Tech Takeover: New Tools and Resources to Improve Cancer Care

Healthcare practitioners know all too well how technology has transformed their workplace. These changes can be a bane or a blessing—sometimes both—as many nurses and other clinicians will attest.

Healthcare practitioners know all too well how technology has transformed their workplace. These changes can be a bane or a blessing—sometimes both—as many nurses and other clinicians will attest.

On the one hand, mobile symptom-monitoring apps, health trackers, social media, and specialized websites can empower patients with cancer to better manage their disease and at the same time, help to connect them with a supportive network of advocates, patients, survivors, and caregivers on the same journey.

On the other hand, some experts and many patients and family members worry that all this technology can sometimes be dehumanizing, hin­dering that all-important clinician—patient human interaction. In her column this month, Oncology Nursing News editor-in-chief Lisa Schulmeister, MN, RN, ACNS-BC, FAAN, writes about this need to pro­vide “high-touch” care in a high-tech world, noting that the realities of high-tech care, which frequently requires practitioners to focus their attention on laptops or machines, can leave them little time to focus on the patient.

Whatever your particular take on how this tech­nology has impacted oncology nursing practice, it is here to stay. Healthcare systems and tech giants like Apple are enlisting technology and clinical ex­perts to help them develop tech-based solutions to address healthcare delivery challenges and improve the patient experience. And, Microsoft is now col­laborating with scientists to analyze large numbers of internet queries and search patterns to identify early signals of a subsequent cancer diagnosis. In their recent study of such indicators in pancreatic cancer, investigators were able to identify 5% to 15% of cases of adenocarcinoma, with low rates of false-positives.¹

The good news is, oncology nurses—ever the problem-solvers looking to advance patient care—are coming up with and deploying their own ideas in the clinic.

Systematic Symptom Monitoring

At the recent 2016 Annual Meeting of the Ameri­can Society of Clinical Oncology (ASCO), research­ers shared impressive results from a pilot study conducted in France of a lung cancer symptom-reporting app known as MoovCare. MoovCare resulted in a 7-month longer survival for those who used the app when compared with controls (19 vs 12 months, respectively). Additionally, 75% of the patients followed through MoovCare were still alive at 1 year versus 49% with standard procedures.²

MoovCare is a software application that patients or their caregiver use to report symptoms. The algorithm analyzes the information for signals of potential relapse or complications and, if necessary, notifies the oncology care provider via email. The app can be accessed on mobile and desktop devices.

The system made a difference for patients because it resulted in early detection of dangerous conditions or recurrences, resulting in healthier in­dividuals who were better able to undergo optimal therapy and earlier supportive care that improved quality of life, reported lead study author Fabrice Denis, MD, PhD, at an ASCO press conference.

Having these tools available as we try to deliver better care will be very important, said Patricia Ganz, MD, of UCLA’s Jonsson Comprehensive Cancer Center and ASCO Expert in breast cancer, who moderated the press panel.

“As someone who has been doing quali­ty-of-life patient-reported outcomes for 35 years, systematically asking patients spe­cific questions and asking them to respond is very different than asking them, ‘How are you today? Do you have any problems?’ This kind of [systematic] monitoring, however you do it, is good. We need to get that information from patients, so we can inter­vene early.” Ganz said.

She added that this is the goal of tools be­ing advanced in the United States, such as the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), an electronic-based system for patient self-reporting. “We’re trying to restructure how we deliver care so that we can be more responsive to these kinds of changes," and with these tools, patients can report their symptoms on a regular basis.

However, Ganz stressed, making it easier for patients to report their symptoms is only part of the equation, and here is where nurses play a pivotal role.

“There have actually been many experiments similar to [the MoovCare app] in the United States, and when the feedback information comes just to the doctor, there’s not much action about it. You need someone in the office practice, whether it’s a nurse or some other person, who is actually looking at the data as they come in, and trigger a response.”

Another ASCO spokesperson, Gregory A. Mas­ters, MD, of the Christiana Care Health System, added that while the MoovCare system presents “one way to engage patients and allow them to take a more active role in their care … it is certainly not the only way,” for example, to monitor patients who are more infirmed or who may not be comfortable with a cell phone app. "If you completely switched over to that, you might lose some of those patients, so we have to figure out how to integrate the new technology.”

Wearable Health Tech

As practitioners know all too well, patient use of wearable health technology (“wearables”) to track their health data has grown tremendously. The consulting firm Accenture reported that the number of US consumers using wearables and mobile health­care apps has doubled from 16% in 2014 to 33% today, with the majority of consumers (77%) and doctors (85%) reporting that using wearables helps patients to engage in their own health.³

“Through wearable devices, Wi-Fi—enabled home health devices, and other innovations, nurses will be able to help patients to be more proactive and feel empowered to maintain and improve their healthcare,” noted Jason J. Fratzke, RN, MSN, chief nursing informatics officer for the Mayo Clinic in Rochester, Minnesota.⁴

Wearable technology also has a role in cancer clinical trials, with wearable activity monitors (WAMs) increasingly being used to monitor patient physical activity, behavior, and sleep in survivors and patients who have a relatively good prognosis.⁵

In a small pilot study reported at the 2016 ASCO Annual Meeting, researchers are looking at the impact of WAMs, using the Fitbit Charge HR, in assessing patient well-being between office visits.⁶

In a recent interview with Oncology Nursing News, researcher Arvind Shinde, MD, a medical oncology and palliative care practitioner at Cedars-Sinai Medical Center in Los Angeles, noted that he has found that, “we really don’t have a good under­standing of how patients are doing outside the four walls of our clinic.”

He explained that while clinicians try to assess performance status during clinic visits, “for a vari­ety of reasons, these assessments are incomplete and biased … patients may not remember how they’ve been doing over the past week, or they may want to convince themselves and their physicians that they’re doing better than they are.”

The study is ongoing, but even early on, Shinde said that investigators are finding that “almost universally, patients are able to wear the trackers continuously and charge them, and most patients want their oncologists to have this information and feel like it will help make better decisions.”⁶ He hopes that with this technology, clinicians will be able to better understand how patients are doing between visits and then “intervene if something isn’t going well in a way that’s beneficial to the patient and less costly to the system:

“It’s all about patient-centric assessments and patient-centric decision making … There’s great value in learning how to use this technology—we just have to learn how to use it. The technology is rapidly progressing, so it’s a great opportunity.”

References

• Paparrizos J, White RW, Horvitz E. Screening for pancreatic adenocarcinomas using signals form web search logs: feasibility study and results [published online before print June 7, 2016]. J Oncol Practice.
• Denis F, Lethrosne C, Pourel N, et al. Overall survival in patients with lung cancer using a web-application-guided follow-up compared to standard modalities: results of phase III randomized trial. J Clin Oncol. 2016;34(suppl; abstr LBA9006).
• Eddy N. eWEEK. “Adoption of Health Apps, Wearable Devices Grows.” http://bit.ly/1LMj7IO. Accessed June 8, 2016.
• The Campaign for Nursing’s Future. Nursing Notes. “Mobile Apps Help Boost Efficiency for Nurses.” http://bit.ly/1UfsHG5. Accessed June 8, 2016.
• Gresham GK, Piantadosi S, Drye L, et al. Applications of wearable activity (WAM) in cancer clinical trials (CT): a review of the literature. J Clin Oncol. 2016;34(suppl; abstr e21598).
• Shinde AM, Gresham GK, Hendifar AE, et al. Biosensors to assess performance status in cancer (BioAPS Study). J Clin Oncol. 2016;34(suppl; abstr TPS6631).