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By Dr Claire Timon,  ARCH

A combination of an unprecedented rise in cancer patients and survivors, the rising costs of medical treatments, a lack of staff and resources and a severely constraint health and social care budget, renders current healthcare models unsustainable. Digital health has the potential to transform cancer care by assisting patients in monitoring their health, improving communication between patients and healthcare professionals and enabling patients to manage their condition more effectively thus contributing to increasing their chances of a good life quality and positive outcomes.

By 2035 it is expected that there will be more than 24 million cancer cases worldwide (1). Fortunately, due to substantial improvements in treatment and early detection, even more patients can expect to live for more than 5 years post diagnosis (2). Recently there has been an increase in digital health developments aimed at those affected by cancer in an attempt to address the unmet clinical and support needs of those living with the consequences of cancer and treatment (3), this blog will explore a few areas.

Outpatient symptom management and monitoring

The Christie NHS Foundation Trust in the UK, a renowned international leader in cancer research and treatment, in partnership with Philips Electronics, is due to pilot a remote monitoring device that enables cancer patients to test their blood for levels of white blood cells and haemoglobin at home. The blood sample is obtained via a simple finger prick test, analysed using the device and using 3G technology, the results are then transmitted to the patients’ oncology team to assess. This development will be particularly beneficial for individuals receiving chemotherapy whereby treatment is dependent on white blood cell levels amongst other things. This device has potential to reduce unnecessary trips to hospitals saving on resources and time and can also assist in the remote assessment of patient symptoms enabling prompt intervention by the oncology team if required.

The e-Symptom Management using Advanced Symptom Management System Remote Technology (eSMART) project is currently, the largest randomised controlled trial (RCT) investigating the potential of eHealth technology to provide to illness/ symptom management support to cancer patients undergoing chemotherapy (4). The eSMART project has recruited over one thousand patients across five countries including Ireland where it is led by Prof Roma McGuire.  Dr Eileen Furlong of the  School of Nursing, Midwifery and Health Systems is the UCD lead. The project aims to evaluate the short and long-term efficacy, cost effectiveness and develop symptom prediction models. This study is ongoing however similar research investigating chemotherapy-related symptom monitoring (CSM) via internet-based applications suggest that when compared with usual care, significant improvements in quality of life and increased survival for cancer patients were observed (5). Further research is needed to determine the acceptability of these technologies to patient groups of all ages, the impact on patient outcomes and the sustainability within healthcare systems.

Information sharing

CureSearch for Children’s Cancer is a U.S. based non-profit foundation that accelerates the search for cures for children’s cancer by driving innovation, overcoming research barriers and solving the field’s most challenging problems. CureSearch developed the CancerCare mobile app to make providing excellent care for children with cancer easier. Some features of the application include (i) the ability to organise medication schedules and treatment dates, ability to track patient mood, symptoms and blood counts in real time and the ability to confidentially share information with other family caregivers and health care providers. The mobile app provides support for the parents and caregivers of the more than 15,000 children diagnosed with cancer every year in the U.S., and the more than 40,000 children undergoing cancer treatment in 2017(6).
Survivorship follow up care

Research suggests that over half of cancer survivors report unmet supportive care needs after cancer treatment (7) and therefore technology applications for cancer survivors are a growing niche in the digital health space, offering digital resources for information on medication adherence, side effects, and care management information, physical and mental health issues, and tools to monitor physical activity and diet.

An example of the application of digital health in this area is a web-based computer tailored intervention, the Kanker Nazorg Wijzer (KNW) (Cancer Aftercare Guide)(8). This web-based tool aims to provide psychosocial and lifestyle support for cancer survivors and was developed by a team of researchers from Maastricht University and the University of the Netherlands. The KNW consists of eight modules covering topics such as return to work, relationships, mood, fatigue, anxiety, diet, physical activity and smoking. An intervention study examining the effect of this tool was undertaken by 462 cancer survivors (half in intervention, half in control group). The intervention group had access to the online intervention for 6 months, and the control group received access after 12 months. Short term effects of the intervention highlight impact on reducing depression and fatigue and increasing vegetable consumption (9) whereas long term effects were increased and maintained moderate physical activity in cancer survivors younger than 57 years (10). This research highlights the potential of digital health platforms to provide patient driven support by incorporating evidence-based approaches to address psychosocial and lifestyle support to improve health outcomes in cancer survivors.

An investigation of commercial mHealth apps developed for cancer survivors concluded that many mHealth apps aren’t having optimal impact for users as developers are rushing important design steps to rush their apps onto the market (11). Although there is a high level of activity in this area in the commercial digital health sector, continued research is needed to clearly define the role that digital health can play in supporting those affected by cancer.

References:

1. World Cancer Research Fund International. Worldwide data on cancer statistics Available from: http://www.wcrf.org/int/cancer-facts-figures/worldwide-data
2. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89.
3. Harris J, Cheevers K, Armes J. The emerging role of digital health in monitoring and supporting people living with cancer and the consequences of its treatments. Curr Opin Support Palliat Care. 2018;12(3):268–75.
4. Maguire R, Fox PA, McCann L, Miaskowski C, Kotronoulas G, Miller M, et al. The eSMART study protocol: a randomised controlled trial to evaluate electronic symptom management using the advanced symptom management system (ASyMS) remote technology for patients with cancer. BMJ Open. 2017;7(5): e015016.
5. Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, et al. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. JAMA. 2017;318(2):197.
6. Cure Search. Cancer Care App. Available from: https://curesearch.org/CureSearch-CancerCare-App
7. Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, et al. Patients’ Supportive Care Needs Beyond the End of Cancer Treatment: A Prospective, Longitudinal Survey. J Clin Oncol. 2009;27(36):6172–9.
8. Willems RA, Lechner L, Verboon P, Mesters I, Kanera IM, Bolman CAW. Working mechanisms of a web-based self-management intervention for cancer survivors: a randomised controlled trial. Psychol Health. 2017;32(5):605–25.
9. Willems RA, Bolman CAW, Mesters I, Kanera IM, Beaulen AAJM, Lechner L. Short-term effectiveness of a web-based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial. 2016;26(2):222-230
10. Kanera IM, Willems RA, Bolman CAW, Mesters I, Verboon P, Lechner L. Long-term effects of a web-based cancer aftercare intervention on moderate physical activity and vegetable consumption among early cancer survivors: a randomized controlled trial. Int J Behav Nutr Phys Act. 2017;14(1):19.
11. Davis SW, Oakley-Girvan I. Achieving value in mobile health applications for cancer survivors. J Cancer Surviv. 2017;11(4):498–504.