Connected healthcare, or the development, testing, and integration of smart tools into medical care is more frequently driving patient engagement, self-management, and empowerment.1 In oncology, there are many mobile options that have been demonstrated to dramatically alter how information, resources, and support are communicated, accessed, monitored, and acted upon.1
Some studies reveal that a substantial lack of health app literacy and not being aware of relevant options are two of the biggest barriers to widespread adoption, which can be even more pronounced for some patient populations, including lower socioeconomic groups, non-English speakers, those with less than a high school education, and seniors.1 But there has also been one study that observed greater improvement in clinical outcomes for those cancer patients that lacked any prior computer experience before enrolling in a connected health clinical trial.2
When connected care technologies are implemented, oncologists, researchers, caregivers, and cancer patients are finding higher than expected adherence rates for remote monitoring, as well as a range of improved outcomes, such as better symptom management that supports longer treatment times, the importance and impact of non-treatment support, and longer survival times.
Improving cancer outcomes with smart tech
Researchers are increasingly learning how the integration of advanced technologies into oncology pathways can simplify and improve patient outcomes.3 In a federally funded randomized clinical trial of more than 350 head and neck cancer patients undergoing radiation therapy, mobile and sensor-based connected health technology made it possible to provide speedier and more efficient responses that reduced symptom severity and eased the burden of treatment.3
The most frequent side effect of radiation therapy for head and neck cancer patients is moderate-to-severe difficulty in swallowing, or mucositis, which can result in dehydration, hospitalization, and poor quality-of-life.4 Enabling physicians to respond and intervene at the earliest signs of dehydration or other symptoms it is proving it can have a significant impact on patient outcomes.3,4
Patients randomized to the technology-plus-usual care group attended regular doctor visits and were remotely monitored on a daily basis.3 They received Bluetooth-enabled devices, including a weight scale and blood pressure cuff, as well as a mobile tablet loaded with a tracking app for patient-reported outcomes.3 Data collected by the app was sent directly to their physicians every weekday in order to closely monitor their well being, including early detection of emerging side effects so they could be addressed before reaching emergency status.3 By comparison, the usual care group was monitored only during doctor visits.3 Overall adherence to daily monitoring by the intervention group was higher than expected at 80 percent given the intensity of radiotherapy.3
Symptom surveys covering general cancer (fatigue, nausea, pain) as well as specific head and neck cancer concerns (swallowing, food tasting, rashes, skin burning) were completed at the start and end of radiation therapy, and again six to eight weeks after the completion of treatment.3 Scores at the start of treatment were similar for both groups.3 After radiotherapy, about six to seven weeks later, self-reported symptom severity scores for general cancer concerns were lower/better (2.9) for the remote monitoring group compared to the usual care participants (3.4).3 Scores for symptoms specific to head and neck cancer were also lower/better (4.2) for the connected health group versus the usual care group (4.8).3
Follow-up scores at six to eight weeks after radiation therapy was complete for the remote monitoring group were lower/better (1.6) for overall health compared to the usual care group (1.9).3 Symptom severity scores specific to head and neck cancer were also lower/better (1.7) for the connected health study participants compared to the usual care group (2.1).1
Navigating the connected cancer journey
Cancer navigators who help patients along their medical journey realized their interactions decreased over time after diagnosis.5 As a result, recommendations for helping patients with various issues, such as reducing anxiety, are less likely to be provided.5 Wanting to stay connected with patients led the care teams at four health systems to investigate whether leveraging connected health technology could boost services offered by the navigators and improve patient outcomes.5
Fifty breast cancer patients in rural Georgia who face a variety of challenges because of their remote geography received help, guidance, and support from a unique mobile app that delivers holistic cancer care in the form of personalized recommendations.5 Each app is programmed with a specific patient's medical data and is also capable of addressing a range of issues from how to prepare for surgery and combat side effects, to insurance and social or emotional issues.5 Artificial intelligence is used to enable the app to adapt to each phase of a patient's cancer journey by adjusting each time progress is made.5
Every app contains a library of reputable resources from the American Cancer Society and similar organizations.5 Personalization is then programmed in and includes an individual patient's caregiver contact information, diagnosis, and treatment plan, along with procedure dates and other key events.5 Along the way, patients complete surveys on a regular basis that continuously inform the artificial intelligence system and care team about changing needs and symptoms as they arise in real-time.5
What this means is that each patient receives suggestions and resources specific only to their personal cancer journey versus having to dig through an internet full of highly technical irrelevant information or other apps that do not offer personalization.5 For example, if a patient with stage two breast cancer has a lumpectomy scheduled they can click on the "Preparing for Surgery" section and find custom-selected articles that will help inform and prepare them.5 When a patient reports nausea while completing one of the system's surveys, the app will alert them to useful information that may help improve their symptoms.5 Many of the most popular app features are not directly related to cancer and instead are frequently clicked buttons that help patients with "Emotional Support" and "Day to Day Matters."5
The app's personalization capabilities were a result of patient feedback and future plans include expansion to cancer survivors.5 A version that can be directly downloaded by individual patients to make it available to many more users is also under consideration.5
Connected health technology improves survival
In an earlier cancer research center study, investigators were looking to document the impact of patient-reported outcomes on clinical outcomes among 766 metastatic breast, genitourinary, gynecologic, and lung cancer patients receiving chemotherapy for advanced solid tumors.2 Study participants were randomized into two groups with one receiving routine between visit monitoring via tablet-based patient-reported outcomes surveys.2 The usual care cohort received in-person doctor visits only.2
While the primary outcome of health-related quality of life at six months was more likely to improve for members of the patient-reported outcomes group (34 percent) compared to the usual care group (18 percent), there were also observed benefits in survival and health service outcomes.2 Additionally, members of the usual care group visited the emergency department (41 versus 34 percent) or were hospitalized (49 versus 45 percent) more frequently compared to the intervention group.2
Study participants in the routinely monitored patient-reported outcomes group were also able to continue their chemotherapy treatment longer (8.2 versus 6.3 months) than those in the usual care group.2 And at one year, researchers found more patients in the intervention group (75 percent) were likely to have survived than those in the usual care group (69 percent).2
Research is increasingly demonstrating that patients are willing to self-report via mobile and web-based connected health tools even during intense treatment creating the opportunities to improve precision and patient-centered cancer care for the right patient at the right time.2
REFERENCES:
- Is Connected Health Contributing to a Healthier Population?. JMIR https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701967/ Accessed 4/2/2019
- Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial. Journal of Clinical Oncology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872028/ AND https://ascopubs.org/doi/10.1200/JCO.2015.64.9491 Accessed 4/2/2019
- Smart technology helps improve outcomes for patients with head and neck cancer. News-Medical.net Medical & Life Sciences New https://www.news-medical.net/news/20180517/Smart-technology-helps-improve-outcomes-for-patients-with-head-and-neck-cancer.aspx Accessed 4/2/2019
- CYCORE System May Improve Radiotherapy-Associated Symptoms in Head and Neck Cancer. Cancer Therapy Advisor https://www.cancertherapyadvisor.com/home/news/conference-coverage/american-society-of-clinical-oncology-asco/asco-2018/cycore-system-may-improve-radiotherapy-associated-symptoms-in-head-and-neck-cancer/ Accessed 4/2/2019
- Novel App Uses AI to Guide, Support Cancer Patients. Georgia Tech News Center https://www.news.gatech.edu/2019/02/16/novel-app-uses-ai-guide-support-cancer-patients Accessed 4/2/2019
