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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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Livingston PM, Heckel L, Orellana L, Ashley D, Ugalde A, Botti M, Pitson G, Woollett A, Chambers SK, Parente P, Chirgwin J, Mihalopoulos C, Lavelle B, Sutton J, Phipps-Nelson J, Krishnasamy M, Simons K, Heynsbergh N, Wickramasinghe N, White V. Outcomes of a randomized controlled trial assessing a smartphone Application to reduce unmet needs among people diagnosed with CancEr (ACE). Cancer Med 2019; 9:507-516. [PMID: 31769226 PMCID: PMC6970035 DOI: 10.1002/cam4.2718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/22/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Smartphone technology represents an opportunity to deliver practical solutions for people affected by cancer at a scale that was previously unimaginable, such as information, appointment monitoring, and improved access to cancer support services. This study aimed to determine whether a smartphone application (app) reduced the unmet needs among people newly diagnosed with cancer. METHODS A single blind, multisite randomized controlled trial to determine the impact of an app-based, 4-month intervention. Newly diagnosed cancer patients were approached at three health service treatment clinics. RESULTS Eighty-two people were randomized (intervention; n = 43 and control; n = 39), average age was 59.5 years (SD: 12.9); 71% female; 67% married or in a de facto relationship. At baseline, there were no differences in participants' characteristics between the groups. No significant effects, in reducing unmet needs, were demonstrated at the end of intervention (4-month) or 12-month follow-up. Overall, 94% used the app in weeks 1-4, which decreased to 41% in weeks 13-16. Mean app use time per participant: Cancer Information, 6.9 (SD: 18.9) minutes; Appointment Schedule, 5.1 (SD: 9.6) minutes; Cancer Services 1.5 minutes (SD: 6.8); Hospital Navigation, 1.4 (SD: 2.8) minutes. CONCLUSIONS Despite consumer involvement in the design of this smartphone technology, the app did not reduce unmet needs. This may have been due to the study being underpowered. To contribute to a meaningful understanding and improved implementation of smartphone technology to support people affected by cancer, practical considerations, such as recruitment issues and access to, and confidence with, apps, need to be considered. Australian New Zealand Clinical Trials Registration (ACTRN) Trial Registration: 12616001251415; WEF 7/9/2016.
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Affiliation(s)
- Patricia M Livingston
- Faculty of Health, Deakin University, Geelong, Vic., Australia.,School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia
| | - Leila Heckel
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Vic., Australia
| | - David Ashley
- Duke University School of Medicine, Durham, NC, USA
| | - Anna Ugalde
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia
| | - Mari Botti
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia.,Epworth HealthCare, Richmond, Vic., Australia
| | - Graham Pitson
- Andrew Love Cancer Centre, Barwon Health, University Hospital, Geelong, Vic., Australia
| | - Anne Woollett
- The University of Melbourne, Medicine, Dentistry and Health Sciences, Melbourne, Vic., Australia
| | - Suzanne K Chambers
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Phillip Parente
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic., Australia.,Eastern Health, Department of Oncology, Box Hill, Vic., Australia
| | | | - Cathrine Mihalopoulos
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Vic., Australia
| | - Barbara Lavelle
- Faculty of Health, Deakin University, Geelong, Vic., Australia
| | | | | | - Mei Krishnasamy
- The University of Melbourne, Medicine, Dentistry and Health Sciences, Melbourne, Vic., Australia
| | - Katherine Simons
- North Eastern Melbourne Integrated Cancer Service, Heidelberg, Vic., Australia
| | - Natalie Heynsbergh
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia
| | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute, Swinburne University, Hawthorn, Vic., Australia
| | - Vicki White
- Faculty of Health, School of Psychology, Deakin University, Geelong, Vic., Australia
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