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Lehmann J, de Ligt KM, Tipelius S, Giesinger JM, Sztankay M, Voigt S, van de Poll-Franse LV, Rumpold G, Weger R, Willenbacher E, Willenbacher W, Holzner B. Adherence to Patient-Reported Symptom Monitoring and Subsequent Clinical Interventions for Patients With Multiple Myeloma in Outpatient Care: Longitudinal Observational Study. J Med Internet Res 2023; 25:e46017. [PMID: 37606979 PMCID: PMC10481208 DOI: 10.2196/46017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The use of software to monitor patient-reported outcome measures (PROMs) can improve outcomes for patients with cancer receiving anticancer therapy; however, evidence from applications used in routine clinical practice is lacking. OBJECTIVE We aimed to investigate adherence to and patient perceptions of a weekly, web-based PROM symptom monitoring program in routine clinical practice for patients with Multiple Myeloma. Moreover, we aimed to capture how clinical alerts prompted by the system influenced clinical care. METHODS We conducted a single-center longitudinal observational study to evaluate patient adherence to and perceptions of the PROM monitoring software in routine practice. Patients with Multiple Myeloma remotely completed weekly treatment-specific PROMs to monitor key symptoms via a dedicated web-based platform. Alarming symptoms triggered clinical alerts in the application for the treatment team, which could initiate clinical interventions. The primary outcomes were the web-based assessment completion rate and patients' perceptions of the monitoring program, as assessed by an evaluation questionnaire. Moreover, clinical alerts prompted by the system and consequential clinical interventions were analyzed. RESULTS Between July 2021 and June 2022, a total of 55 patients were approached for participation; 39 patients participated (24, 61% male, mean age 63.2, SD 9.2 years). The median assessment completion rate out of all weekly scheduled assessments was 70.3% (IQR 41.2%-89.6%). Most patients (77%) felt that the health care team was better informed about their health status due to the web-based assessments. Clinical alerts were triggered for 1758 of 14,639 (12%) reported symptoms. For 548 of 1758 (31.2%) alerts, the symptom had been registered before and no further action was required; for 348 of 1758 (19.9%) alerts, telephone consultation and self-management advice sufficed. Higher-level interventions were seldom needed in response to alerts: referral to a doctor or specialist (88/1758, 5% alerts), medication changes (22/1758, 1.3%), scheduling additional diagnostics (9/1758, 0.5%), or unplanned emergency visits (7/1758, 0.4%). Most patients (55%) reported the calls in response to alerts gave them "quite a bit" or "very much" of an added feeling of security during therapy. CONCLUSIONS Our study shows that high adherence to regular and tailored PROM monitoring can be achieved in routine clinical care. The findings provide valuable insight into how the PROM monitoring program and the clinical alerts and resulting interventions shaped clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT05036863; https://clinicaltrials.gov/study/NCT05036863.
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Affiliation(s)
- Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
- Syndena GmbH, Innsbruck, Austria
| | - Kelly M de Ligt
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Johannes M Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Sztankay
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sandra Voigt
- Syndena GmbH, Innsbruck, Austria
- Internal Medicine V: Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lonneke V van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, Netherlands
| | - Gerhard Rumpold
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
- Evaluation Software Development GmbH, Innsbruck, Austria
| | | | - Ella Willenbacher
- Internal Medicine V: Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Syndena GmbH, Innsbruck, Austria
- Internal Medicine V: Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
- Evaluation Software Development GmbH, Innsbruck, Austria
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2
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Ruseckaite R, Mudunna C, Caruso M, Ahern S. Response rates in clinical quality registries and databases that collect patient reported outcome measures: a scoping review. Health Qual Life Outcomes 2023; 21:71. [PMID: 37434146 DOI: 10.1186/s12955-023-02155-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Patient Reported Outcome Measures (PROMs) are being increasingly introduced in clinical registries, providing a personal perspective on the expectations and impact of treatment. The aim of this study was to describe response rates (RR) to PROMs in clinical registries and databases and to examine the trends over time, and how they change with the registry type, region and disease or condition captured. METHODS We conducted a scoping literature review of MEDLINE and EMBASE databases, in addition to Google Scholar and grey literature. All English studies on clinical registries capturing PROMs at one or more time points were included. Follow up time points were defined as follows: baseline (if available), < 1 year, 1 to < 2 years, 2 to < 5 years, 5 to < 10 years and 10 + years. Registries were grouped according to regions of the world and health conditions. Subgroup analyses were conducted to identify trends in RRs over time. These included calculating average RRs, standard deviation and change in RRs according to total follow up time. RESULTS The search strategy yielded 1,767 publications. Combined with 20 reports and four websites, a total of 141 sources were used in the data extraction and analysis process. Following the data extraction, 121 registries capturing PROMs were identified. The overall average RR at baseline started at 71% and decreased to 56% at 10 + year at follow up. The highest average baseline RR of 99% was observed in Asian registries and in registries capturing data on chronic conditions (85%). Overall, the average RR declined as follow up time increased. CONCLUSION A large variation and downward trend in PROMs RRs was observed in most of the registries identified in our review. Formal recommendations are required for consistent collection, follow up and reporting of PROMs data in a registry setting to improve patient care and clinical practice. Further research studies are needed to determine acceptable RRs for PROMs captured in clinical registries.
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Affiliation(s)
- Rasa Ruseckaite
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia.
| | - Chethana Mudunna
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Marisa Caruso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
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3
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Page KM, Spellman SR, Logan BR. Worldwide sources of data in haematology: Importance of clinician-biostatistician collaboration. Best Pract Res Clin Haematol 2023; 36:101450. [PMID: 37353283 DOI: 10.1016/j.beha.2023.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/19/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
The field of haematology has benefitted greatly from registry-based observational research. Medical and technical advances, changes in regulations and events such as the global pandemic is changing the landscape for registries. This review describes features of high-quality registries, statistical approaches and study design needed, an overview of worldwide hematologic registries, and how registries are evolving and expanding. The importance of collaborations between biostatisticians and haematologists in designing and conducting registry-related research is highlighted.
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Affiliation(s)
- Kristin M Page
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA.
| | | | - Brent R Logan
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin (MCW), Milwaukee, WI, USA.
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4
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Kiderlen TR, Schnack A, de Wit M. Essential barriers and considerations for the implementation of electronic patient-reported outcome (ePRO) measures in oncological practice: contextualizing the results of a feasibility study with existing literature. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-18. [PMID: 36320803 PMCID: PMC9613453 DOI: 10.1007/s10389-022-01767-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/16/2022] [Indexed: 12/02/2022]
Abstract
Aim Monitoring electronic patient-reported outcomes (ePRO) can provide various benefits to cancer patients, such as enhanced quality of life, reduction of hospital admissions, and even prolonged survival. Furthermore, ePRO might offer significant benefits to patients under antineoplastic treatment in the context of the current COVID-19 pandemic. However, evidence on feasibility of ePRO in routine cancer care and barriers met in a real-life setting remains limited. Subject and methods We conducted a feasibility study among patients diagnosed with multiple myeloma currently under antineoplastic treatment. Patients filled out weekly ePRO questionnaires and were followed up for 6 months. In case of adverse events, an alert was sent to the clinic. We assessed uptake and adherence, as well as subjective perceptions of patients and clinic staff. A semi-structured literature review was conducted to contextualize results. Results Eleven patients were recruited and followed up for 6 months. Overall adherence was found at a high level and remained stable throughout the study period. Feedback from patients was positive; however, clinic staff expressed disappointment and frustration, criticising an increase of workload while not perceiving any benefit to the oncological treatment. Both findings were backed by evidence we found in literature. Conclusions Implementation of ePRO monitoring to routine cancer treatment seems to be feasible regarding patients' acceptance and compliance. However, integration of the tool into clinical workflow without increasing workload and deterring clinicians proves to be a major challenge. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01767-3.
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Affiliation(s)
- Til Ramón Kiderlen
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Alexandra Schnack
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, Berlin, Germany
| | - Maike de Wit
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, Berlin, Germany
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Lehmann J, Schreyer I, Riedl D, Tschuggnall M, Giesinger JM, Ninkovic M, Huth M, Kronberger I, Rumpold G, Holzner B. Usability evaluation of the Computer-Based Health Evaluation System (CHES) eDiary for patients with faecal incontinence: a pilot study. BMC Med Inform Decis Mak 2022; 22:81. [PMID: 35346170 PMCID: PMC8962247 DOI: 10.1186/s12911-022-01818-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background Faecal incontinence (FI) is prevalent in 15–20% of elderly individuals and is frequently monitored in clinical trials and practice. Bowel diaries are the most common way to document FI, but, in clinical practice, are mainly used as paper-based versions. Electronic diaries (eDiaries) offer many potential benefits over paper-based diaries. The aim of this study was to develop and test an eDiary to document FI. Methods We migrated a paper FI diary to an eDiary app based on the Computer-based Health Evaluation System (CHES). To assess usability, we conducted functionality and usability tests at two time points in a sample of patients with FI. In the first assessment, the eDiary functionalities were tested, patients completed the System Usability Scale (SUS, range 0–100) and compared the paper diary with the eDiary. We set a threshold for minimum acceptable average usability at 70 points. Patients were then instructed to use the eDiary for 2 days at home and contacted to report on their usage and completed the SUS a second time.
Results We recruited a sample of N = 14 patients to use the eDiary. All patients were able to use all functionalities of the eDiary and only a few patients with lower technological literacy or access to devices (n = 3) needed initial assistance. The mean usability rating given at the first time point was high with 88 points (SD 18, 95% CI 78.2–96.8) and most patients (n = 10) reported they would prefer the eDiary over the paper-based version. Nine patients (n = 9) participated in the follow-up assessment and the mean SUS rating at the second time point was 97 points (SD 7, 95% CI 92.8–100). Conclusion The eDiary showed excellent usability scores for the assessment of FI at both assessments. Generally, patients preferred the eDiary over the paper-based version. We recommend the eDiary for usage with patients who own and use a smartphone and discuss potential solutions for patients with lower technological literacy or access. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01818-5.
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Affiliation(s)
- Jens Lehmann
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Isabel Schreyer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - David Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | | | - Johannes M Giesinger
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Marjiana Ninkovic
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Marcus Huth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Irmgard Kronberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Evaluation Software Development, Innsbruck, Austria
| | - Bernhard Holzner
- Evaluation Software Development, Innsbruck, Austria.,University Hospital of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
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Jagannath S, Mikhael J, Nadeem O, Raje N. Digital Health for Patients With Multiple Myeloma: An Unmet Need. JCO Clin Cancer Inform 2021; 5:1096-1105. [PMID: 34735265 DOI: 10.1200/cci.20.00145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Multiple myeloma (MM) is associated with the highest symptom burden and lowest health-related quality of life (HRQoL) among patients with hematologic malignancies. HRQoL in MM is heterogeneous, varying over the course of disease, with the highest burden at diagnosis and relapse. Patients with MM are increasingly being treated with oral maintenance medications at home. As a result, longitudinal monitoring of medication adherence and patient-reported outcomes, including HRQoL, could inform on disease status, therapeutic tolerability, and satisfaction with care. Digital health technologies, including telemedicine, mobile health, and wearable devices, are poised to become an integral part of modern health care, in part due to the surge in telemedicine necessitated by the COVID-19 pandemic. Although the literature has many reports on the use of digital health technologies in other types of cancers, fewer studies report on their application to MM. In the current narrative review, we survey the applications of digital health for MM. Although there is evidence that some are associated with improved health outcomes, challenges exist that must be met to ensure more widespread adoption. These include the need for increased awareness by patients and health care providers, lack of access by the typical older patient with MM, absence of randomized clinical trials, and low integration with current workflows such as electronic health records. Following our summary of technologies that could benefit patients with MM, we end by describing our vision for how they can be integrated into each phase of the patient journey.
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Affiliation(s)
| | - Joseph Mikhael
- Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Phoenix, AZ
| | - Omar Nadeem
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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7
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Lehmann J, Buhl P, Giesinger JM, Wintner LM, Sztankay M, Neppl L, Willenbacher W, Weger R, Weyrer W, Rumpold G, Holzner B. Using the Computer-based Health Evaluation System (CHES) to Support Self-management of Symptoms and Functional Health: Evaluation of Hematological Patient Use of a Web-Based Patient Portal. J Med Internet Res 2021; 23:e26022. [PMID: 34100765 PMCID: PMC8262597 DOI: 10.2196/26022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
Background Patient portals offer the possibility to assess patient-reported outcome measures (PROMs) remotely, and first evidence has demonstrated their potential benefits. Objective In this study, we evaluated patient use of a web-based patient portal that provides patient information and allows online completion of PROMs. A particular focus was on patient motivation for (not) using the portal. The portal was developed to supplement routine monitoring at the Department of Internal Medicine V in Innsbruck. Methods We included patients with multiple myeloma and chronic lymphocytic leukemia who were already participating in routine monitoring at the hospital for use of the patient portal. Patients were introduced to the portal and asked to complete questionnaires prior to their next hospital visits. We used system access logs and 3 consecutive semistructured interviews to analyze patient use and evaluation of the portal. Results Between July 2017 and August 2020, we approached 122 patients for participation in the study, of whom 83.6% (102/122) consented to use the patient portal. Patients were on average 60 (SD 10.4) years old. Of patients providing data at all study time points, 37% (26/71) consistently used the portal prior to their hospital visits. The main reason for not completing PROMs was forgetting to do so in between visits (25/84, 29%). During an average session, patients viewed 5.3 different pages and spent 9.4 minutes logged on to the portal. Feedback from interviews was largely positive with no patients reporting difficulties navigating the survey and 50% of patients valuing the self-management tools provided in the portal. Regarding the portal content, patients were interested in reviewing their own results and reported high satisfaction with the dynamic self-management advice, also reflected in the high number of clicks on those pages. Conclusions Patient portals can contribute to patient empowerment by offering sought-after information and self-management advice. In our study, the majority of our patients were open to using the portal. The low number of technical complaints and average time spent in the portal demonstrate the feasibility of our patient portal. While initial interest was high, long-term use was considerably lower and identified as the main area for improvement. In a next step, we will improve several aspects of the patient portal (eg, including a reminder to visit the portal before the next appointment and closer PROM symptom monitoring via an onconurse).
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Affiliation(s)
- Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.,Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Petra Buhl
- Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Johannes M Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Lisa M Wintner
- University Hospital of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Sztankay
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Lucia Neppl
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria.,Internal Medicine V: Haematology & Oncology, Innsbruck University Hospital, Innsbruck, Austria
| | - Roman Weger
- Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | | | - Gerhard Rumpold
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria.,Evaluation Software Development GmbH, Innsbruck, Austria
| | - Bernhard Holzner
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.,Evaluation Software Development GmbH, Innsbruck, Austria
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Efficace F, Breccia M, Fazi P, Cottone F, Holzner B, Vignetti M. The GIMEMA-ALLIANCE Digital Health Platform for Patients With Hematologic Malignancies in the COVID-19 Pandemic and Postpandemic Era: Protocol for a Multicenter, Prospective, Observational Study. JMIR Res Protoc 2021; 10:e25271. [PMID: 33890580 PMCID: PMC8171289 DOI: 10.2196/25271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 01/03/2023] Open
Abstract
Background The COVID-19 pandemic has raised unprecedented challenges in the management of patients with cancer and has increased the demands for digital health tools that, for example, could facilitate remote monitoring of patients. Based on this, the Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) has recently developed a digital health tool dedicated to patients with hematologic malignancies: the GIMEMA-ALLIANCE platform. Objective The main objectives of this web-based platform are to generate relevant data to better understand quality of life, symptoms, and medication adherence during the COVID-19 pandemic and postpandemic era; to develop a prospective real-life registry on outcomes of patients with hematologic cancer, with or without a diagnosis of COVID-19; and to facilitate patient-centered care in routine practice. Methods The platform consists of physician- and patient-secure portals and enables electronic patient-reported outcome (ePRO) assessments with real-time graphical presentation to physicians of individual patient symptoms and quality-of-life outcomes. Automated alerts are sent to treating hematologists based on the following predetermined criteria: presence of clinically important problems and symptoms, problems with adherence to therapy, and risk of COVID-19 diagnosis. The platform also allows physicians to set up video consultations. Clinical information regarding disease and treatment as well as clinical and survival outcomes are also prospectively collected. Results Recruitment of participants started in December 2020. As of April 2021, a total of 116 patients have been enrolled in this study. Use of this platform may help to improve patient-physician communication and help hematologists in the early recognition of clinically important problems and symptoms of their patients. More than 20 community and university-based hospitals have currently agreed to participate. In addition to patient-reported outcome data, the prospective collection of disease- and treatment-related information, as well as data on possible COVID-19 diagnosis and COVID-19 vaccination, will allow the development of a large database to also identify subgroups of patients at risk of poor outcomes. Conclusions Data generated via this platform will help to answer clinically relevant questions for patients with hematologic malignancies during the COVID-19 pandemic and postpandemic era. The use of the GIMEMA-ALLIANCE platform in routine practice may also contribute to enhancing patient-centered care. Trial Registration ClinicalTrials.gov NCT04581187; https://clinicaltrials.gov/ct2/show/NCT04581187 International Registered Report Identifier (IRRID) PRR1-10.2196/25271
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Affiliation(s)
- Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Massimo Breccia
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | - Paola Fazi
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Francesco Cottone
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Bernhard Holzner
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.,Evaluation Software Development Ltd, Innsbruck, Austria
| | - Marco Vignetti
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
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Koinig KA, Arnold C, Lehmann J, Giesinger J, Köck S, Willenbacher W, Weger R, Holzner B, Ganswindt U, Wolf D, Stauder R. The cancer patient's perspective of COVID-19-induced distress-A cross-sectional study and a longitudinal comparison of HRQOL assessed before and during the pandemic. Cancer Med 2021; 10:3928-3937. [PMID: 33973411 PMCID: PMC8209623 DOI: 10.1002/cam4.3950] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background To permit timely mitigation of adverse effects on overall clinical outcome, it is essential to understand how the pandemic influences distress and health‐related quality of life (HRQOL) in cancer patients during the coronavirus disease 2019 (COVID‐19) pandemic. Methods In this cross‐sectional study, adult cancer patients, without COVID‐19 symptoms, completed a 13‐item questionnaire about the pandemic's impacts on distress and everyday‐life; associations with age, sex, or impaired HRQOL were then assessed by binary logistic regressions. In a subsample of patients with HRQOL assessment available from both before and during the pandemic, we evaluated the pandemic's impact on longitudinal changes in HRQOL reported within 6 months before versus during the COVID‐19 lockdown using McNemar's test, and thresholds for clinical importance. Results We consecutively enrolled 240 patients with solid (50%) or hematological (50%) cancers. Median age was 67 years, 46% were females. The majority ranked heeding their health (80%) and keeping their appointment schedule in hospital (78%) as important. Being younger than 60, or aged 60–70 was independently associated with limitations in everyday life (OR = 3.57, p < 0.001; and 2.05, p = 0.038); female individuals and those with restricted emotional functioning were more distressed by the COVID‐19 situation (OR = 2.47, p = 0.040; and 3.17, p = 0.019); the latter group was also significantly more concerned about being a patient at risk (OR = 2.21, p = 0.029). Interestingly, in a subsample of patients (n = 47), longitudinal comparisons pre‐ versus during the pandemic revealed that HRQOL was not substantially affected by the pandemic. Conclusion Particularly younger and female cancer patients, and those with impaired emotional functioning are distressed by COVID‐19. During the first COVID‐19 lockdown, cancer patients remained predominantly resilient. This analysis highlights the need to mitigate distress situations in vulnerable patients and thereby enhance resilience during pandemics.
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Affiliation(s)
- Karin A Koinig
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Arnold
- Department of Radiation Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.,OncoTyrol-Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Johannes Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Köck
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria.,OncoTyrol-Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Roman Weger
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria.,OncoTyrol-Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Bernhard Holzner
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Ute Ganswindt
- Department of Radiation Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik Wolf
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhard Stauder
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
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Peltola MK, Poikonen-Saksela P, Mattson J, Parkkari T. A Novel Digital Patient-Reported Outcome Platform (Noona) for Clinical Use in Patients With Cancer: Pilot Study Assessing Suitability. JMIR Form Res 2021; 5:e16156. [PMID: 33955841 PMCID: PMC8138702 DOI: 10.2196/16156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/07/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background As the incidence of cancer is on the rise, there is a need to develop modern communication tools between patients and the medical personnel. Electronic patient-reported outcome (ePRO) measures increase the safety of cancer treatments and may have an impact on treatment outcome as well. ePRO may also provide a cost-efficient way to organize follow-up for patients with cancer. Noona is an internet-based system for patients to self-report symptoms and adverse events of cancer treatments from home via a computer or a smart device (eg, smartphone, tablet). Objective In this pilot study, we assessed the suitability of a novel ePRO application (Noona) for patients with cancer, nurses, and doctors at the Helsinki University Hospital, Finland. Methods The study included 44 patients with cancer (different solid tumor types) and 17 health care professionals (nurses or medical doctors). Patients were either operated or received systemic treatment or radiotherapy. Patients reported their symptoms to the medical staff via Noona. In addition, patients and clinicians answered a questionnaire, based on which Noona’s suitability for clinical use was evaluated in terms of usability (ease of use, operability, and learnability), reliability (subjective opinion of the participant), and incidence of harmful events reported by the participants. Results A total of 41/44 (93%) patients and 15/17 (88%) professionals reported that the program was easy or quite easy to use; 38/44 (86%) patients and 11/17 (65%) professionals found Noona reliable, and 38/44 (86%) patients and 10/17 (59%) professionals would recommend Noona to other patients or their colleagues. No harmful incidences caused by the use of Noona were reported by the patients; however, 1 harmful incidence was reported by one of the professionals. Conclusions The majority of the participants felt that Noona appeared reliable and it was easy to use. Noona seems to be a useful tool for monitoring patient’s symptoms during cancer therapy. Future studies will determine the impact of this ePRO platform in routine clinical practice.
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Affiliation(s)
- Maria Kristiina Peltola
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki University, Helsinki, Finland
| | - Paula Poikonen-Saksela
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki University, Helsinki, Finland
| | - Johanna Mattson
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki University, Helsinki, Finland
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“Magnitude of clinical benefit” of solid tumour drugs and their real-world application in the Austrian health care setting. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sztankay M, Neppl L, Wintner LM, Loth FL, Willenbacher W, Weger R, Weyrer W, Steurer M, Rumpold G, Holzner B. Complementing clinical cancer registry data with patient reported outcomes: A feasibility study on routine electronic patient-reported outcome assessment for the Austrian Myelome Registry. Eur J Cancer Care (Engl) 2019; 28:e13154. [PMID: 31465136 PMCID: PMC6900154 DOI: 10.1111/ecc.13154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/22/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Routinely assessed patient-reported outcomes (PROs), such as quality of life (QOL), are important to supplement clinical cancer data but requires rigorous implementation. This study aims at depicting the implementation procedure and evaluating the feasibility of routine electronic PRO monitoring (ePRO) for collecting data supplementing the Austrian Myeloma Registry (AMR). METHODS Integration of ePRO monitoring into clinical routine was planned according to the Replicating Effective Programs framework. QOL data were assessed regularly during treatment and aftercare at the hematooncological outpatient unit at the Medical University of Innsbruck with the EORTC QLQ-C30/ +MY20 and the EQ-5D-5L. Feasibility and usability testing were performed via a multimethod approach. RESULTS Within the first year, 94.4% of the MM patients (N = 142, mean age 65.4, SD 11.8, 60% male) provided 748 PRO assessment time points overall. Patients and clinicians were satisfied with ePRO monitoring and indicated no to little disruption in clinical routine. Patient preference on assessment time points and completion frequency became evident. CONCLUSIONS Complementing the AMR with ePRO data proved to be feasible. Our findings provide useful insights for healthcare providers considering introducing ePRO monitoring to their units for informing clinical registries as well as individualised feedback to patients alike.
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Affiliation(s)
- Monika Sztankay
- Medical University of InnsbruckInnsbruckTirolAustria
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
- University of InnsbruckInnsbruckTirolAustria
| | - Lucia Neppl
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
| | - Lisa M. Wintner
- Medical University of InnsbruckInnsbruckTirolAustria
- University of InnsbruckInnsbruckTirolAustria
| | - Fanny L. Loth
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
| | - Wolfgang Willenbacher
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
- Oncotyrol–Center for Personalized Cancer MedicineInnsbruckTirolAustria
| | - Roman Weger
- Oncotyrol–Center for Personalized Cancer MedicineInnsbruckTirolAustria
| | - Walpurga Weyrer
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
| | - Michael Steurer
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
| | | | - Bernhard Holzner
- Medical University of InnsbruckInnsbruckTirolAustria
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
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