Researchers at University of Michigan Comprehensive Cancer Center developed a new first-of-its-kind mobile app to help patients with breast cancer manage and navigate the multitude of information that accompanies a cancer diagnosis.
The free app is different from other health care apps in that it creates a customizable experience based upon the patient’s individual treatment plan at a specific institution.
“We approached Breast Cancer Ally with a simple concept in mind,” Michael Sabel, MD, associate professor of surgery and chief of surgical oncology at University of Michigan Comprehensive Cancer Center, said in a press release. “We went to each specialist involved in breast cancer care and asked, ‘If you could have someone follow your patients after they left the office or the hospital, what would you want to remind the patient or encourage the patient to do?’ We then went to our patients and asked them a similar question: ‘What are the things you need after you leave us?’”
HemOnc Today asked Sabel, who led the development of the app, about some of the unique features of the app, as well what types of new and improved features are on the horizon.
Question: How did the breast cancer app come about?
Answer: At the University of Michigan, we have been very interested in how we can use mobile technologies to improve patient–physician communication and outcomes, particularly in areas of multidisciplinary care, and cancer is obviously an example of this. We previously released an app in melanoma for screening and early detection of melanoma lesions, and we have been looking to build on this success. We saw breast cancer and really multiple areas of multidisciplinary care where mobile technology may be very useful in filtering information and providing patients with encouragement and tools to improve outcomes after treatment.
Q: Can you describe the need for this app, as well as its mission?
A: This is a patient-navigation app. What it is meant to do is help filter education and information for patients, so that it is specific to the patient’s case and institution. One of the problems that we see is that patients receive a whole host of information when they are diagnosed with breast cancer, or any type of cancer. Particularly as patients start their long journey through cancer treatment, they get all of this information upfront about all aspects of treatment and it can be very overwhelming. It can also be conflicting. Sometimes a patient will get [one piece of] information from the surgeon, but then the medical oncologist is telling you another and the radiation oncologist is telling you yet another.
One very good example is with lymphedema. For the patient undergoing breast cancer treatment ― this includes surgery, chemotherapy and radiation therapy ― the patient is going to receive information from different physicians. Each physician is talking about the patient’s risk for lymphedema, and sometimes they are all giving different recommendations of how to prevent lymphedema and manage it.
Patient education is incredibly important, and we are making sure that it is delivered in a way that it helps patients instead of increasing their stress level. One of the advantages of mobile technology is that we can provide the patient with very specific treatment that they are going to have so they are not overwhelmed by all the information that is out there. This is one of the primary goals we are trying to accomplish with our patient navigation apps. The second goal of the app is that, with changes in health care, we have less face-to-face time with patients. Sometimes we do not have enough time to emphasize a lot of the extra things that we would like patients to know, such as diet and exercise and what they can do to alleviate symptoms and improve outcomes. Mobile technology, when given the opportunity to intervene when necessary, can encourage patients to do more self-care activities and to be more proactive in care.
Q: What are some examples of things that mobile technologies can do to help improve patient outcomes?
A: One good example is that we emphasize the benefit of exercise during chemotherapy in order to decrease fatigue and improve tolerability. I am not really sure how many physicians have the time to talk to their patients about an exercise program. But with mobile technology, we can deliver this information when it is important, send reminders to encourage them, and track whether patients are doing this. There are activities we can recommend to combat what we call chemo-brain that we may not have time to emphasize in the office, but could use mobile technologies for this purpose.
Another advantage is that physicians can track real-time patient-reported outcomes. We can get information on the symptoms that patients are having and we can try to initiate early intervention and we can also deliver educational materials so patients can try and manage some of these without having to call their health care provider. These are things that we have incorporated into the app. Finally, we are trying to incorporate decision aids. Many times patients undergoing complex care face very difficult decisions that we can present in the office and discuss face to face, but there are additional tools that we have that can help patients make very complex decisions.
Q: Why was breast cancer chosen specifically?
A: It is important to point out that breast cancer was chosen as the first of what we hope will be a suite of customizable apps. What we are really interested is multidisciplinary care and breast cancer is the perfect place to begin. Not only is it a very common cancer, it is a situation where patients have a lot of choices and a lot of autonomy and it is a cancer that has a lot of data emerging as to what patients can do in addition to sort of improve outcomes that we can incorporate into the app.
Q: In what ways is this app different from other health care apps available today?
A: There are several ways. One, it is a true multidisciplinary app. It covers the broad spectrum from diagnosis through survivorship for breast cancer patients. What we are really trying to do is have one app to help guide patients through every aspect of care. The way we went about doing this is we conducted a bunch of interviews with experts across the spectrum of breast cancer care in the field here at the University of Michigan. We are only on version 1.0 but version 2.0 is coming out and we are incorporating more of the features recommended by health care providers and current and former patients.
The other thing that is different is that the app is not a “one-app-fits-all” approach, but rather we want the app to be institution-specific. This includes not only providing the patient with maps, phone numbers and clinic information that is specific to where they are being treated, but also because each institution has different approaches to treatment, which can range from minor differences to rather significant differences in philosophy. Creating a very general app with generic information adds to the information overload by including education that conflicts with what they are hearing from their physicians. These apps are readily customizable to any institution, so they reflect the same information the patient is receiving in the office.
Finally, I think we have a real problem with where we are going in mobile technology in health care. The health care field has been very slow to adopt the idea of mobile technologies when compared with other industries. More concerning is that a lot of the people who are designing these apps are not physicians with experience in the diseases the apps are addressing. And the goal seems to be to replace the physician. This is not the right type of approach. We need doctors to design apps that incorporate an evidence-based approach and that enhance patient–physician communication. We want the app to be used with the doctor. What we do not want is this or any app to be is an alternative to a physician. This is how we are unique.
Q: What type of feedback have you received about the app thus far from both patients and physicians?
A: The feedback has been tremendous. Patients have really appreciated it and we have received a lot of great suggestions about the things we can incorporate into the app that we as physicians maybe didn’t pay a lot of attention to. For example, patients say that the app tells them what they need to know so they don’t have to call the nurse practitioner but sometimes the verbal communication is important from a social perspective. So they have asked that the app deliver inspirational messages or words of encouragement. This is something that I personally didn’t think about, but I think it’s a very important aspect and this is something that we are trying to incorporate now.
Our early look at the app shows that patients are, for example, compliant with the recommended exercises. Right now, this information isn’t visible to the physicians, but version 2.0 will have the ability for physicians to see patient-related outcomes. So, I anticipate receiving more physician feedback then. We are hoping to release version 2.0 within the next 2 to 3 months and this version will include a physician dashboard where physicians will be able to see what their patients are reporting in terms of outcomes and what they are being compliant with.
Q: What are some of the challenges you have encountered with the app and how have you overcome them?
A: One important challenge when you are designing any mobile technology is that not everyone has an iPhone. It has been a challenge to develop an Android version, but this is something that we are working on. We ae also looking into the idea of providing patients who we really think would benefit from patient navigation with technology, with an iPad or iPhone, so that they can take advantage of this, as well. I also think we need to be very sensitive to the idea that there are some patients who respond well to technology and there are some patients who do not. So, we need to make sure that we are not moving in a direction that we are leaving behind patients who do not use these technologies.
Q: What is your ultimate hope for the app? Do you foresee it becoming available outside of U-M?
A: Improving patient outcomes is number one. But what I am really interested in is proving that as doctors, we can use mobile technologies in a way that isn’t replacing us but can be used in a way to enhance our relationship with the patient in order to improve outcomes. We are presently converting and coming out with another breast cancer app for another institution. So we are creating Breast Cancer Ally apps for other institutions, and our ultimate goal is that we are going to be able to customize this app so that any institution will be able to use it with their patients. We are also expanding into other cancers. We have a Melanoma Ally app that will be coming out within the next few months, and we are looking to expand it to other cancers such as prostate and colorectal cancer, where the app may be specifically useful for these patients.
Q: Is there anything else you would like to add?
A: A lot of doctors are very hesitant about apps because they are being promoted in way that they replace the physician. I think that if we take control of mobile technology ourselves as physicians, there is a tremendous role. I think this is the next iteration of telemedicine and I think that we should be early adopters. We should not sit back and let third parties surpass us in this regard because it will harm the patient–physician relationship. – by Jennifer Southall
For more information:
Michael S. Sabel, MD, can be reached at University of Michigan Health Systems, 1500 E. Medical Center Drive, 3303 Cancer Geriatric Center SPC 5932, Ann Arbor, MI 48109-5932; e-mail: email@example.com.
Disclosure: Sabel reports no relevant financial disclosures.