1. Fuerst, Mark L.

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CHICAGO-The use of mobile and sensor technology can lower symptom severity for patients with head and neck cancer, according to a new study (Abstract 6063). Sensor and mobile technology can enable monitoring of patients' symptoms and related outcomes during critical periods of outpatient cancer treatment, can provide timely information to facilitate rapid clinical decision-making about care, and may ultimately result in better quality-of-life and health outcomes.

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"Our study generated evidence on how newer technologies can be integrated into cancer care relatively easily and improve patient outcomes without interfering too much in a person's daily life," said lead author Susan K. Peterson, PhD, Professor in the Department of Behavioral Science at The University of Texas MD Anderson Cancer Center in Houston. "This study was done during a rather intense period in the patients' care for head and neck cancer. The system helped their physicians to provide valuable support that ultimately resulted in lower symptom severity."


Peterson presented the findings at a press briefing in advance of the 2018 ASCO Annual Meeting.


The researchers used the CYCORE (Cyberinfrastructure for Comparative effectiveness REsearch) system to remotely collect and analyze weight, blood pressure, and pulse using Bluetooth-enabled devices, as well as gather patient-reported outcomes with a mobile app on week days. Clinicians reviewed data daily to evaluate symptoms and dehydration risk, and intervened when medically necessary.


Head and neck cancer patients who receive radiation treatment have a high symptom burden and increased risk for dehydration, said Peterson, adding that "mobile and sensor technology can assist in early detection of treatment-related symptoms and dehydration risk in outpatient care."


Significant infrastructure was developed to analyze and view data in near real-time, and ensured confidentiality and security of patient information. "We compared longitudinal symptom data in head and neck patients who used CYCORE during radiation therapy versus those who did not use CYCORE," said Peterson.


A total of 357 patients, median age 60 years, were randomized to CYCORE plus usual care (169 patients) versus usual care only (188 patients) at the start of radiation therapy. Usual care patients had weekly visits with a radiation oncologist.


Patients used a Bluetooth-enabled weight scale, Bluetooth-enabled blood pressure cuff, and mobile tablet with a symptom-tracking app that sent information directly to their physician each weekday. They also used mobile tablets with proprietary Wi-Fi. An in-home area network hub/router transmitted their sensor readouts. The mobile app transmitted patients' symptoms data through a back-end cyber-infrastructure to secure firewall-protected computers at The University of Texas MD Anderson Cancer Center to ensure patient confidentiality.


At the start of radiation therapy, participants completed a 28-item MD Anderson Symptom Inventory survey about their health and common activities of daily living. The survey covered general symptoms that are common in people with cancer, such as pain, fatigue, and nausea, as well as symptoms that are particularly relevant to people with head and neck cancer, such as difficulty swallowing or chewing, skin pain/burning/rash, and problems with tasting food. The participants completed a similar survey at the end of their radiation therapy, usually 6-7 weeks later. A final survey was completed 6-8 weeks after their radiation therapy ended.


Key Findings

There was no difference in self-reported health severity scores between the CYCORE participants and those who received usual care at the start of the trial. Symptom severity was scored on a scale of 0-10, with 0 being no symptom or pain and 10 being the highest level of symptom severity.


Those in the CYCORE arm had lower symptom severity than participants who had standard weekly visits with their doctors. After completion of radiation therapy, the CYCORE participants had lower mean scores for general symptoms versus usual care participants (2.9 vs. 3.4), as well as lower mean scores for symptoms specific to head and neck cancer (4.2 vs. 4.8).


Six to 8 weeks after completion of therapy, CYCORE participants had a mean score of 1.6 vs. 1.9 for usual care participants based on overall health. Both groups had slightly higher severity scores for specific head and neck symptoms (1.7 vs. 2.1).


In addition, daily remote tracking of patient well-being enabled physicians to detect concerning symptoms early and respond more rapidly, compared to usual care, she said.


Most patients (80% or more) adhered to daily monitoring, which was "an excellent outcome," said Peterson, given the intensity of their treatments. Scores reflecting how various symptoms interfered in activities of daily living were about the same in both groups across the entire time of survey reporting. She noted that the study population was mostly white, which closely reflected the overall head and neck patient population at the cancer center.


In conclusion, Peterson said: "Patients randomized to CYCORE reported lower severity of general and head and neck cancer-specific symptoms compared to usual care. Good patient adherence plus minimal clinician burden support the implementation of systems like CYCORE during intensive treatment periods in cancer care. Using sensor and mobile technology to monitor patients during critical periods of outpatient treatment can provide timely information for clinical decision-making, and may improve quality of life and health outcomes."


The next step for researchers may be to determine how long the benefit of a CYCORE intervention could persist. They also hope to implement the CYCORE intervention in non-academic cancer treatment settings where the majority of cancer patients receive their treatment.


ASCO President Bruce E. Johnson, MD, Professor of Medicine at Harvard Medical School, Boston, commented: "The application of technology enabled shows information generated at home reduces symptoms and improves the patient's experience. Integrating patient-reported data into oncology practice increasingly is a way to get timely information. This is particularly important in head and neck cancer, where commonly patients are not able to swallow enough fluid."


Mark L. Fuerst is a contributing writer.