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Steen-Olsen EB, Pappot H, Hjerming M, Hanghoej S, Holländer-Mieritz C. Monitoring Adolescent and Young Adult Patients With Cancer via a Smart T-Shirt: Prospective, Single-Cohort, Mixed Methods Feasibility Study (OncoSmartShirt Study). JMIR Mhealth Uhealth 2024; 12:e50620. [PMID: 38717366 PMCID: PMC11084117 DOI: 10.2196/50620] [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: 07/06/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 05/12/2024] Open
Abstract
Background Wearables that measure vital parameters can be potential tools for monitoring patients at home during cancer treatment. One type of wearable is a smart T-shirt with embedded sensors. Initially, smart T-shirts were designed to aid athletes in their performance analyses. Recently however, researchers have been investigating the use of smart T-shirts as supportive tools in health care. In general, the knowledge on the use of wearables for symptom monitoring during cancer treatment is limited, and consensus and awareness about compliance or adherence are lacking. objectives The aim of this study was to evaluate adherence to and experiences with using a smart T-shirt for the home monitoring of biometric sensor data among adolescent and young adult patients undergoing cancer treatment during a 2-week period. Methods This study was a prospective, single-cohort, mixed methods feasibility study. The inclusion criteria were patients aged 18 to 39 years and those who were receiving treatment at Copenhagen University Hospital - Rigshospitalet, Denmark. Consenting patients were asked to wear the Chronolife smart T-shirt for a period of 2 weeks. The smart T-shirt had multiple sensors and electrodes, which engendered the following six measurements: electrocardiogram (ECG) measurements, thoracic respiration, abdominal respiration, thoracic impedance, physical activity (steps), and skin temperature. The primary end point was adherence, which was defined as a wear time of >8 hours per day. The patient experience was investigated via individual, semistructured telephone interviews and a paper questionnaire. Results A total of 10 patients were included. The number of days with wear times of >8 hours during the study period (14 d) varied from 0 to 6 (mean 2 d). Further, 3 patients had a mean wear time of >8 hours during each of their days with data registration. The number of days with any data registration ranged from 0 to 10 (mean 6.4 d). The thematic analysis of interviews pointed to the following three main themes: (1) the smart T-shirt is cool but does not fit patients with cancer, (2) the technology limits the use of the smart T-shirt, and (3) the monitoring of data increases the feeling of safety. Results from the questionnaire showed that the patients generally had confidence in the device. Conclusions Although the primary end point was not reached, the patients' experiences with using the smart T-shirt resulted in the knowledge that patients acknowledged the need for new technologies that improve supportive cancer care. The patients were positive when asked to wear the smart T-shirt. However, technical and practical challenges in using the device resulted in low adherence. Although wearables might have potential for home monitoring, the present technology is immature for clinical use.
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Affiliation(s)
- Emma Balch Steen-Olsen
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maiken Hjerming
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Signe Hanghoej
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Cecilie Holländer-Mieritz
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
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Innominato PF, Macdonald JH, Saxton W, Longshaw L, Granger R, Naja I, Allocca C, Edwards R, Rasheed S, Folkvord F, de Batlle J, Ail R, Motta E, Bale C, Fuller C, Mullard AP, Subbe CP, Griffiths D, Wreglesworth NI, Pecchia L, Fico G, Antonini A. Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study. JMIR Res Protoc 2024; 13:e52957. [PMID: 38687985 PMCID: PMC11094600 DOI: 10.2196/52957] [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: 09/21/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. OBJECTIVE This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. METHODS This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). RESULTS This study is part of an array of pilots within a European Union funded project, entitled "GATEKEEPER," conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. CONCLUSIONS In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52957.
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Affiliation(s)
- Pasquale F Innominato
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- Warwick Medical School & Cancer Research Centre, University of Warwick, Coventry, United Kingdom
- Chronotherapy, Cancers and Transplantation Research Unit, Faculty of Medicine, Université Paris-Saclay, Villejuif, France
| | - Jamie H Macdonald
- Institute for Applied Human Physiology, School of Psychology and Sports Science, Bangor University, Bangor, United Kingdom
| | - Wendy Saxton
- Research and Development Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Laura Longshaw
- Research and Development Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Rachel Granger
- Institute for Applied Human Physiology, School of Psychology and Sports Science, Bangor University, Bangor, United Kingdom
| | - Iman Naja
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
| | | | - Ruth Edwards
- Dietetics Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Solah Rasheed
- Dietetics Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Frans Folkvord
- PredictBy, Barcelona, Spain
- Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Rohit Ail
- Health Innovation, Samsung, Staines, United Kingdom
| | - Enrico Motta
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
| | - Catherine Bale
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Claire Fuller
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Anna P Mullard
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Christian P Subbe
- Acute and Critical Care Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Dawn Griffiths
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Nicholas I Wreglesworth
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, United Kingdom
- Facoltà Dipartimentale di Ingegneria, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Fico
- Life Supporting Technologies, Escuela Técnica Superior de Ingenieros de Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alessio Antonini
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
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Pappot H, Steen-Olsen EB, Holländer-Mieritz C. Experiences with Wearable Sensors in Oncology during Treatment: Lessons Learned from Feasibility Research Projects in Denmark. Diagnostics (Basel) 2024; 14:405. [PMID: 38396444 PMCID: PMC10887889 DOI: 10.3390/diagnostics14040405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The fraction of elderly people in the population is growing, the incidence of some cancers is increasing, and the number of available cancer treatments is evolving, causing a challenge to healthcare systems. New healthcare tools are needed, and wearable sensors could partly be potential solutions. The aim of this case report is to describe the Danish research experience with wearable sensors in oncology reporting from three oncological wearable research projects. CASE STUDIES Three planned case studies investigating the feasibility of different wearable sensor solutions during cancer treatment are presented, focusing on study design, population, device, aim, and planned outcomes. Further, two actual case studies performed are reported, focusing on patients included, data collected, results achieved, further activities planned, and strengths and limitations. RESULTS Only two of the three planned studies were performed. In general, patients found the technical issues of wearable sensors too challenging to deal with during cancer treatment. However, at the same time it was demonstrated that a large amount of data could be collected if the framework worked efficiently. CONCLUSION Wearable sensors have the potential to help solve challenges in clinical oncology, but for successful research projects and implementation, a setup with minimal effort on the part of patients is requested.
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Affiliation(s)
- Helle Pappot
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark (C.H.-M.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Emma Balch Steen-Olsen
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark (C.H.-M.)
| | - Cecilie Holländer-Mieritz
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark (C.H.-M.)
- Department of Oncology, Zealand University Hospital, 4700 Naestved, Denmark
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Subbe C, Hughes DA, Lewis S, Holmes EA, Kalkman C, So R, Tranka S, Welch J. Value of improving patient safety: health economic considerations for rapid response systems-a rapid review of the literature and expert round table. BMJ Open 2023; 13:e065819. [PMID: 37068893 PMCID: PMC10111929 DOI: 10.1136/bmjopen-2022-065819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers. DESIGN We undertook a rapid review of the available literature and convened a round table of international specialists in the field including experts on health economics and value-based healthcare to better understand health economics of clinical deterioration and impact of systems to reduce failure to rescue. RESULTS Only a limited number of publications have examined the health economic impact of failure to rescue. Literature examining this topic lacked detail and we identified no publications on long-term cost outside the hospital following a deterioration event. The recent pandemic has added limited literature on prevention of deterioration in the patients' home.Cost-effectiveness and cost-efficiency are dependent on broader system effects of adverse events. We suggest including the care needs beyond the hospital and loss of income of patients and/or their informal carers as well as sickness of healthcare staff exposed to serious adverse events in the analysis of adverse events. They are likely to have a larger health economic impact than the direct attributable cost of the hospital admission of the patient suffering the adverse event. Premorbid status of a patient is a major confounder for health economic considerations. CONCLUSION In order to optimise health at the population level, we must limit long-term effects of adverse events through improvement of our ability to rapidly recognise and respond to acute illness and worsening chronic illness both in the home and the hospital.
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Affiliation(s)
- Christian Subbe
- Bangor University, School of Medical Sciences, Bangor, UK
- Department of Medicine, Ysbyty Gwynedd, Bangor, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Sally Lewis
- National Clinical Director for Value-Based Healthcare & Honorary Professor Swansea University Medical School, Swansea University, Swansea, UK
- National Clinical Director for Value-Based Healthcare, Wales, UK
| | - Emily A Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Cor Kalkman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ralph So
- Intensive Care and Medical Manager Department Quality, Safety and Innovation, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - John Welch
- Intensive Care, University College London Hospitals NHS Foundation Trust, London, UK
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Steen-Olsen EB, Pappot H, Green A, Langberg H, Holländer-Mieritz C. Feasibility of Monitoring Patients Who Have Cancer With a Smart T-shirt: Protocol for the OncoSmartShirt Study. JMIR Res Protoc 2022; 11:e37626. [PMID: 36190744 PMCID: PMC9577710 DOI: 10.2196/37626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Studies have shown that there may be dissimilar perceptions on symptoms or side effects between patients with cancer and health care professionals. This may lead to symptomatic patients notifying the clinic irregularly or not telling the clinic at all. Wearables could help identify symptoms earlier. Patients with low socioeconomic status and less self-awareness of their health may benefit from this. A new design of wearables is a smart t-shirt that, with embedded sensors, provides measurement flows such as electrocardiogram, thoracic and abdominal respiration, and temperature. Objective This study evaluates the feasibility of using a smart t-shirt for home monitoring of biometric sensor data in adolescent and young adult and elderly patients during cancer treatment. Methods The OncoSmartShirt study is an explorative study investigating the feasibility of using the Chronolife smart t-shirt during cancer treatment. This smart t-shirt is designed with multiple fully embedded sensors and electrodes that engender 6 different measurement flows continuously. A total of 20 Danish patients with cancer ≥18 years old in antineoplastic treatment at Department of Oncology Rigshospitalet Denmark will be recruited from all cancer wards, whether patients are in curative or palliative care. Of these 20 patients, 10 (50%) will be <39 years old, defined as adolescent and young adult, and 10 (50%) will be patients >65 years old, defined as elderly. Consenting patients will be asked to wear a smart t-shirt daily for 2 weeks during their treatment course. Results The primary outcome is to determine if it is feasible to wear a smart t-shirt throughout the day (preferably 8 hours per day) for 2 weeks. Inclusion of patients started in March 2022. Conclusions The study will assess the feasibility of using the Chronolife smart t-shirt for home monitoring of vital parameters in patients with cancer during their treatment and bring new insights into how wearables and biometric data can be used as part of symptom or side-effect recognition in patients with cancer during treatment, with the aim to increase patients’ quality of life. Trial Registration ClinicalTrials.gov NCT05235594; https://beta.clinicaltrials.gov/study/NCT05235594 International Registered Report Identifier (IRRID) PRR1-10.2196/37626
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Affiliation(s)
- Emma Balch Steen-Olsen
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen Ø, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen Ø, Denmark
| | - Allan Green
- Knowledge Center of Telemedicine, Region Hovedstaden, Hillerød, Denmark
| | - Henning Langberg
- Department of Innovation, Rigshospitalet, University Hospital of Copenhagen, Copenhagen Ø, Denmark
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Gibb M, Winter H, Komarzynski S, Wreglesworth NI, Innominato PF. Holistic Needs Assessment of Cancer Survivors-Supporting the Process Through Digital Monitoring of Circadian Physiology. Integr Cancer Ther 2022; 21:15347354221123525. [PMID: 36154506 PMCID: PMC9520145 DOI: 10.1177/15347354221123525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The year 2022 could represent a significant juncture in the incorporation of mHealth solutions in routine cancer care. With the recent global COVID-19 pandemic leading a surge in both observation- and intervention-based studies predominantly aimed at remote monitoring there has been huge intellectual investment in developing platforms able to provide real time analytics that are readily usable. Another fallout from the pandemic has seen record waiting times and delayed access to cancer therapies leading to exhausting pressures on global healthcare providers. It seems an opportune time to utilize this boom in platforms to offer more efficient “at home” clinical assessments and less “in department” time for patients. Here, we will focus specifically on the role of digital tools around cancer survivorship, a relevant aspect of the cancer journey, particularly benefiting from integrative approaches. Within that context a further concept will be introduced and that is of the likely upsurge in circadian-based interpretation of continuous monitoring and the engendered therapeutic modifications. Chronobiology across the 24-hour span has long been understood to control key bodily aspects and circadian dysregulation plays a significant role in the risk of cancer and also the response to therapy and therefore progressive outcome. The rapid improvement in minimally invasive monitoring devices is, in the opinion of the authors, likely to advance introducing chronobiological amendments to routine clinical practices with positive impact on cancer survivors.
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Affiliation(s)
- Max Gibb
- Cancer Services, Betsi Cadwaladr University Health Board, Bodelwyddan, UK
| | - Hannah Winter
- Respiratory Medicine, Betsi Cadwaladr University Health Board, Bangor, UK
| | | | - Nicholas I Wreglesworth
- Cancer Services, Betsi Cadwaladr University Health Board, Bodelwyddan, UK.,Bangor University, Bangor, UK
| | - Pasquale F Innominato
- Cancer Services, Betsi Cadwaladr University Health Board, Bodelwyddan, UK.,University of Warwick, Coventry, UK.,Paris-Saclay University, Villejuif, France
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