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openEHR-ELOM.breast_cancer_treatment.v1

language
    original_language = <[ISO_639-1::en]>
    
description
    lifecycle_state = <"unmanaged">
    original_author = <...>

use_model
    org.openehr.rm
    
data_context
    in $cancer_diagnosis: Terminology_code
    in $has_metastasis, $er_positive, $pr_positive, $her2_positive: Boolean
    in $ki67: Real
    in $tnm_t, $tnm_n, $tnm_g: String
    in $has_dx_transmural_mi, $hs_dx_hf_stage_2_4, $has_dx_severe_diabetes: Boolean
    in $ejection_fraction: Real
    out $recommendation: String
    
preconditions
    $cancer_diagnosis = [ICD_10::C50|Breast cancer|]
    
definition
    tumor_molecular_subtype (is_er_positive, is_pr_positive, is_her2_positive: Boolean; ki67_level: Real): Terminology_code 
    {
        if is_er_positive and not is_her2_positive and ki67_level < 0.20 then
            return [1111|luminal A|]
        elseif is_er_positive and not is_her2_positive and ki67_level >= 0.20 then
            return [2222|Luminal B (HER2 negative)|]
        elseif is_er_positive and is_her2_positive then
            return [3333|Luminal B (HER2 positive)|]
        elseif not is_er_positive and not is_pr_positive and is_her2_positive then
            return [4444|HER2|]
        elseif not is_er_positive and not is_pr_positive and not is_her2_positive then
            return [55555|Triple negative|]
    }

	has_contraindications_to_anthracyclines(): Boolean
	{
        return $has_dx_transmural_mi or $ejection_fraction < 0.4 or $hs_dx_hf_stage_2_4
	}

	chemo_1_recommendation (): Message
	{
        -- RECOMMENDATION
		-- consider contraindications to anthracyclines
        if has_contraindications_to_anthracyclines() then
            return Recommend_cmf_message
        else
			-- RECOMMENDATION
            if $has_critical_cardio_pathology or $age > 75 then
                return Recommend_apirubicin_cycloPosphamide_message
            else
                return Recommend_ac_message
            end
        end
	}
    
	chemo_2_recommendation (): Message
	{
        -- RECOMMENDATION
		if $has_dx_severe_diabetes or $allergic_to_taxanes or $has_taxane_intolerance then
			if has_contraindications_to_anthracyclines() then
                return Recommend_dc_message
			else
				-- CHOICE
				return [Recommend_ac4p4_message, Recommend_ac4p12_message, Recommend_ac4d4_message]
			end
		else
  	        -- RECOMMENDATION
 	        return chemo_1_recommendation ()
		end
	}

	-- REQUIRED
    if $has_metastasis then
        -- Luminal A
        if tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [1111|luminal A|] then
            
        -- Luminal B (HER2 negative)
        elseif tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [2222|Luminal B (HER2 negative)|] then
             
        -- Luminal B (HER2 positive)
        elseif tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [3333|Luminal B (HER2 positive)|] then

        -- HER2 type
        elseif tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [4444|HER2|] then

        -- Triple negative
        elseif tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [55555|Triple negative|] then


        end
    else
		-- REQUIRED
        -- Luminal A
        if tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [1111|luminal A|] then
			-- REQUIRED
            if tnm_major_number ($tnm_t) < 3 and tnm_major_number ($tnm_n) < 2 and tnm_major_number ($tnm_g) < 3 then
                $recommendation := No_intervention_message
            else
                -- RECOMMENDATION
                $recommendation := chemo_1_recommendation ()
            end
            
        -- Luminal B (HER2 negative)
        elseif tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [2222|Luminal B (HER2 negative)|] then
			-- REQUIRED
            if $tnm_t = "1a" and tnm_major_number ($tnm_n) = 0 then
                $recommendation := No_intervention_message
            else
            	-- RECOMMENDATION
 	            $recommendation := chemo_2_recommendation ()
            end
             
        -- Luminal B (HER2 positive)
        elseif tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [3333|Luminal B (HER2 positive)|] then
			-- REQUIRED
            if $tnm_t = "1a" and tnm_major_number ($tnm_n) = 0 then
                $recommendation := No_intervention_message
            elseif $tnm_t matches {"T1b", "T1c"} and tnm_major_number ($tnm_n) = 0 then
            
            elseif tnm_major_number ($tnm_t) matches {|2..4|} and tnm_major_number ($tnm_n) > 0 then

            else
            
            end


        -- HER2 type
        elseif tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [4444|HER2|] then
			-- REQUIRED
            if $tnm_t = "1a" and tnm_major_number ($tnm_n) = 0 then
                $recommendation := No_intervention_message
            elseif $tnm_t matches {"T1b", "T1c"} and tnm_major_number ($tnm_n) = 0 then
            
            elseif tnm_major_number ($tnm_t) matches {|2..4|} and tnm_major_number ($tnm_n) > 0 then

            else
            
            end

        -- Triple negative
        elseif tumor_molecular_subtype ($er_positive, $pr_positive, $her2_positive, $ki67) = [55555|Triple negative|] then
			-- REQUIRED
            if $tnm_t = "1a" and tnm_major_number ($tnm_n) = 0 then
                $recommendation := No_intervention_message
            elseif tnm_major_number ($tnm_t) > 1 and tnm_major_number ($tnm_n) > 0 then
            	-- RECOMMENDATION
 	            $recommendation := chemo_2_recommendation ()
            end
        end
        
        user_alert ($recommendation)
    end
    
terminology
    symbol_definitions = <
        ["en"] = <
            ["er_positive"] = <
                text = <"Oestrogen receptor positive"> 
                description = <"Oestrogen receptor positive">
            >
        >
    >
   
data_bindings
    content_bindings = <
        ["openEHR-EHR-OBSERVATION.cancer_investigation.v1"] = <
            ["er_positive"] = <
                target = <"/data/events[id3]/data/items[id5]/value/magnitude">
                direction = <"in">
            >
        >
    query_bindings = <
        ["https://oncology.health.org/cdr/"] = <
            ["has_dx_transmural_mi"] = <
                query_id = <"dx_transmural_mi">,
                parameters = <
                    ["$type"] = <"'xxx'">
                >
            >
        >
    >