Istituto Europeo di Oncologia, IEO

One in three of us faces a cancer diagnosis in our lifetime, and the disease claims nearly ten million each year—about 18 every minute. Sobering numbers by any measure.

Yet advanced medical care developed in the past century remains one of humankind’s most profoundly substantive achievements. Medical oncology, a relatively recent specialization, tackles some of the most pernicious diseases plaguing humankind across millennia. The discipline attracts talented individuals with a breadth of medical understanding, wide-ranging competence, and deep wells of compassion and empathy. Now consider the multiplier effect that rises at the crossroads of that science and those skills with more recent learnings from breakthroughs in medical care and intelligent data technologies. At that intersection is where you will find the European Institute of Oncology (Istituto Europeo di Oncologia, IEO). The world-renowned institute offers an impressively wide array of treatment protocols at their clinic in Milan, Italy, all aimed at saving lives, improving patient outcomes, and one day realizing a cancer-free world.

The history of IEO is built on groundbreaking innovation, hard science, and transformed patient experiences. It began when IEO’s co-founder, Prof. Umberto Veronesi, led multiple trials in the 1970’s and 80’s which resulted in volumes of data pointing to radically new—and dramatically more effective—treatments across a range of cancers. Today, in the same spirit of scientific discovery established by Prof. Veronesi, the institute is in itself an innovation hub in oncology: in the method of treatment, the doctor/patient/hospital relationship, and the integration of research in each task. That’s why a spirit of innovation pervades throughout the whole institute and can be breathed in all activities, including the IT department, which significantly embodies this spirit.

It’s a journey that began for IEO more than 30 years ago. A journey which sole mission is to provide something as precious and invaluable as time itself—hope.

In lockstep with the rise of the digital age, recent decades have brought renewed hope for cancer treatment. The successful decoding of the human genome has allowed for the identification of specific genetic mutations within tumors. This development is in addition to the burgeoning of other new treatments available today which span an impressively broad spectrum.

Cancer treatment methodologies in the 21st century

Angiogenesis inhibitors; Cell therapy; Chemotherapy; Cryoablation; Hematopoietic stem cell transplantation; Hormone therapy; Immunotherapy; Monoclonal antibody therapy; Photodynamic therapy; Radiation therapy; Targeted surgery and therapy; Thermal ablation

Now add fast-evolving developments like Machine Learning (ML), Artificial Intelligence (AI), and Large Language Models (LLMs). The growing importance of specialized data lakes containing unprecedented volumes of information helps scale the timely diagnosis and effective treatment of cancer.

In seizing the power of intelligent data infrastructure in its mission to ease pain, save lives, and increase our collective understanding of cancer, the IEO has a committed partner in NetApp in its drive to understand cancer’s causes, its behaviors, and its eventual eradication.

Our intelligent bodies today are too often outwitted by a particularly cunning range of cancers. While cancer mortality rates have declined over the past 25 years, the disease remains stubbornly difficult to combat. A concerning trend is the recent global spike in the diagnosis of 17 types of cancer in Millennial and Gen X populations. While things are undoubtedly better with regards to outcomes than they were 5,000 years ago when Egyptians carved hieroglyphs declaring, “There is no treatment,” looking back even 100 years helps us understand history’s long arc with fighting the disease. An early 20th-century diagnosis of the ‘C-word’ (often only whispered) was dire. Yet it also was a century ago that innovation in medical science caught fire. That, and a child was born in the outskirts of Milan.

A century of innovation begins

In the ‘Roaring 1920’s’ the world witnessed a blizzard of advancements. Having lost more than 40 million lives to WWI and the global H1N1 pandemic, a new energy sparked the imaginations of great thinkers around the world in the 20th century’s second decade. Their ideas would change the course of history forever.

A few inventions from that era: traffic lights, frozen food, and sliced bread. But no aspect of the human condition then was more affected by innovations than the medical field. The discoveries of insulin, vitamins, and penicillin saved or improved the lives of millions across the intervening century. It’s against this backdrop of life-saving progress in 1925 that Prof. Umberto Veronesi was born.

After completing medical school a few decades later, his groundbreaking ideas would likewise re-write the future history of cancer, because Prof. Veronesi’s specialization in oncology steeped him in the practice of antiquated cancer treatments from decades past. Those old ways are what inspired him to redefine the discipline of cancer prevention, diagnosis, treatment, and research around the world. It’s a story of monumental challenges and different thinking to blaze new paths—by simply following the data.

Prof. Veronesi’s data-driven story begins with a melanoma trial in 1980. For over 70 years ‘wide’ excisions of malignant melanoma had been the standard. Prof. Veronesi imagined a better way with ‘narrow’ excisions. Data from a trial with the World Health Organization confirmed his reasoning. Next, having proven that dramatically smaller margins of skin removal could prove just as effective in controlling melanoma, he set out to apply the same less invasive treatment to a second use case—cancerous growths in women’s breasts.

He promoted an alternate course: the quadrantectomy, in which only a quarter of the breast is impacted during a lumpectomy. Again, data from trials showed not only increased life expectancy, but also improved quality of life related to body image and mental health.

Another significant innovation in breast cancer diagnosis and treatment for which Prof. Veronesi was a pioneer is the ‘sentinel node’ biopsy. This technique allows for the early detection of cancer spread, or metastasis. It’s a third example of Prof. Veronesi’s insight that maximally aggressive treatment protocols from times gone by needn’t be the only, or best options.

With new surgical techniques and standards at hand, Prof. Veronesi also found a new language of care was in order. This new model of cancer treatment was one that moved from ‘maximum tolerated’ intervention to ‘minimum effective’ treatment. It was an approach that gave back dignity to women going through what was far too often a very disfiguring and emotionally anguishing experience. Under Prof. Veronesi’s leadership, IEO became an early advocate of what is now called psychosocial oncology, providing emotional, behavioral, and psychosocial support to patients, their loved ones, and friends in their orbit of care.

In 1987 Prof. Veronesi founded the IEO, a new cancer center of excellence. Six years later, the IEO was joined by the Monzino Cardiology Center (Centro Cardiologico Monzino, or CCM), both centers sharing a mission to provide best-in-class care, each with their particular focus of cancer or cardiac health. Annarosa Farina, IEO-Monzino’s Chief Information Officer and Chief Data Officer, aggregates her insights and skills to serve IEO and Monzino by creating an integrated data strategy that spans disciplines across both medical communities.

From paper to pixels

As the IEO-Monzino teams entered the new century it was clear that paper medical records and photographic film imaging were soon to be a thing of the past. With NetApp data storage in place, they began a transformation of how they managed patient records, diagnostic test findings, research data, scientific analysis, lab reports, regulatory compliance filings, and overall internal management of the non-profit organizations.

Meanwhile, the need for standardized communication across the European Union and around the world was also driving change. One result is DICOM—an international interoperability standard to transmit, store, retrieve, print, process, and display medical imaging information. This makes it possible, for instance, for patients from Buenos Aires to have digital medical records like MRIs and CT scans from Argentina follow them as they enroll for treatment at IEO in Milan. XML tagging keeps everything in order across diverse healthcare systems, including legacy devices and the latest software.

Trained in Electrical Engineering, Annarosa has spent more than two decades in healthcare technology, including extended tenures at IBM and Milan’s San Raffaele Hospital with its 58 departments and wards. In 2019, IEO came calling, and she answered. Annarosa says, “I had a mission of transforming IEO into a data-driven company. This is the mission I hope I’m accomplishing.” Along the way she married a doctor and researcher, so she continues, “I’m submerged, because I’ve also got great exposure in my private life with clinicians and researchers in the healthcare space.”

One would be hard pressed to find a technologist more experienced, more credentialed, and more impassioned for the challenge, even as it changes seemingly every day.

When Annarosa joined IEO the hospital’s core storage architecture was already in place. But Annarosa immediately set about designing a new architecture that supported a holistic approach to total data lifecycle management. She says, “In the healthcare space the reliability of primary storage is essential. But just as critical for business continuity is speedy access to back-ups for recovery in case of failure. We take snapshots of our data every two hours, 5-6 times a day, and consolidate that chain of snapshots into a daily backup. And all of this data must meet our RTO (Recovery Time Objective) commitment.” NetApp StorageGRID plays a vital role in this part of the lifecycle. Capturing, tiering, and storing data across the patient journey, including during televisits and digital exams, proved to be an especially critical differentiator for IEO patients during the COVID-19 pandemic.

Annarosa also explains that IEO patient data remains consistently relevant, which is why the IEO team uses NetApp’s FabricPool to archive and tier Electronic Health Record (EHR) data from the time it’s created. One use case makes the point: If a patient experiences a new round of cancer after an extended period of remission, physicians need fast access to imaging from years’ past to understand the patient’s entire history and to advise the best course of treatment.

But what about analog patient records, radiography, and EHRs created long before the digital revolution? Annarosa is leading IEO into the future on that front too, as recent work to build a new Clinical Data Platform (CDP) referencing 30 years of archived IEO data illustrates.

The goal is to expand IEO’s data strategy by translating and integrating all data collected during the care process into a centralized data lake. The project is centered on AI, complemented by LLMs, ML, Deep Learning (DL), Natural Language Processing (NLP), Natural Language Understanding (NLU), and Retrieval-Augmented Generation (RAG). It’s an acronym-palooza without doubt, but it all comes together to amplify the impact of IEO’s future research, faster-better-lower cost diagnosis, and the highest standards of cancer care in the world. These are ambitious goals, but the results speak for themselves.

Annarosa expands on the Clinical Data Platform story: “We used Vertex AI techniques to train our proprietary AI models. One was finalized in just 46 days, during which the NLP improved rapidly. In fact, we were able to transform 76,000 unstructured reports into a structured data set 300 times faster than if it had been done manually. In healthcare we generate a great deal of data—30% of the world’s data comes from the medical field, and it’s only growing year on year. With our AI-enabled data lake we are now able to collect data at the point of care, combine it with data from our deep repository of records going back decades, and then transmit actionable insights to our physicians, surgeons, researchers, trial collaborators, and pharmaceutical partners, whoever and wherever they may be. Our CDP is just one more powerful tool we now have to maximize our investment in an intelligent data infrastructure that makes me very excited about the future.”

The CDP is also crucial for enabling personalized value-based care, as not all patients are in need of the same treatment strategy for their conditions. For instance, a young woman diagnosed early with a breast tumor may opt for aggressive chemotherapy and other treatments to aim for a cancer-free future. On the other hand, an elderly man diagnosed with prostate cancer and for whom sexual performance isn’t as central as it was earlier in life may choose the comfort and peace of mind that comes from less aggrssive care. Key Performance Indicators vary from patient to patient, and algorithms targeting IEO’s data lake can develop therapeutic pathways tailored to each situation.

IEO’s story is living and breathing proof that when advances in IT and developments in healthcare come together, challenges like cancer can be put on notice. Innovations such as AI are giving physicians a welcome edge as they continue to diagnose classic tumor markers from the literature of cancer, whether AFPs (alpha-fetoproteins), CEAs (carcinoembryonic antigens), or PSAs (prostate-specific antigens). It’s a welcome development in a long battle which is beginning to make headlines.

Of course, it’s still early days with AI-enabled models like IEO’s Clinical Data Platform. Annarosa says, “In Europe we speak very many languages, and we did hit some walls with the LLMs, so we have some things to work out. Which is why we tend to develop or train smaller models in order to better govern the quality of the scores.” But as the models learn more, diagnostic procedures like MRI’s will be easier to administer, faster to complete, and more accurate than ever—an exciting development, especially if you’re claustrophobe.

The institute’s Clinical Data Platform will soon be enhanced by a Value-Based Medicine (VBM) platform combining AI and Big Data to uncover further therapeutic paths for personalized medicine. The approach includes both scientific accuracy and sensitivity to an individual patient’s needs. It’s an important adjunct to the psychosocial approach established by Prof. Veronesi more than 30 years ago.

From ancient Greece to Milan, and back again

When Prof. Umberto Veronesi passed away in 2016, the global medical community mourned. They also celebrated his many achievements, including 11 positions of leadership in medical institutions, education, and government. They re-visited the impact of his 810 scientific publications and 12 oncological treatises. They pointed out the citation declaring the Professor an ‘Honorary Woman’ for his advocacy of women's rights, and for founding Europa Donna, the European Breast Cancer Coalition. They recalled his 14 honorary degrees, the foundation bearing his name, and how 2,000 of his peers had nominated him for a Nobel Prize in Medicine. But also, among their many glowing recollections of gratitude was one shared by a member of the New York University Medical Center who remembered Prof. Veronesi’s final message to them in a speech near the end of his life:

“Il mondo ha bisogno di scienza e ragione.” (English, “The world needs science and reason.”)

It's timeless wisdom that seems to echo from the ancient past, and which sounds like a perfect definition of data, itself—science and reason. A professed student of philosophy, Annarosa Farina is fond of sharing Plato’s ancient teachings that machines and mechanics are but tools. The real work is human connection. She says, “We’re on a journey. AI, as one example, is not a final destination. It’s just the latest tool we can use to build a better tomorrow, because technology enables us to improve the human condition. This gives me great peace of mind.” Her observation mirrors that of another healthcare professional whose passions encompassed technology and healing.

Prof. Umberto Veronesi’s legacy of innovation—in both science-based treatment and deeply-reasoned care—is foundational to the future of IEO in their mission to defeat cancer. As new eras of technology join life-saving protocols from the past, it’s clear the institute is giving patients, researchers, physicians, and the wider world the most essential thing of all—hope.