March 2017 VOL 8, NO 3
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International Association for the Study of Lung Cancer
eHealth and Supportive Care in Thoracic Oncology
Remote monitoring can improve quality of care and patient outcomes in the management of people with cancer, according to Roma Maguire, PhD, MSc, BN, RGN.
“Today we’re seeing huge advances in technology, but I would argue that in healthcare, we haven’t totally embraced the technological revolution and all of the ways we can use technology to enhance health outcomes,” said Dr Maguire at the International Association for the Study of Lung Cancer 17th World Conference on Lung Cancer in Vienna, Austria.
Healthcare systems have evolved from a hospital-focused system to one more focused on delivering care in local settings, closer to where patients actually live. According to Dr Maguire, Professor of Cancer Care and Head of eHealth at the School of Health Sciences at the University of Surrey in the United Kingdom, only patients with complex health needs should be managed in the hospital. “In the future we’ll have too many people with multiple comorbidities, and we don’t have enough workforce to deal with these patients in a face-to-face manner,” she stated. “So we need to look at ways to embrace technology to enhance our care of patients.”
She said the future of care in local settings involves a system of “connected health” that connects people and information within a system. Connected health consolidates information from many different components of a person’s world to give a more complete picture of their health (biologic, genetic, mood, medical, lifestyle, etc). The system aggregates data to inform service provision and medical innovation and enables care to be provided in the best location, by the best person, using the most relevant and efficient methods. “This technology allows information to travel with the patient so they don’t have to keep recounting what’s happened to them over and over again,” she said. “And with these data we can personalize care to the individual and allow this information to cross many pathways.”
eHealth and Lung Cancer
People with lung cancer typically experience more symptoms than people with other cancer types. This symptom burden and high level of supportive care needs have a negative impact on patient outcomes such as quality of life and physical functioning, she said.
Patient-reported outcome measures (PROMs) can help to manage and measure the patient experience, particularly when dealing with the high burden of lung cancer. Reported benefits of PROMs in clinical practice include the identification of patient concerns, more timely reporting and management of symptoms, less patient anxiety and greater patient satisfaction with care, improved communication between patients and health professionals, and the promotion of self-care.
“We can use that information to really direct how we manage clinical decision-making, how we personalize care, and how we care for individuals within the context of their own illness and their own lives,” she said, noting that an even greater benefit is observed when patient-reported outcomes are collected electronically on a tablet or mobile phone. Electronically reported PROMs allow for systematic assessment in real time, expanded geographic access (benefiting patients in rural areas), and rapid therapeutic response. “A patient can report his or her needs or symptoms, and a professional can respond in a matter of minutes, which is very powerful,” she noted.
ASyMS: Advanced Symptom Management System
Dr Maguire and her colleagues established the ASyMS program of research, one of the most evolved and tested mobile health systems in cancer care. The program was developed in conjunction with actual cancer patients and clinicians, and it employs a rigorous framework for intervention development. Patients in ASyMS trials use a dedicated mobile phone rather than an app, and after each study, data collected from the mobile phones are used to shape future trials.
Patients enrolled in the trials complete daily questionnaires on their mobile phones. Questions are slightly adapted for varying populations, and the information is sent in real time to a study server where it triggers an alert to cancer specialists at the clinic site. A clinician receives the alert on a mobile phone and responds to the patient immediately if deemed appropriate. Red alerts are urgent patient complaints like neutropenic sepsis or high temperature, whereas amber alerts are considered less urgent.
Patients also receive evidence-based self-care advice to their mobile phone, tailored to the symptoms they have reported. “This is very much an evidence-based system, and we really feel it can improve the quality of care,” she said. “When clinicians are managing symptoms, it’s impeccable what that can bring to your clinical decision-making.”
Dr Maguire and colleagues performed 2 ASyMS trials in patients with lung cancer—one examining the feasibility and acceptability of palliative care in the lung cancer setting, and one following patients through treatment with thoracic radiotherapy—and feedback from patients in both studies was overwhelmingly positive.
Patients reported feeling safe, reassured and cared for, albeit virtually, and they found the rapid clinician responses especially helpful. The simplicity of the program was also well received, and some patients found that the simple advice activated them to self-care. It also allowed patients to track their symptoms over time, which reportedly gave them a better handle on their symptoms.
According to Dr Maguire, healthcare professionals reported feeling more prepared to speak with patients. “When clinicians are prepared, they can be thinking about possible interventions to suggest to the patient,” she said. Professionals also commented on the benefit of the program’s self-care component.
To date, Dr Maguire and colleagues have developed ASyMS patient support systems for chemotherapy (their most evolved system), hematology, palliative care, teenagers with cancer, and radiotherapy, and a mesothelioma program is currently in development. Dr Maguire is also principal investigator for the EU FP7 eSMART study, which will evaluate the impact of a mobile phone–based remote patient monitoring system on chemotherapy-related toxicity on 1000 patients in 5 European countries.
“We do need more large-scale trials in this patient group, and particularly in supportive care,” said Dr Maguire. “What I’d like to see is a much more holistic assessment; if we can build that into the remote monitoring component of our system, we might see even better results.”
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