

industrial research in the field of cancer biology in

order to broaden the knowledge on the molecular

mechanisms of neoplastic transformation and its

clinical evolution.

1.2 Spatial Data Science

Spatial Data Science concerns Spatial Data

Representation, Visualization and Analysis, and can

outline best practices and alternatives for visualizing

spatial and geographic phenomena and for the

analysis of spatial issues: different map options and

data visualizations can provide different possibilities

in the display of data and can show trends, patterns,

critical points and spatial relations among data, and in

particular, and can improve the detection of spatial

networks among objects.

1.3 Reasons for Connecting

Immuno-Oncology and Spatial Data

Science

The main reason for connecting I-O and Spatial Data

Science, was the “weak connection” detected among

these two fields in Italy; As a proof of this “scientific

gap” we can say that there is no wide literature

available on the topic, even if some steps forward

have been made in the 90’s: in Campbell’s

publication on the foundation of clinical data

representation, (Campbell, 1994). In the last years the

National Institutes of Health (NIH), is promoting the

Storing, managing, standardizing and publishing the

vast amounts of data produced by biomedical

research, and released its first “Strategic Plan for Data

Science”, (NIH, 2018), that provides a roadmap for

modernizing the NIH-funded biomedical data science

ecosystem. Moreover, NIH is actively implementing

its strategy and is continuing to seek the scientific

community input. In Italy there is a central

Observatory (Osservatorio Terapie Avanzate, OTA)

on the collection of all the advanced bio-therapies

available, also concerning Oncology, but it still to be

improved on the side of data collection, management,

interoperability and visualization. This research pilot

project was born to promote and exploit the

connection of I-O and Spatial Data Science, and to

exploit data visualization and analysis in order to

improve I-O information and communication

especially in the Web (J. E. Brody, 2019).

To make the access to I-O information easier, fair

and homogeneous, the research group proposed a

pilot project that fully exploits the new Information

and Communication Technology (ICT), through the

implementation of Geographic Information System

(GIS) for Immuno-Oncology in Italy. The first step

was to verify the status of the I-O information access,

and to identify the difficulties encountered by

patients, doctors and researchers in accessing

information. The innovative contribution of this

project is not only linked to the intention to reduce the

I-O information gap, but also to put attention in how

to improve the display of information itself promoting

a visual approach:

 spatially representing all the data related to

the immuno-therapies administered in the

Italian authorized centres;

 using thematic maps and applications of

smart data visualization to display, analyse

and compare the data collected in the geo-

database and identify trends, criticality,

periodicity, relations and patterns.

In this way the project would provide to researchers,

doctors and patients a graphic and visual support to I-

O through the use of GIS software and digital

cartographic displays. The expected results are,

starting from the implementation of a WebGIS, also

the implementation of a series of digital information

tools useful for:

 Promoting the connection of I-O research

centres;

 promoting the connection of I-O databases

related;

 promoting the connection between the

growing demand for innovative oncological

treatments by the patients with the growing

offer produced by research at national and

international level.

2 PURPOSES OF THE PROJECT

The main purposes of the project are to promote, in

Italy, the improvement of the I-O information system,

concerning prevention, diagnosis, therapy and

follow-up of patients with the introduction of the new

indications available in clinical practice, through:

 The promotion of the building of a unique

national systematic and updated database on I-

O data with interoperable standards and

statistics;

 A more systematic management (with

interoperable standards) of the existing online

database on experimental and non-experimental

I-O clinical trials;

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136

 The connection and implementation of the

existing I-O fragmentary databases;

 The consolidation and the expansion of the

networks of I-O hospitals and research centres.

These objectives can be achieved by the

implementation of innovative techniques of visual

representation and analysis of data, by the use of

indicators of Immunotherapy information and

statistics. Many improvements in I-O could be

achieved through the sharing of data in the different

phases of prevention, diagnostic, therapeutic and

monitoring phases of cancers treated or treatable with

immunotherapies and in particular through the

optimization of:

 Therapeutic indications,

 experimental clinical trials,

 pharmacological research,

 economic resources for researchers and

medical staff.

3 STRUCTURE AND PHASES OF

THE PROJECT

The project is divided into three phases that are

described in the following paragraphs.

3.1 First Phase of the Project

The first phase of the project concerns the analysis of

the Italian context and the evaluation of the existing

landscape of Immuno-Oncology information in Italy,

(Emens et. al., 2017). We analysed I-O structures,

networks, online database and also I-O projects

promoted by public institutions, foundations,

associations, and companies. We started to build the

project’s database from the collection of data on:

1. Italian structures, research centres and

institutions that deal with Immuno-Oncology;

2. Real and virtual networks that connect

structures and research centres in Italy that deal

with Immuno-Oncology;

3. Online database and search-engines available

to access information about the Immuno-

therapies, clinical trials, treatments in Italy and

abroad;

4. Projects involved in Immuno-Oncology that

have been developed by structures and research

centres in Italy.

In the following part each point is briefly illustrated:

1. Structures and research centres in Italy that

deal with Immuno-Oncology. For the

implementation of this point, we have started an

independent survey, using different sources,

such as AIOM publications (AIOM Libro

Bianco, 2015, AIOM Libro Bianco, 2017),

Fondazione Serono database, and other sources.

We have built a database that we are using as a

basic information layer for the mapping of the

other information layers. For the moment, the

Italian Regions with I-O hospital structures that

we mapped in our project are ten.

2. Real and virtual networks that connect

structures and research centres in Italy that deal

with Immuno-Oncology. For the

implementation of this point, we analysed the

Italian Regions that have active oncological

networks compared with the pilot Regions we

started to map in our project. Some of the I-O

institutions, promote I-O networks, as for

example the Italian Network for Tumor

Biotherapy (NIBIT) in Siena, Toscany, and the

Regional Network for Tumor Biotherapy “Rete

del Lazio per la Medicina Traslazionale e

Sviluppo delle Bioterapie dei Tumori” in the

Latium Region. Besides the official networks

there are many non-official networks that have

been established independently. The objective

of the project is to highlight all the networks and

to promote a “network of networks” through the

WebGIS.

3. Online database and search-engines available

to access information about the Immuno-

therapies in Italy and abroad, that facilitate the

diagnosis and therapies for patients and doctors.

In Figure 3.1 it is possible to see the preliminary UML

model of the project’s database.

3.2 Second Phase of the Project

In the second part of this project, considering the

important improvements in access to information

given by the new digital information systems, and the

indications to digitalisation of the entire public health

sector, (medical records, diagnostic reports, etc.), we

proposed the implementation of a Geographic

Information System of Immuno-Oncology in Italy.

This platform should be available on a website to all

citizens, researchers and operators of the sector (by

registration and passwords with dedicated access

profiles according to the role), and it should also

collect the information about the different phases of

the project and in particular should display:

A Pilot Project Proposal for the Implementation of a Geographic Information System for Immuno-Oncology in Italy

137

Figure 3.1: The UML model of the project’s database.

1. The existing literature on immune-therapies

applied to oncology in Italy, for each immuno-

therapy centre, easily visible on a map;

2. Database on medical and non-medical

personnel involved in the research

management and data managers, and

administration of oncological immuno-

therapies, for each hospital structure;

3. Database on treatments authorized by AIFA

4. Database on treatments mapped by Regions;

5. Clinical trials with immuno-therapy drugs,

approved by ethic committees;

6. Dissemination and distribution in the territory

of the results of the trials, with due caution;

7. The therapeutic offer in terms of immuno-

oncology, for each hospital structure in Italy,

divided into:

a. the number and type of protocols approved

and available in clinical practice for each

hospital facility;

b. the number and type of experimental

clinical trials, protocols available for a

single hospital structure;

8. Estimates of the volume of patients who prefer

non-regional or foreign therapeutic centres;

9. Administration of a questionnaire by voluntary

associations, to test doctors, patients and

ordinary citizens on their knowledge about

Immuno-oncology.

3.3 Third Phase of the Project

The third phase of the project concerns the

implementation of a pilot study in a selected Italian

area, that will be analysed through GIS, geo-statistics,

and visual data analysis, in order to detect the

relationships between geographical, economic, social

and environmental factors and the therapies access,

health inequalities and outcomes of the therapies. The

testing process of the pilot Regions consists in the

evaluation, through a set of indicators, of the

improvement of the patients’ care and healing.

In the Italian Project Periplo, they analysed some

indicators and discovered that where the networks are

active, the patients’ healings grow, and also their life

quality. In particular, they studied the diffusion of

Diagnostic and therapeutic assistance paths (in Italian

PDTA), that promote the personalized therapy. In our

project we propose to use some of the Periplo’s set of

indicators, but also other specific I-O indicators.

4 RESULTS, OPEN ISSUES AND

PERSPECTIVES

The results we expect to present at the conclusion of

the project pilot study are:

1. Representation of the network of pilot

immuno-oncology centres;

2. development of an online platform for

information sharing;

3. creation of interactive maps for easy access to

information;

4. creation of statistical indicators for the network

evaluation of clinical studies;

5. monitoring and assessment of the degree of

satisfaction among the users of the online

platform.

The specific issues that remain open for the

implementation of the project are:

1. Identification of pilot hospital structures and

their database;

2. difficulty in accessing and recovering data

3. patients’ privacy problem;

4. authorization to link the project’s database in

the NIBIT website and with other national

cancer networks websites;

5. caution in the communication and

dissemination of experimental data under

study;

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6. approval of the project by the Italian expert

centres (such as NIBIT, ISS, AIOM, AIRTUM,

Ministry of Health, etc.

It is also important to say that an important topic to

debate could be the implementation of a series of

specific tools and network services (and the related

digital information) useful to connect the research

centres and the growing demand for innovative

oncologic treatments with the growing offer of

oncologic treatments produced by scientific research

at National and International level.

ACKNOWLEDGEMENTS

Prof. P. Ascierto, Director of the Complex Structure

of Medical Oncology, Melanoma Immunotherapy

Oncology and Innovative Therapies, Pascale

Hospital, Naples, Italy.

Dr. Carlo Capalbo, oncology scientist,

Sant’Andrea University Hospital, Rome, Italy.

Dr. Michele Maio, President of NIBIT

Foundation, Director of the Division of Medical

Oncology and Immunotherapy at the University

Hospital of Siena ‐ Department of Oncology, Adjunct

Professor at the College of Science and

Biotechnology at Temple University, Philadelphia,

USA.

Prof. Andrea Laghi, Full Professor of Radiology,

Department of Radiological Sciences, Oncology and

Pathology, "Sapienza" - University of Rome

Director, Radiology Unit – Sant’Andrea

University Hospital, Rome, Italy.

Dr. Manlio Mencoboni, Director Unit of Medical

Oncology,Hospital Villa Scassi, ASL 3 Genova,

Italy.

Dr. Salvatore Vaccarella, Scientist at Infections

and Cancer Epidemiology Group, IARC-WHO,

Lyon, France.

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