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Web application-guided follow-up may improve survival in high-risk lung cancer
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CHICAGO — Patients who self-reported symptoms using a web application experienced earlier detection of relapse and improved survival, according to a results of a randomized phase 3 trial presented at the ASCO Annual Meeting.
“We would likely see the same results if we called patients as often, but that is not possible,” Fabrice Denis, MD, PhD, researcher at the Institut Inter-regional de Cancérologie Jean Bernard in Le Mans, France, said during a press briefing. “Early relapse detection is essential for lung cancer patients because 3 or 4 weeks with symptoms which go unreported can lead to poor outcomes.”
Patricia Ganz
Research shows that patients who self-report symptoms are more likely to have their relapses detected early and undergo earlier supportive care than patients who only communicate with their physicians during scheduled visits.
Denis and colleagues sought to evaluate the effectiveness of using a mobile application to monitor patient-reported symptoms.
The analysis included data from 121 patients (median age, 65 years), 90% of whom had stage III or stage IV lung cancer.
Researchers randomly assigned patients to a clinical routine assessment with a CT scan every 3 to 6 months or at investigator decision (n = 61) or to follow-up using the web application to send weekly reviews of self-scored symptoms between planned visits (n = 60). Oncologists were alerted via email when a patient in the experimental arm reported a predefined criterion, and the patient then underwent imaging. Patients also underwent early supportive care when the symptoms warranted it.
The study was designed to detect a 12% improvement in 9-month OS. Secondary outcomes included performance status after first relapse, PFS and quality of life.
Median follow-up was 9 months.
Overall, rates of OS were higher in the web application arm at 9 months (79% vs. 59%) and 12 months (75% vs. 49%).
Median OS for patients in the web-application arm was 19 months compared with 12 months for the control arm (HR = 0.33; 95% CI, 0.16-0.67).
Relapse rates were similar in the web-application and control arms (51% vs. 49%). However, patients in the web-application arm were more likely to be in a high health condition at relapse than the control arm. The median ECOG performance status was 0 to 1 in 77% of the experimental arm compared with 33% the control arm.
Patients in the web-application arm also were more likely to receive optimal therapy (74% vs. 33%; P < 0.001).
Patients in the web-application arm underwent 50% fewer imaging procedures compared with the control arm.
“If there was a drug that caused this level of benefit, we would use it,” Patricia Ganz, MD, FASCO, director of the center for cancer prevention and control research at the Jonsson Comprehensive Cancer Center and professor at Fielding School of Public Health and David Geffen School of Medicine at UCLA, said at the briefing. “Further, this is personalized medicine. The data show that it is easy to use for patients and that performing tests as needed, instead of on a schedule, is a more efficient use of resources.” – by Nick Andrews
References:
Denis F, et al. Abstract 9006. Presented at ASCO Annual Meeting; June 3-7, 2016; Chicago.
Disclos ure: Denis reports honoraria from, patents/royalties with and expert testimony for Chugai Pharma, Roche/Genentech, Siva and Takeda. Please see the abstract for a list of all other researchers’ relevant financial disclosures.
Perspective
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Gregory Masters, MD, FACP, FASCO
Lung cancer is a unique cancer in some ways because a lot of patients have some guilt about their diagnosis and so they do not want to bother their physicians, nurses or caregivers with their symptoms. This is one way to engage patients and allow them to take a more active role in their care.
This study does not prove that mobile applications are the only way or the best way, but it is one way to get the patient more involved. The survival data look very encouraging, but we need to add context and evaluate how implementation of this data would work in practice. It would require a change in the dynamics of a patient's care team by including nurses and staff, as well as a change in how patients are educated.
This may not be the best way to monitor patients who have worse disease or patients who are not comfortable with mobile technology. In those cases, implementing a monitoring system like this could add difficulty.
Regardless, this research is important to help guide future research and practice.
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