Several pilot studies are underway at Jefferson Health to evaluate patient engagement, electronic capturing of patient-reported outcomes and remote monitoring in at-risk patients with cancer.
“Ultimately, we aim to merge remote monitoring of patients with the electronic capture of patient-reported outcomes to demonstrate decreased hospitalizations and ER visits and lead to an overall improvement in patient care,” Noelle Williams, radiation oncology resident at Thomas Jefferson University, told HemOnc Today.
Williams is working with coders and mobile app builders to identify technology solutions to common patient and physician challenges.
One project will evaluate the feasibility of at-home blood pressure monitoring in patients with head and neck cancer who are receiving chemoradiotherapy. The goal is to determine cutoff points that prompt provider intervention. In a substudy of these patients, Williams and colleagues will seek to assess the feasibility of collecting electronic patient-reported outcomes in this population.
Another ongoing project is the prospective trial, Strength Through Insight, which will evaluate the feasibility of electronic capture of patient-reported outcomes via validated measures in individuals with prostate cancer.
Ed Cunicelli Photographer. All rights reserved.
HemOnc Today spoke with Williams about the goals of these projects, how they are fulfilling a unique need for patients and how technology can increasingly play a role in patient care.
Question: What is the goal of the project looking at ways to conduct remote blood pressure monitoring in patients with head and neck cancer receiving chemoradiotherapy?
Answer: Together with our colleagues in medical oncology, we came up with several project ideas looking at remote monitoring in patients as a way to catch symptoms early, and then be able to intervene on those symptoms and potentially prevent unplanned hospitalizations or ED visits. When we thought about the patient population that goes through the toughest treatment, it is typically patients with head and neck cancer who are undergoing a combination of chemotherapy with radiation therapy. These patients are a high-risk population, and they often require emergency room evaluation during their treatment course for treatment-related toxicities, including dehydration because of esophagitis. We picked this patient population because we believe that — by monitoring their symptoms remotely — we can potentially pick up on dehydration early, leading to early intervention and a decrease in unplanned admissions and ED visits. Remote monitoring could have a big impact on these patients, who not infrequently end up with a feeding tube at the end of their treatment course.
Q: What is the goal of the project looking to measure
reported outcomes in those with prostate cancer?
A: Patient-reported outcomes account for the status of a patient’s health without interpretation of their response by a clinician. In our routine clinical practice, patient-reported outcomes have been receiving increasing interest because they have the potential to improve patient symptom management and ultimately improve clinical outcomes. In our prostate cancer population, there are urinary and sexual side effects that may develop during treatment or within several months following treatment. It is not uncommon for patients to have recall bias when reporting symptoms to clinicians during their set appointments. In this pilot project, we collaborated with several members from our Center for Digital Innovation and Consumer Experience (CDICE) to develop an Apple ResearchKit app, called Strength Through Insight, for patients with a diagnosis of prostate cancer to be able to electronically capture patient-reported outcome data and measure the feasibility of this method of remote data collection between routinely scheduled visits. This trial is accruing and we eagerly await this feasibility data to then be able to incorporate patient-reported outcomes into additional trials.
Q: How are these projects fulfilling a unique need for each of these patient groups?
A: Clinical trials often focus on outcome measures such as OS, PFS and local control. As I progressed through my training in radiation oncology, I began to notice that the patient’s voice can often be missing in clinical trial reporting. If two different therapy options provide the same outcomes in terms of control and survival, then the secondary outcomes in these trials really do become important. Those often include quality-of-life measures and patient-reported outcome data. By capturing patient-reported data upfront and incorporating biometric parameters remotely, it gives us the opportunity to let the patient’s voice be heard.
Q: What role will technology play in each of these projects?
A: An electronic blood pressure device will be used in the head and neck remote monitoring project, and the Strength Through Insight project uses an app that was specifically developed through collaboration with our information services and technology group via the Apple ResearchKit platform. Our future work will include apps with Android and iOS platforms. The next phase will include activity trackers, as they provide a complementary dimension to the patient experience.
Q: What is the anticipated timeline
A: We are in the planning and development stages of the head and neck project. We are coming up with the paradigm in terms of the frequency of remote data collection and data integration into clinic flow. This project should be rolling out within the next few months. The Strength Through Insight project opened for enrollment at the end of September and is accruing patients.
Q: Are there any other projects that you would like to mention?
A: We are in the development stages of a collaboration with a company to test a device initially manufactured for pediatric patients with asthma as a metric to monitor their respiratory status. The device has an adhesive element that sticks to the patient’s chest wall and is able to capture several variables, including respiratory rate, temperature, number of coughs, wheezes and activity levels. Our goal working with this company is to test the feasibility of this device in patients undergoing treatment for lung cancer. Our hypothesis is that we will be able to identify pneumonitis, a relatively common toxicity associated with chemoradiotherapy for lung cancer patients, earlier than traditional imaging would show and before clinically significant symptoms develop.
Q: Is there anything else
that you would like to mention?
A: We envision a future in multidisciplinary patient care where we can empower patients and their families to better understand diseases and overcome health challenges in a data-driven manner, with the ability to be proactive rather than reactive. Our goal through digital health is to improve patient care, reduce resource utilization and enhance a patient’s total disease management plan. Moving forward, we also envision wearable sensor-based technology as an increasingly valuable tool. We traditionally have not had a way of knowing about quality of life in between office visits unless a patient reported it. However, the continuous collection of data from wearables will provide a more in-depth perspective of what the patient experiences, and when combined with other clinical data, the power of these data stands to change our understanding of disease states, with the goal of ultimately benefiting our patients. – by Jennifer Southall
For more information:
Noelle Williams can be reached at Jefferson Health, 111 S. 11th St., Philadelphia, PA 19107; email: firstname.lastname@example.org.
Disclosure: Williams reports no relevant financial disclosures.