1. Susman, Ed

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SAN FRANCISCO-An at-home system that monitors how well cancer patients undergoing radiation therapy are doing may help keep patients with head and neck cancer from life-threatening bouts of dehydration, suggest researchers at the University of Texas MD Anderson Cancer Center (Abstract 152).

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The so-called CYCORE program, funded in an ongoing National Cancer Institute study, uses remote-sensor technology to collect data on cancer survivors when they are away from the clinic setting, explained Susan Peterson, PhD, Professor of Behavioral Science, Cancer Prevention, and Population Sciences at MD Anderson Cancer Center, and Adjunct Professor of Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston School of Public Health.


"This project is specifically related to head and neck cancer patients who are undergoing radiation treatment," Peterson told OT. "They are at increased risk during radiation treatment for becoming dehydrated because of their treatment.


"Radiation-induced mucositis makes it very difficult to eat, to drink, to swallow, and the onset of dehydration can occur very rapidly-even within a day's time," she said at her poster presentation. "People can come in the morning for their treatment and then they can decline very quickly, which results in emergency room visits, hospitalization, increased costs, and possibly interruption in treatment."


Up to 80% of patients receiving radiation therapy for head and neck cancer experience mucositis, she said, which occurs along with other symptoms that impact eating and drinking, such as difficulty swallowing, pain, taste alterations, nausea, and appetite loss. In 2015, there were expected to be 45,780 new cases and 8,650 deaths from head and neck cancers. Up to one-third of head and neck cancer patients may be hospitalized due to dehydration during radiation therapy, she said.


Study Details

As of the end of 2015, the researchers assigned 79 patients with head and neck cancer who are undergoing radiation to the intervention through the CYCORE system and 80 similar patients to usual care. The patients were gleaned from 801 patients, most of whom failed to meet entry criteria.


"We are about halfway through with recruitment," Peterson said. "We have really great recruitment-about 90% of the patients being treated-and we have 90% retention. The patients love it. Even the patients on the control arm like it. The ones on the CYCORE intervention say 'we feel we are being extra cared for' or 'this is an extra tool I can use to keep me from being sick.'"


The primary objective of the study is to reduce hospitalization and emergency room visits relative to usual care and to determine if the system reduces concomitant health care-related costs.


"Hopefully at this time next year, we will be able to show some results," Peterson reported. Early identification and mitigation of dehydration risk during radiation therapy can help avoid treatment interruptions, improve quality of life, and reduce complications and health care costs.


Peterson said the study is being developed in conjunction with colleagues at the University of California at San Diego and the University of Alabama at Birmingham Comprehensive Cancer Center.


Sensor Technology

The patients use the sensing devices at home and on the go, Peterson said. The sensors collect blood pressure, pulse, and weight data. Data is sent to a 2net hub, which gathers data from sensors and then sends it on to CYCORE. Data from patient-reported outcomes on tablets or smartphones are also sent to CYCORE.


"Our clinicians log in to our system every day to take a look at the patients who are being monitored.


The patients, through a mobile app, will also answer questions related to symptoms of dehydration," Peterson said. "When these symptoms look worrisome in regard to pain or vomiting, the system also flags the condition so that the clinician's attention will be drawn to it. The clinician then evaluates the finding, will call the patient or have them come in for intravenous fluids, or talk to them about their medications."


Patients were eligible for the study if they had received a head and neck cancer diagnosis, specifically: oropharyngeal, hypopharyngeal, nasopharyngeal, laryngeal, salivary gland, thyroid, oral cavity, or unknown primary head and neck cancer with cervical metastasis. They also were required to be undergoing bilateral radiation therapy with curative intent. They were not eligible if they had prior dysphagia, radiation therapy for head and neck cancer, or enrollment in a trial with toxicity endpoint.


Possible Outcomes

In commenting on the study, Dennis H Kraus, MD, Director of the Center for Head & Neck Oncology within the New York Head & Neck Institute at Northwell Health Cancer Institute at Lenox Hill Hospital, told OT. "The problem of dehydration among people with head and neck cancer undergoing radiation is a very real problem."


The system outlined in the MD Anderson study is an innovative proposal and it may allow for early detection of patients who have become dehydrated. It really is a cool idea. I think the system has real potential for changing outcomes and avoiding hospitalizations and acute complications," Kraus said.