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de Ligt KM, Koppert LB, de Rooij BH, van de Poll-Franse LV, Velikova G, Cardoso F. Seizing the moment: The time for harnessing electronic patient-reported outcome measures for enhanced and sustainable metastatic breast cancer care is now. Breast 2024; 74:103676. [PMID: 38359564 PMCID: PMC10877629 DOI: 10.1016/j.breast.2024.103676] [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: 10/20/2023] [Revised: 12/11/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
The sustainability of healthcare systems is under pressure. Unlike care for many other chronic diseases, cancer care has yet to empower patients in effectively self-managing both the medical and emotional consequences of their condition, including adapting to changes in lifestyle and work, which is essential to achieve optimal health and recovery. Although proposed as a potential solution for sustainable healthcare and support for optimal health and recovery already decades ago, practical implementation of digital care lags behind. We believe electronic patient reported outcome measures (ePROMs) could play an important role in creating sustainable healthcare, both to guide complex treatment pathways and to empower survivors to self-manage consequences of diagnosis and treatment. That is, ePROMs can be used for screening and monitoring of symptoms, but also for treatment decision-making and to facilitate communication about quality of life. We therefore see opportunities for improvements in quality of care, quality of life, and survival of cancer patients, as well as research opportunities, as ePROMs collection can lead to better understanding of care needs. The '10 Actions for Change report' of the Advanced Breast Cancer Global Alliance stresses a critical need for improvement of care for metastatic breast cancer (MBC) patients. We therefore in this paper focus on MBC care and research.
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Affiliation(s)
- K M de Ligt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - B H de Rooij
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands.
| | - L V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands.
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Woodhouse Lane, LS2 9JT, Leeds, United Kingdom; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett St, Harehills, LS9 7LP, Leeds, United Kingdom.
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Avenida Brasília s/n, 1400-038, Lisbon, Portugal.
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Wolff J, Wuelfing P, Koenig A, Ehrl B, Damsch J, Smollich M, Baumann FT, Harbeck N, Wuerstlein R. App-Based Lifestyle Coaching (PINK!) Accompanying Breast Cancer Patients and Survivors to Reduce Psychological Distress and Fatigue and Improve Physical Activity: A Feasibility Pilot Study. Breast Care (Basel) 2023; 18:354-365. [PMID: 37901047 PMCID: PMC10601684 DOI: 10.1159/000531495] [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: 04/20/2023] [Accepted: 06/09/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction This pilot study aimed to investigate the effects of using an app-based certified medical product named PINK! on breast cancer patients and survivors. The objectives were to measure psychological distress, physical activity, and therapy-related fatigue of patients using PINK! to identify trends and develop a study design for a subsequent multicentric proof of efficacy RCT. Materials and Methods PINK! offers individualized, evidence-based therapy and side-effect management, mindfulness-based stress reduction, nutritional and psychological education, physical activity tracking, and motivational exercises to implement lifestyle changes sustainably in daily routine. A prospective, intraindividual RCT was performed with n = 60 patients in 2021 at Comprehensive Cancer Center Munich. Patients with BC were included independent of the stage of diseases. The intervention group got access to PINK! over 12 weeks. Control group served as a waiting-list comparison to "standard of care." Results Primary efficacy variable analysis revealed a relative average decrease of 32.9% in psychological distress, which corresponds to a statistically significant reduction (p < 0.001) within 12 weeks compared to the control group. Linear regressions within usage groups showed a correlation of high app usage and a reduction of psychological distress. Fatigue data presented a statistically significant antifatigue efficacy (p < 0.001) and physical activity increased by 63.9%. Conclusion App-based supportive care offers a promising, low-threshold, and cost-efficient opportunity to improve psychological well-being, quality of life, fatigue, and physical activity. More research is needed to implement eHealth solutions in clinical cancer care.
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Affiliation(s)
- Josefine Wolff
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University, University Hospital, Munich, Germany
| | - Pia Wuelfing
- PINK! gegen Brustkrebs GmbH, Department Clinical Research, Hamburg, Germany
| | - Alexander Koenig
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University, University Hospital, Munich, Germany
| | - Brigitte Ehrl
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University, University Hospital, Munich, Germany
| | - Jana Damsch
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University, University Hospital, Munich, Germany
| | - Martin Smollich
- Institute of Nutritional Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University, University Hospital, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University, University Hospital, Munich, Germany
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Degenhardt T, Fasching PA, Lüftner D, Müller V, Thomssen C, Schem C, Witzel I, Decker T, Tesch H, Kümmel S, Uleer C, Wuerstlein R, Hoffmann O, Warm M, Marschner N, Schinköthe T, Kates RE, Schumacher J, Otremba B, Zaiss M, Harbeck N, Schmidt M. PRECYCLE: multicenter, randomized phase IV intergroup trial to evaluate the impact of eHealth-based patient-reported outcome (PRO) assessment on quality of life in patients with hormone receptor positive, HER2 negative locally advanced or metastatic breast cancer treated with palbociclib and an aromatase inhibitor or palbociclib and fulvestrant. Trials 2023; 24:338. [PMID: 37198674 DOI: 10.1186/s13063-023-07306-z] [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: 04/12/2021] [Accepted: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Efficacy and quality of life (QoL) are key criteria for therapy selection in metastatic breast cancer (MBC). In hormone receptor positive (HR +) human epidermal growth factor receptor 2 negative (HER2 -) MBC, addition of targeted oral agents such as everolimus or a cycline-dependent kinase 4/6 (CDK 4/6) inhibitor (e.g., palbociclib, ribociclib, abemaciclib) to endocrine therapy substantially prolongs progression-free survival and in the case of a CDK 4/6i also overall survival. However, the prerequisite is adherence to therapy over the entire course of treatment. However, particularly with new oral drugs, adherence presents a challenge to disease management. In this context, factors influencing adherence include maintaining patients' satisfaction and early detection/management of side effects. New strategies for continuous support of oncological patients are needed. An eHealth-based platform can help to support therapy management and physician-patient interaction. METHODS PreCycle is a multicenter, randomized, phase IV trial in HR + HER2 - MBC. All patients (n = 960) receive the CDK 4/6 inhibitor palbociclib either in first (62.5%) or later line (37.5%) together with endocrine therapy (AI, fulvestrant) according to national guidelines. PreCycle evaluates and compares the time to deterioration (TTD) of QoL in patients supported by eHealth systems with substantially different functionality: CANKADO active vs. inform. CANKADO active is the fully functional CANKADO-based eHealth treatment support system. CANKADO inform is a CANKADO-based eHealth service with a personal login, documentation of daily drug intake, but no further functions. To evaluate QoL, the FACT-B questionnaire is completed at every visit. As little is known about relationships between behavior (e.g., adherence), genetic background, and drug efficacy, the trial includes both patient-reported outcome and biomarker screening for discovery of forecast models for adherence, symptoms, QoL, progression free survival (PFS), and overall survival (OS). DISCUSSION The primary objective of PreCycle is to test the hypothesis of superiority for time to deterioration (TTD) in terms of DQoL = "Deterioration of quality of life" (FACT-G scale) in patients supported by an eHealth therapy management system (CANKADO active) versus in patients merely receiving eHealth-based information (CANKADO inform). EudraCT Number: 2016-004191-22.
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Affiliation(s)
- Tom Degenhardt
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany
- Hausarztpraxis Wolfratshausen, Wolfratshausen, Germany
| | - Peter A Fasching
- Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow, Germany
- Immanuel Hospital Rüdersdorf and Medical University of Brandenburg Theodor Fontane, Brandenburg, Germany
| | - Volkmar Müller
- Clinic and Polyclinic for Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Christoph Thomssen
- Gynecology, Martin-Luther-University Halle-Wittenberg, Halle-Saale, Germany
| | | | - Isabell Witzel
- Clinic and Polyclinic for Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Thomas Decker
- Hematology/Oncology, Onkologie Ravensburg, Ravensburg, Germany
| | - Hans Tesch
- Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt, Germany
| | | | | | - Rachel Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany
- West German Study Group, Moenchengladbach, Germany
| | | | - Mathias Warm
- Breast Center, Academic Hospital Cologne-Holweide, Cologne, Germany
| | | | - Timo Schinköthe
- CANKADO Service GmbH, Kirchheim, Germany
- Research Center Smart Digital Health, University of the Bundeswehr, Neubiberg, Germany
| | | | | | | | - Matthias Zaiss
- Praxis Interdisziplinäre Onkologie U. Hämatologie, Freiburg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany.
- West German Study Group, Moenchengladbach, Germany.
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Raza M, Khalid R, Wisetsri W, Cavaliere LPL, Alnawafleh HSM, Guzman-Avalos M. The technological intervention in e-health management: evidence from Thailand. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2022. [DOI: 10.1108/ijhrh-02-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Purpose
The e-health services came up as an effective tool to mitigate effects of COVID-19 and following social distance norms. This study highlighted an issue of contentious usage intentions of e-health services among Thai older citizens. This study aims to examine the relationship of social influence (SI), information quality (IQ) and the digital literacy (DL) to contentious usage intentions.
Design/methodology/approach
This study follows quantitative techniques, and the sample size is 140 to analyze, that is collected from the older Thai citizens. The convenient sampling technique was used to collect the data and the items were measured by using a five-point Likert scale.
Findings
The findings of this study are having mixed results. The effect of DL and satisfaction (SAT) on continuous usage intention (CUI) is significant. The effect of IQ and SI on CUI is non-significant. The effect of IQ and SI on SAT is significant. Further, the mediating effect of SAT between IQ and CUI is non-significant. However, the mediating effect of SAT between SI and CUI is significant.
Originality/value
This study contributes to knowledge by empirical testing of DL and usage of the medicine. Furthermore, to the best of the authors’ knowledge, this study is one of the rare studies that incorporate technological intervention for drug usage intentions.
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Eggersmann TK, Harbeck N, Schinkoethe T, Riese C. eHealth solutions for therapy management in oncology. BREAST CANCER MANAGEMENT 2017. [DOI: 10.2217/bmt-2017-0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
In an outpatient setting, some challenges of cancer treatment include continuous patient–physician communication, lack of adherence, potential side effects and their impact on quality of life and other patient-reported outcomes. These challenges in the support of disease management can be overcome by the introduction of eHealth applications. Though the market of eHealth applications is fast growing, many applications lack evidence regarding their effectiveness, safety and utility. Only few prospective randomized trials have been conducted, so far. Results of these studies univocally show a gain in health-related quality of life, in the examined eHealth applications. It remains unclear if procedural and cost efficacy are affected by eHealth applications. The upcoming PreCycle study will be the largest randomized eHealth study in oncology.
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Affiliation(s)
- Tanja K Eggersmann
- Department of Obstetrics & Gynecology, University Hospital, LMU Munich 81377, Germany
| | - Nadia Harbeck
- Department of Obstetrics & Gynecology, University Hospital, LMU Munich 81377, Germany
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