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Monitoring tool lowers symptom severity for head, neck cancer
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Patients with head and neck cancer who underwent remote monitoring by a mobile app and sensor technology had less severe symptoms than patients who had weekly doctor visits, according to a study scheduled for presentation at the ASCO Annual Meeting.
Both cancer- and treatment-related symptoms appeared less severe among the technology-monitored group. Clinicians detected concerning symptoms early and responded to them more rapidly.
“Head and neck cancer patients who receive radiation treatment have a high symptom burden and are also at increased risk for dehydration during treatment,” Susan K. Peterson, PhD, professor in the department of behavioral science at The University of Texas MD Anderson Cancer Center, said during a press conference. “Previously, we showed that it was feasible to use mobile and sensor technology to identify treatment-related symptoms and early dehydration in patients while receiving their radiation treatment as part of their outpatient care.”
Peterson and colleagues studied 357 patients (mean age, 60 years; 21% women; 85% white) receiving radiation for head and neck cancer.
Researchers randomly assigned patients to usual care (n =188) or to a technology system called CYCORE (n = 169) — developed by four institutions with a grant from the NCI — which included Bluetooth-enabled blood pressure cuffs and weights scales, as well as a mobile tablet with a symptom tracking app. The CYCORE technology transmitted symptom data back to the patient’s physician.
“Patients’ ages ranged up to 86 years, which supports the notion that the use of technology-based intervention can be feasible in older patients,” Peterson said. “Also, we had good adherence to the CYCORE regimen.”
More than 80% of patients adhered to daily monitoring.
All patients had weekly in-person doctor visits.
Patients completed the MD Anderson Symptom Inventory at baseline, at the end of their radiation therapy, and 6 to 8 weeks following the completion of radiation therapy. Patients scored their symptoms on a scale of 0 to 10, where 0 indicated no symptom or pain and 10 indicated the highest level of symptom severity
Baseline symptom severity score did not differ between the two groups.
At the completion of radiation therapy, patients monitored with CYCORE had lower mean scores for general symptoms (2.9 vs. 3.4; P = .003) and head and neck cancer-related symptoms (4.2 vs. 4.8; P = .009) than those who received usual care.
The technology-monitored group also had better symptom scores at 6 to 8 weeks after radiation therapy (general, 1.69 vs. 1.96; P = .003; cancer specific, 1.78 vs. 2.11; P = .009).
“Good patient adherence — plus the fact that this posed a minimal burden on clinicians to do the monitoring — supports the use of symptoms like CYCORE during intensive treatment periods in cancer care,” Peterson said. “Using sensor and mobile technology to monitor patients during critical periods of outpatient treatment can provide a timely source of information for clinical decision-making and may improve quality of life and health outcomes.”
The next steps include working to implement these technologies into cancer care, including in community centers, where most patients receive their care, according to Peterson. – by Cassie Homer
Reference:
Peterson SK, et al. Abstract 6063. Scheduled for presentation at: ASCO Annual Meeting; June 1-5, 2018; Chicago.
Disclosures: Peterson reports no relevant financial disclosures. One author reports a consultant/advisory role with Ayala Pharmaceuticals and institutional research funding from AstraZeneca/MedImmune, EMD Serono, G1 Therapeutics, Genentech/Roche, Merck Serono and OncoMed.
Perspective
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Jorge Nieva, MD
The internet is everywhere. We use it for everything from communicating with colleagues to buying shoes. And, if those shoes are delivered a day late, we get a notification from tracking software telling us where our package is located. But, until recently, such technology did not apply to patients. For example, we often did not find out when patients had been struggling at home, unable to eat for the past week, until they came in for their previously scheduled appointment, dehydrated and ready for hospital admission.
Peterson and colleagues’ study of CYCORE technology illustrates how the “Internet of Things” can also be the “Internet of Patients.” Computer-enabled outpatient monitoring of symptoms with the use of patient reported outcome metrics, internet-connected scales and blood pressure cuffs can bring data from where people live all the way to the clinic, and those who are caring for the patient remotely can learn how sick the patient is getting in their absence in real time.
The study demonstrated that access to this information empowers physicians to intervene earlier, thus alleviating symptoms, and providing a higher standard of care.
Many other industries that are far more commonplace than health care have eagerly found their place in the Internet of Things to make life more convenient for consumers, whereas health care — which should be driven by technology and innovation — has yet to do the same for patients. It could be that physicians do not yet feel empowered to analyze the readouts from real-time monitoring and make medical decisions, or that this responsibility has not been fully incorporated in a physician or caretaker’s scope of work. We must also ensure that the benefits of the new Internet of Patients are not exclusive to the young, the technology-literate or only those who can afford at-home Wi-Fi. Failing to do so could widen already existing socioeconomic disparities in health care delivery.
All these issues can be overcome, and should be. After all, shouldn’t our best communication technology apply to curing cancer?
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