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Miller M, McCann L, Lewis L, Miaskowski C, Ream E, Darley A, Harris J, Kotronoulas G, V Berg G, Lubowitzki S, Armes J, Patiraki E, Furlong E, Fox P, Gaiger A, Cardone A, Orr D, Flowerday A, Katsaragakis S, Skene S, Moore M, McCrone P, De Souza N, Donnan PT, Maguire R. Patients' and Clinicians' Perceptions of the Clinical Utility of Predictive Risk Models for Chemotherapy-Related Symptom Management: Qualitative Exploration Using Focus Groups and Interviews. J Med Internet Res 2024; 26:e49309. [PMID: 38901021 PMCID: PMC11224704 DOI: 10.2196/49309] [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: 06/01/2023] [Revised: 11/22/2023] [Accepted: 03/06/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Interest in the application of predictive risk models (PRMs) in health care to identify people most likely to experience disease and treatment-related complications is increasing. In cancer care, these techniques are focused primarily on the prediction of survival or life-threatening toxicities (eg, febrile neutropenia). Fewer studies focus on the use of PRMs for symptoms or supportive care needs. The application of PRMs to chemotherapy-related symptoms (CRS) would enable earlier identification and initiation of prompt, personalized, and tailored interventions. While some PRMs exist for CRS, few were translated into clinical practice, and human factors associated with their use were not reported. OBJECTIVE We aim to explore patients' and clinicians' perspectives of the utility and real-world application of PRMs to improve the management of CRS. METHODS Focus groups (N=10) and interviews (N=5) were conducted with patients (N=28) and clinicians (N=26) across 5 European countries. Interactions were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS Both clinicians and patients recognized the value of having individualized risk predictions for CRS and appreciated how this type of information would facilitate the provision of tailored preventative treatments or supportive care interactions. However, cautious and skeptical attitudes toward the use of PRMs in clinical care were noted by both groups, particularly in relationship to the uncertainty regarding how the information would be generated. Visualization and presentation of PRM information in a usable and useful format for both patients and clinicians was identified as a challenge to their successful implementation in clinical care. CONCLUSIONS Findings from this study provide information on clinicians' and patients' perspectives on the clinical use of PRMs for the management of CRS. These international perspectives are important because they provide insight into the risks and benefits of using PRMs to evaluate CRS. In addition, they highlight the need to find ways to more effectively present and use this information in clinical practice. Further research that explores the best ways to incorporate this type of information while maintaining the human side of care is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081.
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Affiliation(s)
- Morven Miller
- Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Lisa McCann
- Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Liane Lewis
- Johnson and Johnson Medical, Norderstedt, Germany
| | | | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jenny Harris
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Grigorios Kotronoulas
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Geir V Berg
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Simone Lubowitzki
- Department of Internal Medicine 1, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Elizabeth Patiraki
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Patricia Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Alexander Gaiger
- Department of Internal Medicine 1, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Stylianos Katsaragakis
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Simon Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, United Kingdom
| | - Margaret Moore
- Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Paul McCrone
- Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nicosha De Souza
- Population Health and Genomics, Medical School, University of Dundee, Dundee, United Kingdom
| | - Peter T Donnan
- Population Health and Genomics, Medical School, University of Dundee, Dundee, United Kingdom
| | - Roma Maguire
- Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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Rosato R, Ferrero A, Mosconi P, Ciccone G, Di Cuonzo D, Evangelista A, Fuso L, Piovano E, Pagano E, Laudani ME, Pace L, Zola P. Impact of different follow-up regimens on health-related quality of life and costs in endometrial cancer patients: Results from the TOTEM randomized trial. Gynecol Oncol 2024; 184:150-159. [PMID: 38309033 DOI: 10.1016/j.ygyno.2024.01.050] [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: 09/04/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE To investigate whether intensive follow-up (INT) after surgery for endometrial cancer impact health-related quality of life (HRQoL) and healthcare costs compared to minimalist follow-up (MIN), in the absence of evidence supporting any benefit on 5-year overall survival. METHODS In the TOTEM trial, HRQoL was assessed using the SF-12 and the Psychological General Well-Being (PGWB) questionnaires at baseline, after 6 and 12 months and then annually up to 5 years of follow-up. Costs were analyzed after 4 years of follow-up from a National Health Service perspective, stratified by risk level. The probability of missing data was analyzed for both endpoints. RESULTS 1847 patients were included in the analyses. The probability of missing data was not influenced by the study arms (MIN vs INT OR: 0.97 95%CI: 0.87-1.08). Longitudinal changes in HRQoL scores did not differ between the two follow-up regimens (MIN vs INT SF-12 PCS: -0.573, CI95%: -1.31; 0.16; SF-12 MCS: -0.243, CI95%: -1.08; 0.59; PGWB: -0.057, CI95%: -0,88; 0,77). The mean cost difference between the intensive and minimalist arm was €531 for low-risk patients and €683 for high-risk patients. CONCLUSION In the follow-up of endometrial cancer after surgery, a minimalist treatment regimen did not affect quality of life and was cost-saving in both low-risk and high-risk recurrence patients. As previous results showed no survival benefit, a minimalist approach is justified. The relevant proportion of missing data on secondary outcomes of interest could be a critical point that deserves special attention.
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Affiliation(s)
- Rosalba Rosato
- Department of Psychology, University of Turin, Italy; Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy.
| | - Annamaria Ferrero
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Paola Mosconi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giovannino Ciccone
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Daniela Di Cuonzo
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Andrea Evangelista
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Luca Fuso
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Elisa Piovano
- SCDU Ginecologia e Ostetricia 2U, Ospedale Sant'Anna, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Eva Pagano
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Maria Elena Laudani
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Luca Pace
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Paolo Zola
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
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Almeida AM, Lima L, Martins T. Monitoring Patient-Reported Outcomes in Self-management of Postsurgical Symptoms in Oncology: A Scoping Review. Cancer Nurs 2024; Publish Ahead of Print:00002820-990000000-00147. [PMID: 37232525 DOI: 10.1097/ncc.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Surgery is used widely for cancer treatment, and in most types, after discharge, patients usually report multiple symptoms, which, if not controlled, can put postoperative recovery at risk. Understanding which patient-reported outcomes (PROs) should be monitored could have a significant impact on reducing the symptom burden associated with cancer and its treatment by playing a pivotal role in developing symptom self-management plans and designing tailored approaches to optimize patients' symptom self-management behaviors. OBJECTIVE To map the PROs used for patients' postsurgical symptom self-management after hospital discharge following cancer surgery. INTERVENTIONS/METHODS Our scoping review process was guided by the steps for conducting scoping reviews recommended by the Joanna Briggs Institute. RESULTS The search identified 97 potentially relevant studies, with 27 articles meeting the inclusion criteria. The most frequently assessed and monitored PROs were problems with surgical wounds, more general physical symptoms, psychological functioning outcomes, and quality of life. CONCLUSIONS Our results showed an overall uniformity among the PROs selected to be monitored in surgical cancer patients after hospital discharge. Monitoring through electronic platforms is widely used and seems useful to self-manage symptoms and optimize the recovery of cancer patients after discharge following surgery. IMPLICATIONS FOR PRACTICE This study provides knowledge about PROs that can be applied in oncologic patients after surgery to self-report their symptoms following discharge.
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Affiliation(s)
- Ana M Almeida
- Author Affiliations: Institute of Biomedical Sciences Abel Salazar of the University of Porto-ICBAS (Mrs Almeida); Imaging Sciences and Radiooncology Department, Portuguese Institute of Oncology of Porto (Mrs Almeida); Nursing School of Porto (Drs Martins and Lima); and Center for Health Technology and Services Research, (CINTESIS@RISE)(Drs Martins and Lima), Porto, Portugal
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Meinlschmidt G, Grossert A, Meffert C, Roemmel N, Hess V, Rochlitz C, Pless M, Hunziker S, Wössmer B, Geuter U, Schaefert R. Smartphone-Based Psychotherapeutic Interventions in Blended Care of Cancer Survivors: Nested Randomized Clinical Trial. JMIR Cancer 2023; 9:e38515. [PMID: 37639296 PMCID: PMC10495843 DOI: 10.2196/38515] [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: 05/11/2022] [Revised: 03/23/2023] [Accepted: 04/27/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Cancer is related to not only physical but also mental suffering. Notably, body image disturbances are highly relevant to cancer-related changes often persisting beyond recovery from cancer. Scalable and low-barrier interventions that can be blended with face-to-face psychotherapy for cancer survivors are highly warranted. OBJECTIVE The aim of the study is to investigate whether smartphone-based bodily interventions are more effective to improve the mood of patients with cancer than smartphone-based fairy tale interventions (control intervention). METHODS We recruited patients with cancer in 2 Swiss hospitals and conducted daily, fully automated smartphone-based interventions 6 times a week for 5 consecutive weeks, blended with weekly face-to-face group body psychotherapy. We applied 2 types of smartphone-based interventions using a within-subject design, randomly assigning patients daily to either bodily interventions or fairy tales. Each intervention type was presented 3 times a week. For this secondary analysis, 3-level mixed models were estimated with mood assessed by the 3 Multidimensional Mood Questionnaire subscales for good-bad mood, wakefulness, and calmness as key indicators. In addition, the effects on experience of presence, vitality, and burden assessed with visual analog scales were investigated. RESULTS Based on the data from s=732 interventions performed by 36 participants, good-bad mood improved (β=.27; 95% CI 0.062-0.483), and participants became calmer (β=.98; 95% CI 0.740-1.211) following smartphone-based interventions. Wakefulness did not significantly change from pre- to postsmartphone-based intervention (β=.17; 95% CI -0.081 to 0.412). This was true for both intervention types. There was no interaction effect of intervention type with change in good-bad mood (β=-.01; 95% CI -0.439 to 0.417), calmness (β=.22; 95% CI -0.228 to 0.728), or wakefulness (β=.14; 95% CI -0.354 to 0.644). Experience of presence (β=.34; 95% CI 0.271-0.417) and vitality (β=.35; 95% CI 0.268-0.426) increased from pre- to postsmartphone-based intervention, while experience of burden decreased (β=-0.40; 95% CI -0.481 to 0.311). Again, these effects were present for both intervention types. There were no significant interaction effects of intervention type with pre- to postintervention changes in experience of presence (β=.14; 95% CI -0.104 to 0.384), experience of vitality (β=.06; 95% CI -0.152 to 0.265), and experience of burden (β=-.16; 95% CI -0.358 to 0.017). CONCLUSIONS Our results suggest that both smartphone-based audio-guided bodily interventions and fairy tales have the potential to improve the mood of cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov NCT03707548; https://clinicaltrials.gov/study/NCT03707548. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s40359-019-0357-1.
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Affiliation(s)
- Gunther Meinlschmidt
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Digital and Blended Psychosomatics and Psychotherapy, Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University Berlin, Berlin, Germany
| | - Astrid Grossert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
- Medical Center of Oncology and Hematology, Department of Psycho-Oncology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Cornelia Meffert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Noa Roemmel
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Digital and Blended Psychosomatics and Psychotherapy, Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Viviane Hess
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Christoph Rochlitz
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Miklos Pless
- Department of Medical Oncology, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - Sabina Hunziker
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Ulfried Geuter
- Institute for Sports and Motology, University of Marburg, Marburg, Germany
| | - Rainer Schaefert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Suchodolska G, Koelmer A, Puchowska M, Senkus E. Are All Societies Ready for Digital Tools? Feasibility Study on the Use of Mobile Application in Polish Early Breast Cancer Patients Treated with Perioperative Chemotherapy. Healthcare (Basel) 2023; 11:2114. [PMID: 37510555 PMCID: PMC10379019 DOI: 10.3390/healthcare11142114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/12/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The population of individuals affected by breast cancer is growing, and with advances in cancer treatment implemented into usual care, there is an urgent need to improve the recognition, monitoring and treatment of therapy-induced adverse effects. This study aims to explore the use of an in-app electronic questionnaire to assess and monitor chemotherapy-related symptoms in early breast cancer patients treated with perioperative chemotherapy. METHOD Between December 2019 and June 2021, 72 female study participants used the mobile app Centrum Chorób Piersi UCK and completed an in-app questionnaire about the 14 most common chemotherapy-related symptoms. Replies including symptoms with a critical value triggered automatic email alerts to the nursing team. RESULTS Acceptance of the study was higher among younger women and patients originating from rural areas, while possible digital exclusion among patients >60 years was observed during the enrolment process. A total of 55 participants completed the electronic questionnaire at least once and generated 553 responses with 1808 specific problems reported. Fatigue (n = 428) was the most common problem, and fever (n = 5) the least reported problem. A total of 21 participants triggered alerts with responses containing symptoms with critical value assessment (n = 89). Significant negative correlation was observed between the number of responses and time from the first chemotherapy administration; however, the number of responses was not determined by any sociodemographic or medical factors. Significant positive correlations were identified between the number of communicated problems and participants' age. The usage of our electronic symptom assessment questionnaire decreased substantially after the period of active encouragement during the study enrolment. CONCLUSIONS Not all societies are ready for innovative eHealth solutions. Patients' age should be carefully considered when app-based interventions are introduced to usual cancer care. Additional support is suggested for older patients to improve their awareness and participation in eHealth interventions. More research involving older participants is needed to explore and address their particular needs and perspectives on eHealth solutions.
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Affiliation(s)
- Grażyna Suchodolska
- Department of Oncology & Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland
| | - Anna Koelmer
- Centre of Biostatistics and Bioinformatics Analysis, Medical University of Gdańsk, Dębinki 1, 80-211 Gdańsk, Poland
| | - Monika Puchowska
- Department of Non-Commercial Clinical Research, Clinical Research Support Centre, Medical University of Gdańsk, Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
| | - Elżbieta Senkus
- Department of Oncology & Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland
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Lopez CJ, Teggart K, Ahmed M, Borhani A, Kong J, Fazelzad R, Langelier DM, Campbell KL, Reiman T, Greenland J, Jones JM, Neil-Sztramko SE. Implementation of electronic prospective surveillance models in cancer care: a scoping review. Implement Sci 2023; 18:11. [PMID: 37101231 PMCID: PMC10134630 DOI: 10.1186/s13012-023-01265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Electronic prospective surveillance models (ePSMs) for cancer rehabilitation include routine monitoring of the development of treatment toxicities and impairments via electronic patient-reported outcomes. Implementing ePSMs to address the knowledge-to-practice gap between the high incidence of impairments and low uptake of rehabilitation services is a top priority in cancer care. METHODS We conducted a scoping review to understand the state of the evidence concerning the implementation of ePSMs in oncology. Seven electronic databases were searched from inception to February 2021. All articles were screened and extracted by two independent reviewers. Data regarding the implementation strategies, outcomes, and determinants were extracted. The Expert Recommendations for Implementing Change taxonomy and the implementation outcomes taxonomy guided the synthesis of the implementation strategies and outcomes, respectively. The Consolidated Framework for Implementation Research guided the synthesis of determinants based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process). RESULTS Of the 5122 records identified, 46 interventions met inclusion criteria. The common implementation strategies employed were "conduct educational meetings," "distribute educational materials," "change record systems," and "intervene with patients to enhance uptake and adherence." Feasibility and acceptability were the prominent outcomes used to assess implementation. The complexity, relative advantage, design quality, and packaging were major implementation determinants at the intervention level. Knowledge was key at the individual level. At the inner setting level, major determinants were the implementation climate and readiness for implementation. At the outer setting level, meeting the needs of patients was the primary determinant. Engaging various stakeholders was key at the process level. CONCLUSIONS This review provides a comprehensive summary of what is known concerning the implementation of ePSMs. The results can inform future implementation and evaluation of ePSMs, including planning for key determinants, selecting implementation strategies, and considering outcomes alongside local contextual factors to guide the implementation process.
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Affiliation(s)
- Christian J Lopez
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Kylie Teggart
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mohammed Ahmed
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Anita Borhani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jeffrey Kong
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, Canada
| | - David M Langelier
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Tony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, Canada
| | - Jonathan Greenland
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
| | - Jennifer M Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sarah E Neil-Sztramko
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
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Aboye GT, Vande Walle M, Simegn GL, Aerts JM. mHealth in sub-Saharan Africa and Europe: A systematic review comparing the use and availability of mHealth approaches in sub-Saharan Africa and Europe. Digit Health 2023; 9:20552076231180972. [PMID: 37377558 PMCID: PMC10291558 DOI: 10.1177/20552076231180972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Background mHealth can help with healthcare service delivery for various health issues, but there's a significant gap in the availability and use of mHealth systems between sub-Saharan Africa and Europe, despite the ongoing digitalization of the global healthcare system. Objective This work aims to compare and investigate the use and availability of mHealth systems in sub-Saharan Africa and Europe, and identify gaps in current mHealth development and implementation in both regions. Methods The study adhered to the PRISMA 2020 guidelines for article search and selection to ensure an unbiased comparison between sub-Saharan Africa and Europe. Four databases (Scopus, Web of Science, IEEE Xplore, and PubMed) were used, and articles were evaluated based on predetermined criteria. Details on the mHealth system type, goal, patient type, health concern, and development stage were collected and recorded in a Microsoft Excel worksheet. Results The search query produced 1020 articles for sub-Saharan Africa and 2477 articles for Europe. After screening for eligibility, 86 articles for sub-Saharan Africa and 297 articles for Europe were included. To minimize bias, two reviewers conducted the article screening and data retrieval. Sub-Saharan Africa used SMS and call-based mHealth methods for consultation and diagnosis, mainly for young patients such as children and mothers, and for issues such as HIV, pregnancy, childbirth, and child care. Europe relied more on apps, sensors, and wearables for monitoring, with the elderly as the most common patient group, and the most common health issues being cardiovascular disease and heart failure. Conclusion Wearable technology and external sensors are heavily used in Europe, whereas they are seldom used in sub-Saharan Africa. More efforts should be made to use the mHealth system to improve health outcomes in both regions, incorporating more cutting-edge technologies like wearables internal and external sensors. Undertaking context-based studies, identifying determinants of mHealth systems use, and considering these determinants during mHealth system design could enhance mHealth availability and utilization.
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Affiliation(s)
- Genet Tadese Aboye
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
- School of Biomedical Engineering, Jimma University, Jimma, Ethiopia
| | - Martijn Vande Walle
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
| | | | - Jean-Marie Aerts
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
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Castillo C, Alfonso AL, Dapueto JJ, Camejo N, Silva M. Inclusion of information technology-based assessments of health-related quality of life in routine oncology practice in Uruguay. J Patient Rep Outcomes 2022; 6:65. [PMID: 35695970 PMCID: PMC9192877 DOI: 10.1186/s41687-022-00458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background Previous research has shown that the inclusion of patient-reported outcomes measures in the patient’s visit to the oncologists might improve the quality of global health care. The aim of the study was to assess the feasibility, acceptance, and utility perceived by patients and oncologists of health-related quality of life (HRQL) assessments obtained prior to clinical visits, and to evaluate if this has an impact on patient’s well-being in a sample of Spanish-speaking patients from Uruguay. Methods Patients assisted regularly in the Oncology Clinic were randomized into two groups: an intervention group that completed a set of questionnaires (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and Hospital Anxiety and Depression Scale using a touch screen device and a control group that did not respond to these questionnaires. At 2 months, the responses of all the participants to the Functional Assessment of Cancer Therapy-General (FACT-G) were collected over a telephone to determine whether there were differences in the HRQL between the intervention and control groups. The graphed scores of the intervention group were included in the clinical history of the patient during consultation. Patients and physicians completed the questionnaires on the usefulness of these measurements. Results In total, 58 patients participated in this study: 36 in the intervention group and 22 in the control group; 65% of the participants were female, and median age was 59 years (18–79). Regarding patients, 97% found the questionnaires easy to complete and thought that they included important questions. As for oncologists, 68.8% used the information and 87.5% found it useful for the consultation. There were no significant differences in the FACT-G scores between the intervention and control groups. Conclusions The routine HRQL assessments using an electronic device prior to the consultations were positively valued by almost all patients and physicians. This could significantly contribute to a better understanding of the patient's overall problems during consultation. These results confirm the benefits of integrating the patient’s self-reported quality of life outcomes into consultations.
Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00458-7.
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Fischer A, Elbeji A, Aguayo G, Fagherazzi G. Recommendations for Successful Implementation of the Use of Vocal Biomarkers for Remote Monitoring of COVID-19 and Long COVID in Clinical Practice and Research. Interact J Med Res 2022; 11:e40655. [PMID: 36378504 PMCID: PMC9668331 DOI: 10.2196/40655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic accelerated the use of remote patient monitoring in clinical practice or research for safety and emergency reasons, justifying the need for innovative digital health solutions to monitor key parameters or symptoms related to COVID-19 or Long COVID. The use of voice-based technologies, and in particular vocal biomarkers, is a promising approach, voice being a rich, easy-to-collect medium with numerous potential applications for health care, from diagnosis to monitoring. In this viewpoint, we provide an overview of the potential benefits and limitations of using voice to monitor COVID-19, Long COVID, and related symptoms. We then describe an optimal pipeline to bring a vocal biomarker candidate from research to clinical practice and discuss recommendations to achieve such a clinical implementation successfully.
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Affiliation(s)
- Aurelie Fischer
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Abir Elbeji
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Gloria Aguayo
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Ruyobeza B, Grobbelaar SS, Botha A. Hurdles to developing and scaling remote patients' health management tools and systems: a scoping review. Syst Rev 2022; 11:179. [PMID: 36042505 PMCID: PMC9427160 DOI: 10.1186/s13643-022-02033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite all the excitement and hype generated regarding the expected transformative impact of digital technology on the healthcare industry, traditional healthcare systems around the world have largely remained unchanged and resultant improvements in developed countries are slower than anticipated. One area which was expected to significantly improve the quality of and access to primary healthcare services in particular is remote patient monitoring and management. Based on a combination of rapid advances in body sensors and information and communication technologies (ICT), it was hoped that remote patient management tools and systems (RPMTSs) would significantly reduce the care burden on traditional healthcare systems as well as health-related costs. However, the uptake or adoption of above systems has been extremely slow and their roll out has not yet properly taken off especially in developing countries where they ought to have made the greatest positive impact. AIM The aim of the study was to assess whether or not recent, relevant literature would support the development of in-community, design, deployment and implementation framework based on three factors thought to be important drivers and levers of RPMTS's adoption and scalability. METHODS A rapid, scoping review conducted on relevant articles obtained from PubMed, MEDLINE, PMC and Cochrane databases and grey literature on Google and published between 2012 and May 2020, by combining a number of relevant search terms and phrases. RESULTS Most RPMTSs are targeted at and focused on a single disease, do not extensively involve patients and clinicians in their early planning and design phases, are not designed to best serve a specific catchment area and are mainly directed at post-hospital, disease management settings. This may be leading to a situation where patients, potential patients and clinicians simply do not make use of these tools, leading to low adoption and scalability thereof. CONCLUSION The development of a user-centred, context-dependent, customizable design and deployment framework could potentially increase the adoption and scalability of RPMTSs, if such framework addressed a combination of diseases, prevalent in a given specific catchment area, especially in developing countries with limited financial resources.
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Affiliation(s)
- Barimwotubiri Ruyobeza
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, South Africa
| | - Sara S Grobbelaar
- Department of Industrial Engineering, Stellenbosch University, South Africa AND DSI-NRF Centre of Excellence in Scientometrics and Science, Technology and Innovation Policy (SciSTIP), Stellenbosch University, Stellenbosch, South Africa.
| | - Adele Botha
- Department of Industrial Engineering, Stellenbosch University and CSIR Next Generation Enterprises and Institutions, Stellenbosch, South Africa
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11
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Pan LC, Wu XR, Lu Y, Zhang HQ, Zhou YL, Liu X, Liu SL, Yan QY. Artificial intelligence empowered Digital Health Technologies in Cancer Survivorship Care: a scoping review. Asia Pac J Oncol Nurs 2022; 9:100127. [PMID: 36176267 PMCID: PMC9513729 DOI: 10.1016/j.apjon.2022.100127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/29/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The objectives of this systematic review are to describe features and specific application scenarios for current cancer survivorship care services of Artificial intelligence (AI)-driven digital health technologies (DHTs) and to explore the acceptance and briefly evaluate its feasibility in the application process. Methods Search for literatures published from 2010 to 2022 on sites MEDLINE, IEEE-Xplor, PubMed, Embase, Cochrane Central Register of Controlled Trials and Scopus systematically. The types of literatures include original research, descriptive study, randomized controlled trial, pilot study, and feasible or acceptable study. The literatures above described current status and effectiveness of digital medical technologies based on AI and used in cancer survivorship care services. Additionally, we use QuADS quality assessment tool to evaluate the quality of literatures included in this review. Results 43 studies that met the inclusion criteria were analyzed and qualitatively synthesized. The current status and results related to the application of AI-driven DHTs in cancer survivorship care were reviewed. Most of these studies were designed specifically for breast cancer survivors’ care and focused on the areas of recurrence or secondary cancer prediction, clinical decision support, cancer survivability prediction, population or treatment stratified, anti-cancer treatment-induced adverse reaction prediction, and so on. Applying AI-based DHTs to cancer survivors actually has shown some positive outcomes, including increased motivation of patient-reported outcomes (PROs), reduce fatigue and pain levels, improved quality of life, and physical function. However, current research mostly explored the technology development and formation (testing) phases, with limited-scale population, and single-center trial. Therefore, it is not suitable to draw conclusions that the effectiveness of AI-based DHTs in supportive cancer care, as most of applications are still in the early stage of development and feasibility testing. Conclusions While digital therapies are promising in the care of cancer patients, more high-quality studies are still needed in the future to demonstrate the effectiveness of digital therapies in cancer care. Studies should explore how to develop uniform standards for measuring patient-related outcomes, ensure the scientific validity of research methods, and emphasize patient and health practitioner involvement in the development and use of technology.
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Affiliation(s)
- Lu-Chen Pan
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiao-Ru Wu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ying Lu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Han-Qing Zhang
- Health Science Center, Yangtze University, Jinzhou 434023, China
| | - Yao-Ling Zhou
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xue Liu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Sheng-Lin Liu
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Corresponding authors.
| | - Qiao-Yuan Yan
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Corresponding authors.
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Tang L, He Y, Pang Y, Su Z, Li J, Zhang Y, Wang X, Han X, Wang Y, Li Z, He S, Song L, Zhou Y, Wang B, Li X. Implementing Symptom Management Follow-up Using an Electronic Patient-Reported Outcome Platform in Outpatients With Advanced Cancer: Longitudinal Single-Center Prospective Study. JMIR Form Res 2022; 6:e21458. [PMID: 35536608 PMCID: PMC9131147 DOI: 10.2196/21458] [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] [Received: 06/24/2020] [Revised: 11/09/2020] [Accepted: 04/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients with cancer experience multiple symptoms related to cancer, cancer treatment, and the procedures involved in cancer care; however, many patients with pain, depression, and fatigue, especially those outside the hospital, receive inadequate treatment for their symptoms. Using an electronic patient-reported outcome (ePRO) platform to conduct symptom management follow-up in outpatients with advanced cancer could be a novel and potentially effective approach. However, empirical evidence describing in detail the preparation and implementation courses in a real setting is needed. OBJECTIVE The purpose of this paper was to describe the implementation process and evaluation of an ePRO platform that facilitates symptom management for patients with cancer, share our experiences and the problems we encountered during the process of implementation, and share the solutions we identified for those problems. Moreover, we tested the feasibility, safety, and efficacy of the ePRO platform. METHODS This was a real-world, ongoing, longitudinal, single-center, prospective study with a total of 7 follow-ups conducted within 4 weeks after the first visit to the symptom management clinic (on days 1, 3, 7, 10, 14, 21, and 28). Participants were encouraged to complete scales for physical symptoms (pain, fatigue, and shortness of breath), cognitive symptoms (memory problems and impaired concentration), and affective symptoms (especially depression and anxiety) during follow-up. The design and function of the ePRO-doctor client and ePRO-patient client, the patient-reported outcome (PRO) scales used in the study, and the strategies to promote symptom tracking have been described. Moreover, the training and evaluation for research assistants have been presented. The efficacy of the ePRO platform was assessed with a comparison of the baseline and 4-week outcomes on the MD Anderson Symptom Inventory. RESULTS Using the ePRO platform for symptom management follow-ups in advanced cancer patients was associated with a high completion rate (72.7%-86.4%) and a low drop-off rate (23.6%). The ePRO platform sent 293 alert notifications to both patients and doctors, which promoted patient security. The short and sharp PRO tool selection, user-friendly interface, automatic reminder notifications and alerts, and multiple dimensional training were essential components for the preparation and implementation of the ePRO system. The results showed significant improvements in the mean scores of pain, fatigue, and numbness from baseline to day 28 (P=.02, P=.02, and P<.001, respectively). CONCLUSIONS The use of an ePRO platform for symptom management follow-ups in advanced cancer patients is time-saving, energy-saving, and effective. PRO tool selection, platform design, and training of research assistants are important aspects for implementation. Future research should validate the ePRO platform in a larger randomized controlled study.
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Affiliation(s)
- Lili Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yi He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying Pang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhongge Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jinjiang Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yening Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xu Wang
- ePRO Vision, Health Technology Co, Ltd, Beijing, China
| | - Xinkun Han
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zimeng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shuangzhi He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lili Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuhe Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bingmei Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiumin Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China
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13
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O'Brien C, Furlong E, Coughlan B, Fox P, Darley A. Building research capacity and culture: Exploring nurses' experience of implementing a nurse-led clinical trial. J Nurs Manag 2022; 30:1002-1010. [PMID: 35246888 PMCID: PMC9314815 DOI: 10.1111/jonm.13576] [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] [Received: 12/23/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
AIM To explore the experiences of a nursing team who implemented an international nurse-led clinical trial in practice and understand the facilitators to their involvement. BACKGROUND The role and responsibilities of the clinical nurse are advancing to encompass research activity to help inform evidence-based practice. However, several personal and organisational challenges can inhibit nurses' capacity to implement and undertake research within clinical practice. METHODS Three focus groups were conducted with members of a nursing team (N=18). Thematic analysis was employed, and themes were identified and agreed upon by the research team. FINDINGS Five themes were identified: 'Previous experience of and attitudes to participation in clinical research', 'Decision-making regarding participation in the clinical trial', 'Facilitators of participation in the clinical trial', 'Challenges of research in nursing practice' and 'Future orientation towards research'. CONCLUSION Through their experiences of implementing a nurse-led clinical trial within practice, nurses recognised a number of facilitators and challenges to their participation. The perceived relevance of the clinical trial to the nurses' practice, potential to improve patient care and appreciation of the nurse leader's expertise and understanding of their context were key motivators. Reciprocal trust with the nurse leader who was encouraging, motivating, supportive and accessible resulted in the engagement and commitment of the nursing team. IMPLICATIONS FOR NURSING MANAGEMENT This paper offers a perspective that can inform senior nursing management teams when implementing and conducting evidence-based research amongst nursing teams and in doing so meet the needs of developing research capacity amongst clinical nurses.
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Affiliation(s)
| | - Eileen Furlong
- University College Dublin, School of Nursing Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Barbara Coughlan
- University College Dublin, School of Nursing Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Patricia Fox
- University College Dublin, School of Nursing Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Andrew Darley
- University College Dublin, School of Medicine, Health Sciences Centre, Belfield, Dublin 4, Ireland
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Maguire R, McCann L, Kotronoulas G, Kearney N, Ream E, Armes J, Patiraki E, Furlong E, Fox P, Gaiger A, McCrone P, Berg G, Miaskowski C, Cardone A, Orr D, Flowerday A, Katsaragakis S, Darley A, Lubowitzki S, Harris J, Skene S, Miller M, Moore M, Lewis L, DeSouza N, Donnan PT. Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART). BMJ 2021; 374:n1647. [PMID: 34289996 PMCID: PMC8293749 DOI: 10.1136/bmj.n1647] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. DESIGN Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. SETTING Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. PARTICIPANTS 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin's disease, or non-Hodgkin's lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. INTERVENTION Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. MAIN OUTCOME MEASURES The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy-General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory-Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). RESULTS For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference -0.15, 95% confidence interval -0.19 to -0.12; P<0.001; Cohen's D effect size=0.5). Analysis of MSAS sub-domains indicated significant reductions in favour of ASyMS for global distress index (-0.21, -0.27 to -0.16; P<0.001), psychological symptoms (-0.16, -0.23 to -0.10; P<0.001), and physical symptoms (-0.21, -0.26 to -0.17; P<0.001). FACT-G scores were higher in the intervention group across all cycles (mean difference 4.06, 95% confidence interval 2.65 to 5.46; P<0.001), whereas mean scores for STAI-R trait (-1.15, -1.90 to -0.41; P=0.003) and STAI-R state anxiety (-1.13, -2.06 to -0.20; P=0.02) were lower. CASE-Cancer scores were higher in the intervention group (mean difference 0.81, 0.19 to 1.43; P=0.01), and most SCNS-SF34 domains were lower, including sexuality needs (-1.56, -3.11 to -0.01; P<0.05), patient care and support needs (-1.74, -3.31 to -0.16; P=0.03), and physical and daily living needs (-2.8, -5.0 to -0.6; P=0.01). Other SCNS-SF34 domains and WLQ were not significantly different. Safety of ASyMS was satisfactory. Neutropenic events were higher in the intervention group. CONCLUSIONS Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A "medium" Cohen's effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients' symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. TRIAL REGISTRATION Clinicaltrials.gov NCT02356081.
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Affiliation(s)
- Roma Maguire
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Lisa McCann
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | | | | | - Emma Ream
- University of Surrey, School of Health Sciences, Guildford, UK
| | - Jo Armes
- University of Surrey, School of Health Sciences, Guildford, UK
| | - Elisabeth Patiraki
- National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Patricia Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Alexander Gaiger
- Department of Internal Medicine 1, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Paul McCrone
- Department of Health Services and Population Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Geir Berg
- Department of Health Sciences, NTNU, Gjøvik, Norway
| | | | | | | | | | - Stylianos Katsaragakis
- National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Simone Lubowitzki
- Department of Internal Medicine 1, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Jenny Harris
- University of Surrey, School of Health Sciences, Guildford, UK
| | - Simon Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
| | - Morven Miller
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Margaret Moore
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Liane Lewis
- Johnson and Johnson Medical, Norderstedt, Germany
| | - Nicosha DeSouza
- Population Health and Genomics, Medical School, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Population Health and Genomics, Medical School, University of Dundee, Dundee, UK
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Parimbelli E, Wilk S, Cornet R, Sniatala P, Sniatala K, Glaser SLC, Fraterman I, Boekhout AH, Ottaviano M, Peleg M. A review of AI and Data Science support for cancer management. Artif Intell Med 2021; 117:102111. [PMID: 34127240 DOI: 10.1016/j.artmed.2021.102111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/23/2020] [Accepted: 05/11/2021] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Thanks to improvement of care, cancer has become a chronic condition. But due to the toxicity of treatment, the importance of supporting the quality of life (QoL) of cancer patients increases. Monitoring and managing QoL relies on data collected by the patient in his/her home environment, its integration, and its analysis, which supports personalization of cancer management recommendations. We review the state-of-the-art of computerized systems that employ AI and Data Science methods to monitor the health status and provide support to cancer patients managed at home. OBJECTIVE Our main objective is to analyze the literature to identify open research challenges that a novel decision support system for cancer patients and clinicians will need to address, point to potential solutions, and provide a list of established best-practices to adopt. METHODS We designed a review study, in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, analyzing studies retrieved from PubMed related to monitoring cancer patients in their home environments via sensors and self-reporting: what data is collected, what are the techniques used to collect data, semantically integrate it, infer the patient's state from it and deliver coaching/behavior change interventions. RESULTS Starting from an initial corpus of 819 unique articles, a total of 180 papers were considered in the full-text analysis and 109 were finally included in the review. Our findings are organized and presented in four main sub-topics consisting of data collection, data integration, predictive modeling and patient coaching. CONCLUSION Development of modern decision support systems for cancer needs to utilize best practices like the use of validated electronic questionnaires for quality-of-life assessment, adoption of appropriate information modeling standards supplemented by terminologies/ontologies, adherence to FAIR data principles, external validation, stratification of patients in subgroups for better predictive modeling, and adoption of formal behavior change theories. Open research challenges include supporting emotional and social dimensions of well-being, including PROs in predictive modeling, and providing better customization of behavioral interventions for the specific population of cancer patients.
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Affiliation(s)
| | - S Wilk
- Poznan University of Technology, Poland
| | - R Cornet
- Amsterdam University Medical Centre, the Netherlands
| | | | | | - S L C Glaser
- Amsterdam University Medical Centre, the Netherlands
| | - I Fraterman
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A H Boekhout
- Netherlands Cancer Institute, Amsterdam, the Netherlands
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Cho Y, Zhang H, Harris MR, Gong Y, Smith EL, Jiang Y. Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review. J Med Internet Res 2021; 23:e24638. [PMID: 33709929 PMCID: PMC7998328 DOI: 10.2196/24638] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electronic symptom self-reporting systems (e-SRS) have been shown to improve symptoms and survival in patients with cancer. However, patient engagement in using e-SRS for voluntary symptom self-reporting is less optimal. Multiple factors can potentially affect patients' acceptance and engagement in using home-based e-SRS. However, such factors have not been fully explored in cancer populations. OBJECTIVE The aim of this study is to understand the acceptance and use of home-based e-SRS by patients with cancer and identify associated facilitators and barriers. METHODS PubMed, CINAHL, Scopus, and PsycINFO (January 2010 to March 2020) were searched using a combination of Medical Subject Headings (MeSH) terms and keywords such as symptom self-reporting, electronic/technology, cancer, and their synonyms. Included studies focused on the use of home-based e-SRS by patients with cancer and their families. Studies on patients' use of e-SRS in clinical settings only were excluded. Of the 3740 papers retrieved, 33 were included in the final review. Factors associated with patient acceptance and use of e-SRS were extracted and synthesized. RESULTS Most e-SRS were web based (22/33, 66%) or mobile app based (9/33, 27%). The e-SRS initial acceptance, represented by patient enrollment rates, ranged from 40% (22/55) to 100% (100/100). High e-SRS acceptance was rated by 69% (59/85) to 77.6% (337/434) of the patients after they used the system. The e-SRS use, measured by patients' response rates to questionnaires (ranging from 1596/3521, 45.33% to 92%) or system log-on rates (ranging from 4/12, 33% to 99/100, 99%), declined over time in general patterns. Few studies (n=7) reported e-SRS use beyond 6 months, with the response rates ranging from 62% (40/64) to 85.1% (541/636) and the log-on rates ranging from 63.6% (103/162) to 77% (49/64). The availability of compatible devices and technical support, interactive system features, information accessibility, privacy, questionnaire quality, patient physical/psychosocial status, and age were associated with patient acceptance and use of home-based e-SRS. CONCLUSIONS Acceptance and use of home-based e-SRS by patients with cancer varied significantly across studies, as assessed by a variety of approaches. The lack of access to technology has remained a barrier to e-SRS adoption. Interactive system features and personalized questionnaires may increase patient engagement. More studies are needed to further understand patients' long-term use of home-based e-SRS behavior patterns to develop personalized interventions to support symptom self-management and self-reporting of patients with cancer for optimal health outcomes.
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Affiliation(s)
- Youmin Cho
- University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Huiting Zhang
- University of Michigan School of Nursing, Ann Arbor, MI, United States
| | | | - Yang Gong
- University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, TX, United States
| | | | - Yun Jiang
- University of Michigan School of Nursing, Ann Arbor, MI, United States
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Real-time symptom management in the context of a remote symptom-monitoring system: prospective process evaluation and cross-sectional survey to explore clinical relevance. Support Care Cancer 2021; 29:3401-3408. [PMID: 33515304 DOI: 10.1007/s00520-021-06029-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Electronic systems for remotely monitoring symptoms during systemic anticancer treatment are increasingly being used. Some of these systems have features triggering alerts to healthcare professionals for worsening and/or severe symptoms, enabling real-time symptom management. This study aimed at exploring the characteristics and process of real-time alert management as well as its clinical relevance as perceived by healthcare professionals. METHODS From January until September 2019, a prospective process evaluation was set up to collect data on all alerts and their management. Also, an online survey presenting a selected number of cases was set up to explore oncologists' and oncology nurses' perceived clinical relevance of the real-time management of the alerts. RESULTS The overall incidence rate of alerts was 1.4%. Of 253 alerts, pain, fever, dyspnea, and nausea were the most prevalent symptoms triggering an alert. The majority of alerts was managed by a nursing telephone consult alone. In 25.3% of cases, clinical examination was deemed necessary to manage the alert. In 148 of the ratings, oncologists and oncology nurses (totally) agreed with the clinical relevance of the real-time management (95.1%). The mean relevance score attached to the cases was 4.51 (±0.80). CONCLUSIONS The majority of alerts triggered by a mobile tool for remote symptom monitoring during cancer treatment can be managed by a telephone nursing consult and real-time management is evaluated as (very) relevant by the majority of clinicians.
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Leppla L, Hobelsberger S, Rockstein D, Werlitz V, Pschenitza S, Heidegger P, De Geest S, Valenta S, Teynor A. Implementation Science Meets Software Development to Create eHealth Components for an Integrated Care Model for Allogeneic Stem Cell Transplantation Facilitated by eHealth: The SMILe Study as an Example. J Nurs Scholarsh 2020; 53:35-45. [PMID: 33348461 DOI: 10.1111/jnu.12621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe a process of creating eHealth components for an integrated care model using an agile software development approach, user-centered design and, via the Behavior Change Wheel, behavior theory-guided content development. Following the principles of implementation science and using the SMILe project (integrated care model for allogeneic stem cell transplantation facilitated by eHealth) as an example, this study demonstrates how to narrow the research-to-practice gap often encountered in eHealth projects. METHODS We followed a four-step process: (a) formation of an interdisciplinary team; (b) a contextual analysis to drive the development process via behavioral theory; (c) transfer of content to software following agile software development principles; and (d) frequent stakeholder and end user involvement following user-centered design principles. FINDINGS Our newly developed comprehensive development approach allowed us to create a running eHealth component and embed it in an integrated care model. An interdisciplinary team's collaboration at specified interaction points supported clear, timely communication and interactions between the specialists. Because behavioral theory drove the content development process, we formulated user stories to define the software features, which were prioritized and iteratively developed using agile software development principles. A prototype intervention module has now been developed and received high ratings on the System Usability Scale after two rounds of usability testing. CONCLUSIONS Following an agile software development process, structured collaboration between nursing scientists and software specialists allowed our interdisciplinary team to develop meaningful, theory-based eHealth components adapted to context-specific needs. CLINICAL RELEVANCE The creation of high-quality, accurately fitting eHealth components specifically to be embedded in integrated care models should increase the chances of uptake, adoption, and sustainable implementation in clinical practice.
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Affiliation(s)
- Lynn Leppla
- Research Assistant, Institute of Nursing Science, Department Public Health, University of Basel, Switzerland & Advanced Practice Nurse, Department of Medicine I, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Sandra Hobelsberger
- Research Assistant, Designer, Faculty of Computer Science, Augsburg University of Applied Sciences, Germany
| | - Dennis Rockstein
- Research Assistant, Software Engineer, Faculty of Computer Science, Augsburg University of Applied Sciences, Germany
| | - Viktor Werlitz
- Research Assistant, Software Engineer, Faculty of Computer Science, Augsburg University of Applied Sciences, Germany
| | - Stefan Pschenitza
- Research Assistant, Software Engineer, Faculty of Computer Science, Augsburg University of Applied Sciences, Germany
| | - Phillip Heidegger
- Professor of Software Engineering, Faculty of Computer Science, Augsburg University of Applied Sciences, Germany
| | - Sabina De Geest
- Professor of Nursing, Director and Department Chair Institute of Nursing Science, Department Public Health, University of Basel, Switzerland & Professor of Nursing, Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Sabine Valenta
- Postdoctoral Research Fellow, Institute of Nursing Science, Department Public Health, University of Basel, Switzerland & Advanced Practice Nurse, Department of Hematology, University Hospital Basel, Switzerland
| | - Alexandra Teynor
- Professor of Software Engineering, Faculty of Computer Science, Augsburg University of Applied Sciences, Germany
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Magalhães B, Fernandes C, Martinez-Galiano JM, Santos C. Exploring the use of Mobile applications by cancer patients undergoing chemotherapy: A scoping review. Int J Med Inform 2020; 144:104293. [PMID: 33091832 DOI: 10.1016/j.ijmedinf.2020.104293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/15/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
Abstract
PROPOSE Advancements in mobile technology, primarily through the use of applications, may support the process of monitoring adherence to oral therapies, controlling toxicities, or providing self-care guidelines to patients undergoing chemotherapy treatment. This study aims to assemble the available knowledge regarding the use of mobile applications by cancer patients undergoing chemotherapy treatment. METHODS A literature review based on the Joanna Briggs Institute model(s) for Scoping Review was conducted. All articles published until 30 May 2019, were identified in the MEDLINE®, CINAHL®, and PsycINFO® electronic databases using the related Boolean logical operators and key terms. Extracted data included research aims, methodological design, application name, the functionalities of the applications, and major results. RESULTS A total of 26 articles were included in this study. The search identified 16 different mobile applications, some of which were addressed in various publications, demonstrating different characteristics in design, use, and development. CONCLUSION The use of mobile applications can be seen as an important and effective way to monitor adherence and support in the self-management of complications associated with chemotherapy treatments. Notwithstanding, these applications should be tested outside the academic environment, outreaching this group of people to effectively investigate its applicability, allowing the assessment of the impact of this "new" technological intervention process.
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Affiliation(s)
- Bruno Magalhães
- Portuguese Institute for Oncology of Porto (IPO-Porto), Porto, Portugal; Health School Santa Maria (ESSSM), Porto, Portugal; CINTESIS - Center for Health Technology and Services Research (NursID: Innovation and Development in Nursing), Porto, Portugal.
| | - Carla Fernandes
- CINTESIS - Center for Health Technology and Services Research (NursID: Innovation and Development in Nursing), Porto, Portugal; Nursing School of Porto (ESEP), Porto, Portugal.
| | - Juan Miguel Martinez-Galiano
- Department of Nursing, University of Jaén, Jaén, Spain; Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Spain.
| | - Célia Santos
- CINTESIS - Center for Health Technology and Services Research (NursID: Innovation and Development in Nursing), Porto, Portugal; Nursing School of Porto (ESEP), Porto, Portugal.
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Aapro M, Bossi P, Dasari A, Fallowfield L, Gascón P, Geller M, Jordan K, Kim J, Martin K, Porzig S. Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives. Support Care Cancer 2020; 28:4589-4612. [PMID: 32533435 PMCID: PMC7447627 DOI: 10.1007/s00520-020-05539-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Digital health provides solutions that capture patient-reported outcomes (PROs) and allows symptom monitoring and patient management. Digital therapeutics is the provision to patients of evidence-based therapeutic interventions through software applications aimed at prevention, monitoring, management, and treatment of symptoms and diseases or for treatment optimization. The digital health solutions collecting PROs address many unmet needs, including access to care and reassurance, increase in adherence and treatment efficacy, and decrease in hospitalizations. With current developments in oncology including increased availability of oral drugs and reduced availability of healthcare professionals, these solutions offer an innovative approach to optimize healthcare resource utilization. DESIGN This scoping review clarifies the role and impact of the digital health solutions in oncology supportive care, with a view of the current segmentation according to their technical features (connection to sensors, PRO collection, remote monitoring, self-management in real time…), and identifies evidence from clinical studies published about their benefits and limitations and drivers and barriers to adoption. A qualitative summary is presented. RESULTS Sixty-six studies were identified and included in the qualitative synthesis. Studies supported the use of 38 digital health solutions collecting ePROs and allowing remote monitoring, with benefits to patients regarding symptom reporting and management, reduction in symptom distress, decrease in unplanned hospitalizations and related costs and improved quality of life and survival. Among those 38 solutions 21 provided patient self-management with impactful symptom support, improvement of QoL, usefulness and reassurance. Principal challenges are in developing and implementing digital solutions to suit most patients, while ensuring patient compliance and adaptability for use in different healthcare systems and living environments. CONCLUSIONS There is growing evidence that digital health collecting ePROs provide benefits to patients related to clinical and health economic endpoints. These digital solutions can be integrated into routine supportive care in oncology practice to provide improved patient-centered care.
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Affiliation(s)
- M Aapro
- Medical Oncology, Genolier Cancer Center, Clinique de Genolier, Genolier, Switzerland.
- Institut Multidisciplinaire d'Oncologie (IMO), Clinique de Genolier, Case Postale (PO Box) 100, 1 Route de Muids, CH-1272, Genolier, Switzerland.
| | - P Bossi
- Department of Medical Oncology, University of Brescia, Brescia, Italy
| | - A Dasari
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - P Gascón
- Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - M Geller
- Gynecologic Oncology, Department of Obstetrics, Gynecology and Women's Health (OBGYN), University of Minnesota, Minneapolis, MN, USA
| | - K Jordan
- Department of Medicine, Haematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Kim
- Medical Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - K Martin
- Gyneco-oncology, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - S Porzig
- Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Grašič Kuhar C, Gortnar Cepeda T, Kovač T, Kukar M, Ružić Gorenjec N. Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study. JMIR Mhealth Uhealth 2020; 8:e17408. [PMID: 32427567 PMCID: PMC7435681 DOI: 10.2196/17408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/14/2020] [Accepted: 05/14/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Providing patients with cancer who are undergoing systemic therapy with useful information about symptom management is essential to prevent unnecessary deterioration of quality of life. OBJECTIVE The aim was to evaluate whether use of an app for symptom management was associated with any change in patient quality of life or use of health resources. METHODS Outpatients with early stage breast cancer receiving systemic therapy were recruited at the Institute of Oncology in Ljubljana, Slovenia. Patients who received systemic therapy between December 2017 and March 2018 (control group) and between April 2018 and September 2018 (intervention group) were eligible. All patients received standard care, but only those in the intervention group were asked to use mPRO Mamma, an Android-based smartphone app, in addition. The app supported daily tracking of 50 symptoms, allowed users to grade their symptom severity (as mild, moderate, or severe), and also provided in-depth descriptions and recommendations based on reported symptom level. Patient-reported outcomes in both groups were assessed through the European Organisation for Research and Treatment of Cancer (EORTC) core (C-30) and breast cancer (BR-23) questionnaires, as well as a questionnaire about health resources use. The primary outcomes were the difference in the global quality of life between groups and the difference in summary score of the EORTC C-30 questionnaire between groups after 3 time periods (the first week of treatment, the first treatment cycle, and the entire treatment). The secondary outcome was the use of health resources (doctor visits and hospitalizations) in each time period. Other scales were used for exploratory analysis. RESULTS The mean difference between the intervention group (n=46) and the control group (n=45) in global quality of life (adjusted for baseline and type of surgery) after the first week was 10.1 (95% CI 1.8 to 18.5, P=.02). The intervention group summary scores were significantly higher than those of the control group after the first week (adjusted mean difference: 8.9, 95% CI 3.1 to 14.7, P=.003) and at the end of treatment (adjusted mean difference: 10.6, 95% CI 3.9 to 17.3, P=.002). Use of health resources was not statistically significant between the groups in either the first week (P=.12) or the first treatment cycle (P=.13). Exploratory analysis findings demonstrated clinically important improvements (indicated by EORTC C-30 or BR-23 scale scores)-social, physical, role, and cognitive function were improved while pain, appetite loss, and systemic therapy side effects were reduced. CONCLUSIONS Use of the app enabled patients undergoing systemic therapy for early stage breast cancer to better cope with symptoms which was demonstrated by a better global quality of life and summary score after the first week and by a better summary score at the end of treatment in the intervention group compared to those of the control group, but no change in the use of health resources was demonstrated.
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Affiliation(s)
- Cvetka Grašič Kuhar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | | | - Timotej Kovač
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Matjaž Kukar
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Ružić Gorenjec
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia
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