1
|
Chyzhyk D, Arregi M, Errazquin M, Ariceta A, Sevilla M, Álvarez R, Alberich Inchausti M. Exploring Usability of a Clinical Decision Support System for Cancer Care: A User-Centered Study. Cancer Rep (Hoboken) 2025; 8:e70173. [PMID: 40110965 PMCID: PMC11924132 DOI: 10.1002/cnr2.70173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 02/03/2025] [Accepted: 02/20/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Adverse effects are a common burden for cancer patients, impacting their well-being and diminishing their quality of life. Therefore, it is essential to have a clinical decision support system that can proactively monitor patient progress to prevent and manage complications. AIMS This research aims to thoroughly test the usability and user-friendliness of a medical device designed for managing adverse events for cancer patients and healthcare professionals (HCPs). The study seeks to assess how well the device meets both patients' and HCPs' needs in real-world scenarios. METHODS AND RESULTS The study used a multi-method approach to obtain a comprehensive understanding of participants experience and objective measure of usability. The testing was conducted with a diverse group of participants of six patients and six HCPs. Analysis included a descriptive summary of the demographic data, scenario completion rates, System Usability Scale (SUS) questionnaire score, and qualitative feedback from users. All participants successfully completed 100% of the activities, indicating a high level of understanding and usability across both user groups. Only two out of six patients encountered errors during the login activities, but these errors were unrelated to product safety. The obtained SUS score is in the 90th percentile for both user groups, classifying the device as grade A and highlighting its superior usability. Patients and HCPs found the interface intuitive and expressed an interest in incorporating the application into their daily routines and would recommend the application to others. CONCLUSION The assessed digital health medical device demonstrates excellent usability, safety, and ease of use for oncology patients and HCPs. Based on the received constructive feedback, minor improvements were identified for further refinement of the application that do not affect either its intended functionality or the overall functioning of the tool. Future work will focus on implementing these improvements and conducting further usability studies in clinical environments.
Collapse
|
2
|
Salem A, AlSamarat F, Farhan F. Expanding Global Radiotherapy Access via Telemedicine. Clin Oncol (R Coll Radiol) 2025; 38:103569. [PMID: 38853061 DOI: 10.1016/j.clon.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 06/11/2024]
Abstract
AIMS Cancer is a leading cause of death globally. Over 70% of the 10 million cancer deaths worldwide in 2020 occurred in low- and middle-income countries. Radiotherapy is an important cancer treatment, used in half of cancer patients. Significant global disparities in radiotherapy access exist, with low access in low- and middle-income countries. The benefits of tele-radiotherapy in low- and middle-income countries for expanding global radiotherapy access are yet to be fully realized. In this paper, we highlight potential applications of tele-radiotherapy in expanding access to high-quality radiotherapy in developing countries. MATERIALS AND METHODS We performed a literature search to retrieve studies involving telemedicine applications in radiotherapy to provide a comprehensive overview of the topic. PubMed database served as the main source for retrieving studies, using the following search terms: ("telemedicine", "radiotherapy", "telehealth", "remote monitoring", "oncology", and "remote training"). Additional selected papers were obtained from Web of Science, and Google Scholar using the same search terms. RESULTS Telemedicine in radiotherapy has many applications. Virtual training could upgrade radiotherapy skills in low- and middle-income countries, enabling safe adoption of new radiotherapy techniques and quality assurance. Tele-radiotherapy consultations and patient follow-up could improve the efficiency of clinics while tele-radiotherapy planning and peer-review could enable equitable global access to radiotherapy expertise. Telemedicine could also facilitate wider global access to radiotherapy trials. While telemedicine in radiotherapy holds significant promise in improving global radiotherapy access, several barriers to its adoption exist. These include a lack of infrastructure, data security concerns, regulatory challenges, resistance from providers and patients, financial constraints, miscommunication during remote consultations, and lack of training. CONCLUSION Tele-radiotherapy applications hold promise in providing solutions to overcome global radiotherapy access inequity but the benefits of tele-radiotherapy in low- and middle-income countries are yet to be fully realized.
Collapse
Affiliation(s)
- A Salem
- Department of Anatomy, Physiology and Biochemistry, The Hashemite University, Zarqa, Jordan; Division of Cancer Sciences, University of Manchester, Manchester, UK; Christie NHS Foundation Trust, Manchester, UK.
| | - F AlSamarat
- Department of Anatomy, Physiology and Biochemistry, The Hashemite University, Zarqa, Jordan
| | - F Farhan
- Data Management and Data Quality Department, Electronic Health Solutions, Amman, Jordan
| |
Collapse
|
3
|
Urretavizcaya M, Álvarez K, Olariaga O, Tames MJ, Asensio A, Cajaraville G, Riestra AC. Assessing health outcomes: a systematic review of electronic patient-reported outcomes in oncology. Eur J Hosp Pharm 2024:ejhpharm-2023-004072. [PMID: 38821720 DOI: 10.1136/ejhpharm-2023-004072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
PURPOSE This study investigates the clinical impact of electronic patient-reported outcome (ePRO) monitoring apps/web interfaces, aimed at symptom-management, in cancer patients undergoing outpatient systemic antineoplastic treatment. Additionally, it explores the advantages offered by these applications, including their functionalities and healthcare team-initiated follow-up programmes. METHODS A systematic literature review was conducted using a predefined search strategy in MEDLINE. Inclusion criteria encompassed primary studies assessing symptom burden through at-home ePRO surveys in adult cancer patients receiving outpatient systemic antineoplastic treatment, whenever health outcomes were evaluated. Exclusion criteria excluded telemedicine-based interventions other than ePRO questionnaires and non-primary articles or study protocols. To evaluate the potential bias in the included studies, an exhaustive quality assessment was conducted, as an additional inclusion filter. RESULTS Among 246 identified articles, 227 were excluded for non-compliance with inclusion/exclusion criteria. Of the remaining 19 articles, only eight met the rigorous validity assessment and were included for detailed examination and data extraction, presented in attached tables. CONCLUSION This review provides compelling evidence of ePRO monitoring's positive clinical impact across diverse cancer settings, encompassing various cancer types, including early and metastatic stages. These systems are crucial in enabling timely interventions and reducing communication barriers, among other functionalities. While areas for future ePRO innovation are identified, the primary limitation lies in comparing clinical outcomes of reviewed articles, due to scale variability and study population heterogeneity. To conclude, our results reaffirm the transformative potential of ePRO apps in oncology and their pivotal role in shaping the future of cancer care.
Collapse
Affiliation(s)
| | - Karen Álvarez
- Pharmacy Department, Nuestra Senora de la Candelaria University Hospital, Santa Cruz de Tenerife, Canarias, Spain
| | - Olatz Olariaga
- Pharmacy Department, Onkologikoa, San Sebastian, País Vasco, Spain
| | - Maria Jose Tames
- Pharmacy Department, Onkologikoa, San Sebastian, País Vasco, Spain
| | - Ainhoa Asensio
- Pharmacy Department, Onkologikoa, San Sebastian, País Vasco, Spain
| | | | - Ana Cristina Riestra
- Pharmacy Department, Onkologikoa, San Sebastian, País Vasco, Spain
- Medicine Department, University of Deusto, Bilbao, País Vasco, Spain
| |
Collapse
|
4
|
Suzuki L, Connon F, Munir S, Piplica S, Pandit H, Rodda D. Evaluation of a Mobile App to Assist Patient Education and Research in Arthroplasty. Arthroplast Today 2024; 30:101549. [PMID: 39629356 PMCID: PMC11612646 DOI: 10.1016/j.artd.2024.101549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/13/2024] [Accepted: 09/23/2024] [Indexed: 12/07/2024] Open
Abstract
Background Paper-based patient-reported outcome measures (PROMs) and patient education can assist in improving outcomes but is administratively burdensome. Mobile phone applications ('apps') can distribute extensive information and PROMs at relevant time points. This study aimed to assess the suitability of an app to guide postoperative management and record PROMs based on satisfaction and compliance. Methods Thirty-four patients who were scheduled for a total hip/knee arthroplasty were enrolled into the study. Automatic notifications were sent by the app to complete PROMs at the appropriate time points. Patients were reminded via phone call if PROMs were not completed. An app satisfaction questionnaire was also completed, where a high score represented satisfaction with the app. Results Patients remained satisfied with the app throughout the study with a mean score of 19.0 out of 25. 57% found the app to be helpful with completing surveys, with 63% preferring the app over paper handouts. Majority of the participants (68%) stated that they would use the app again. There was an overall mean compliance of 78% at all time points. Most patients (82%) required at least one phone call reminder, with 18% of patients completing their PROMs prompted by the app notification alone. Conclusions A mobile phone app can be useful for both distributing patient education and collecting PROMs. PROMs collected using a mobile phone app still caused some administrative burden with many participants requiring multiple reminders to complete their questionnaires. While paper-forms will still be required for some patients, most found the app preferable to paper-form.
Collapse
Affiliation(s)
- Leina Suzuki
- Medacta Australia Pty Ltd, Lane Cove, New South Wales, Australia
| | - Francis Connon
- Department of Orthopaedic Surgery, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Selin Munir
- School of Health, University of Sunshine Coast, Birtinya, Queensland, Australia
- Fortius Institute for Musculoskeletal Research, Birtinya, Queensland, Australia
| | - Sarah Piplica
- UniSC Clinical Trials, University of Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Daevyd Rodda
- Department of Orthopaedic Surgery, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| |
Collapse
|
5
|
Klaar R, Rabe M, Stüber AT, Hering S, Corradini S, Eze C, Marschner S, Belka C, Landry G, Dinkel J, Kurz C. MRI-based ventilation and perfusion imaging to predict radiation-induced pneumonitis in lung tumor patients at a 0.35T MR-Linac. Radiother Oncol 2024; 199:110468. [PMID: 39111637 DOI: 10.1016/j.radonc.2024.110468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/10/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND AND PURPOSE Radiation-induced pneumonitis (RP), diagnosed 6-12 weeks after treatment, is a complication of lung tumor radiotherapy. So far, clinical and dosimetric parameters have not been reliable in predicting RP. We propose using non-contrast enhanced magnetic resonance imaging (MRI) based functional parameters acquired over the treatment course for patient stratification for improved follow-up. MATERIALS AND METHODS 23 lung tumor patients received MR-guided hypofractionated stereotactic body radiation therapy at a 0.35T MR-Linac. Ventilation- and perfusion-maps were generated from 2D-cine MRI-scans acquired after the first and last treatment fraction (Fx) using non-uniform Fourier decomposition. The relative differences in ventilation and perfusion between last and first Fx in three regions (planning target volume (PTV), lung volume receiving more than 20Gy (V20) excluding PTV, whole tumor-bearing lung excluding PTV) and three dosimetric parameters (mean lung dose, V20, mean dose to the gross tumor volume) were investigated. Univariate receiver operating characteristic curve - area under the curve (ROC-AUC) analysis was performed (endpoint RP grade≥1) using 5000 bootstrapping samples. Differences between RP and non-RP patients were tested for statistical significance with the non-parametric Mann-Whitney U test (α=0.05). RESULTS 14/23 patients developed RP of grade≥1 within 3 months. The dosimetric parameters showed no significant differences between RP and non-RP patients. In contrast, the functional parameters, especially the relative ventilation difference in the PTV, achieved a p-value<0.05 and an AUC value of 0.84. CONCLUSION MRI-based functional parameters extracted from 2D-cine MRI-scans were found to be predictive of RP development in lung tumor patients.
Collapse
Affiliation(s)
- Rabea Klaar
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, 81377, Germany; Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, 81377, Germany.
| | - Moritz Rabe
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, 81377, Germany
| | - Anna Theresa Stüber
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, 81377, Germany; Department of Statistics, LMU Munich, Munich, 80539, Germany; Munich Center for Machine Learning (MCML), Munich, 80539, Germany
| | - Svenja Hering
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, 81377, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, 81377, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, 81377, Germany
| | - Sebastian Marschner
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, 81377, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, 81377, Germany; German Cancer Consortium (DKTK), partner site Munich, a partnership between DKFZ and LMU University Hospital Munich, Munich, 80336, Germany; Bavarian Cancer Research Center (BZKF), Munich, 80336, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, 81377, Germany
| | - Julien Dinkel
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, 81377, Germany; Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, 81377, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, 81377, Germany
| |
Collapse
|
6
|
Phung TH, Bradford N, Pitt E, Alexander K. Unleashing patient voices: empowering adverse event assessment with complete patient-reported outcomes. Oncologist 2024; 29:e953-e956. [PMID: 38785396 PMCID: PMC11224975 DOI: 10.1093/oncolo/oyae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
The 124-item patient reported-outcome common terminology criteria for adverse events (PRO-CTCAE) questionnaire, assessing 78 symptoms, is widely used in cancer clinical trials to identify side effects. However, its regular use in routine cancer care is rarely reported. We aimed to investigate the feasibility of weekly PRO-CTCAE completion over 9 weeks in a prospective study with 30 patients with cancer undergoing chemotherapy. Participants were asked to complete electronic surveys with reminders, but no feedback or incentives. Only 136 (50%) of the planned 270 time points at which a PRO-CTCAE self-report was expected were completed, with an additional 21 (8%) partially completed, and represents a failure to achieve the expected level of completion. Patients reported experiencing up to 51 and a median of 30 symptoms across all time points, highlighting the complexity of symptom assessment in acute cancer care. While weekly implementation of the PRO-CTCAE may not be feasible outside of clinical trial settings, this study highlights the breadth of symptoms experienced.
Collapse
Affiliation(s)
- Thi Hanh Phung
- School of Nursing, Faculty of Health, N block, Queensland University of Technology, Kelvin Grove, 4059, Australia
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Natalie Bradford
- School of Nursing, Faculty of Health, N block, Queensland University of Technology, Kelvin Grove, 4059, Australia
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, X Block, 66 Musk Avenue, Kelvin Grove, 4059, Australia
- Cancer Nurses Society of Australia, 165 Sovereign Hill Drive, Gabbadah Western Australia, 6041, Australia
- Centre for Children’s Health Research, Children’s Health Queensland Hospital and Health Services, South Brisbane, 4101, Australia
| | - Erin Pitt
- School of Nursing, Faculty of Health, N block, Queensland University of Technology, Kelvin Grove, 4059, Australia
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, X Block, 66 Musk Avenue, Kelvin Grove, 4059, Australia
| | - Kimberly Alexander
- School of Nursing, Faculty of Health, N block, Queensland University of Technology, Kelvin Grove, 4059, Australia
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, X Block, 66 Musk Avenue, Kelvin Grove, 4059, Australia
- Cancer Nurses Society of Australia, 165 Sovereign Hill Drive, Gabbadah Western Australia, 6041, Australia
- Centre for Children’s Health Research, Children’s Health Queensland Hospital and Health Services, South Brisbane, 4101, Australia
| |
Collapse
|
7
|
Schunn FA, El Shafie RA, Kronsteiner D, Sauer LD, Kudak A, Bougatf N, Oetzel D, Krämer A, Regnery S, Machmer T, Debus J, Nicolay NH. Oncologic treatment support via a dedicated mobile app: a prospective feasibility evaluation (OPTIMISE-1). Strahlenther Onkol 2024; 200:475-486. [PMID: 37947806 PMCID: PMC11111550 DOI: 10.1007/s00066-023-02166-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Mobile health (mhealth) is gaining interest, with mobile devices and apps being ever more available among medical facilities and patients. However, in the field of radiation oncology, the medical benefits of mhealth apps are still underexplored. As an additional approach to patient care during radiotherapy, we designed a mobile treatment surveillance app based on patient-reported outcomes. OBJECTIVE We aimed to examine the feasibility of app-based treatment surveillance in patients undergoing radiotherapy (RT). Alongside technical practicability and acceptance, we assessed patient satisfaction and quality of life during treatment. METHODS This prospective single-center study was performed at Heidelberg University Hospital between August 2018 and January 2020. During RT we measured patients' quality of life, symptoms, and treatment satisfaction. Respective questionnaires (EORTC QLQ-C30 with diagnosis-specific modules, RAND PSQ-18) were presented to patients via a mobile app running on a designated tablet device. The primary endpoint was determined by the fraction of patients who completed at least 80% of the items. Secondary endpoints were disease-related quality of life and patient satisfaction. RESULTS A total of 49 cancer patients (14 breast, 13 pelvic, 12 lung, 10 prostate) were eligible for analysis. 79.6% (95% confidence interval: 66.4-88.5%; n = 39) of all patients completed at least 80% of the items received by the mobile app. A mean of 227.5 ± 48.25 questions were answered per patient. Breast cancer patients showed the highest rate of answered questions, with 92.9% (n = 13) completing at least 80% of the items. CONCLUSION Patients showed high acceptance, with 79.6% (n = 39) completing at least 80% of the given items. The use of a mobile app for reporting symptoms and quality of life during RT is feasible and well accepted by patients. It may allow for resource-efficient, detailed feedback to the medical staff and assist in the assessment of side effects over time.
Collapse
Affiliation(s)
- Fabian A Schunn
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Rami A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Department of Radiation Oncology, Göttingen University Hospital, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Dorothea Kronsteiner
- Institute for Medical Biometry (IMBI), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Lukas D Sauer
- Institute for Medical Biometry (IMBI), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Andreas Kudak
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Dieter Oetzel
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Anna Krämer
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | | | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| |
Collapse
|
8
|
Gani C, Bickenbach P, Tenev A, Niyazi M, Festl-Wietek T, Herrmann-Werner A. Impact of electronic patient-reported outcome measures on patients' perception of the physician - the randomized ePREFERENCE study. Radiother Oncol 2024; 194:110192. [PMID: 38428640 DOI: 10.1016/j.radonc.2024.110192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/15/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Electronic Patient-reported outcome measures (ePROMs) are increasingly used in radiotherapy departments. However, the impact of ePROM integration on patients' perceptions of healthcare providers, particularly in terms of empathy and professionalism, remains unclear. Thus, this study aims to assess the patients' views on healthcare professionals during ePROM-based consultations. METHODS In this randomized trial, radiotherapy patients were enrolled and asked to evaluate video vignettes of consultations between a radiation oncologist and a patient. Two scenarios were shown in random order, one vignette portrayed a paper-chart-based clinic visit, and the other a consultation in which ePROMs were implemented. Established questionnaires such as Physician Compassion Questionnaire (PCQ), Jefferson Patient Perception of Physician Empathy (JPP), Physician Professionalism Questionnaire (PPQ) and Global Consultation Rating Scale (GCRS) were used to rate the healthcare professional. The primary endpoint was physician compassion. RESULTS Between May and August 2022, 152 patients, predominantly with malignancies of the breast, prostate, and brain participated. Patients rated the physician in ePROM-based consultations with higher mean scores for physician compassion compared to paper chart-based ones (36.4 vs. 34.2, p = 0.029). No negative impact of ePROMs was observed in terms of professionalism, global rating or physician empathy. Despite a shorter duration of the visit and reduced eye contact, 63 % of patients ultimately favored ePROM-based consultations. CONCLUSION The ePREFERENCE trial shows that the implementation of ePROMs in clinic visits during radiotherapy treatment positively impacts the patients' perception of the physician's compassion. ePROMs can therefore not only be considered a useful tool to improve workflows but are also broadly accepted by patients.
Collapse
Affiliation(s)
- C Gani
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany.
| | - P Bickenbach
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - A Tenev
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - M Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - T Festl-Wietek
- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - A Herrmann-Werner
- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
9
|
Dunlop E, Ferguson A, Mueller T, Baillie K, Laskey J, Clarke J, Kurdi A, Wales A, Connolly T, Bennie M. Involving Patients and Clinicians in the Design of Wireframes for Cancer Medicines Electronic Patient Reported Outcome Measures in Clinical Care: Mixed Methods Study. JMIR Form Res 2023; 7:e48296. [PMID: 38127422 PMCID: PMC10767627 DOI: 10.2196/48296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/28/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Cancer treatment is a key component of health care systems, and the increasing number of cancer medicines is expanding the treatment landscape. However, evidence of the impact on patients has been focused more on chemotherapy toxicity and symptom control and less on the effect of cancer medicines more broadly on patients' lives. Evolving electronic patient-reported outcome measures (ePROMs) presents the opportunity to secure early engagement of patients and clinicians in shaping the collection of quality-of-life metrics and presenting these data to better support the patient-clinician decision-making process. OBJECTIVE The aim of this study was to obtain initial feedback from patients and clinicians on the wireframes of a digital solution (patient app and clinician dashboard) for the collection and use of cancer medicines ePROMs. METHODS We adopted a 2-stage, mixed methods approach. Stage 1 (March to June 2019) consisted of interviews and focus groups with cancer clinicians and patients with cancer to explore the face validity of the wireframes, informed by the technology acceptance model constructs (perceived ease of use, perceived usefulness, and behavioral intention to use). In stage 2 (October 2019 to February 2020), the revised wireframes were assessed through web-based, adapted technology acceptance model questionnaires. Qualitative data (stage 1) underwent a framework analysis, and descriptive statistics were performed on quantitative data (stage 2). Clinicians and patients with cancer were recruited from NHS Greater Glasgow & Clyde, the largest health board in Scotland. RESULTS A total of 14 clinicians and 19 patients participated in a combination of stage 1 interviews and focus groups. Clinicians and patients indicated that the wireframes of a patient app and clinician dashboard for the collection of cancer medicines ePROMs would be easy to use and could focus discussions, and they would be receptive to using such tools in the future. In stage 1, clinicians raised the potential impact on workload, and both groups identified the need for adequate IT skills to use each technology. Changes to the wireframes were made, and in stage 2, clinicians (n=8) and patients (n=16) indicated it was "quite likely" that the technologies would be easy to use and they would be "quite likely" to use them in the future. Notably, clinicians indicated that they would use the dashboard to enable treatment decisions "with around half" of their patients. CONCLUSIONS This study emphasizes the importance of consulting both patients and clinicians in the design of digital solutions. The wireframes were perceived positively by patients and clinicians who were willing to use such technologies if available in the future as part of routine care. However, challenges were raised, and some differences were identified between participant groups, which warrant further research.
Collapse
Affiliation(s)
- Emma Dunlop
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Aimee Ferguson
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | | | | | - Julie Clarke
- NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Department of Clinical Pharmacy, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Ann Wales
- NHS Healthcare Improvement Scotland, Glasgow, United Kingdom
| | | | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| |
Collapse
|
10
|
Hulse K, Li LQ, Lowit A, Maguire R, Douglas C. Digital health in head and neck cancer: a systematic review. J Laryngol Otol 2023; 137:1312-1325. [PMID: 37078528 DOI: 10.1017/s0022215123000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Digital health tools are increasingly being recognised as effective interventions in monitoring chronic health conditions. This systematic review addressed how digital health is currently utilised in patients with head and neck cancer as an adjunct to care. METHOD Studies of the development or evaluation of an eHealth, telemedicine or telemonitoring tool were eligible. A narrative synthesis was performed as per Preferred Reporting Items for Systematic Review and Meta-Analyses reporting guidelines. RESULTS Twenty-nine studies of digital health tools in head and neck cancer were identified. Nine were randomised, controlled trials but most had concern of bias. Fourteen (48 per cent) of the interventions used multiple modes of delivery. The primary digital tool functions are symptom tracking and self-care, prehabilitation and rehabilitation, psychological support, and education, including decision aids. Most tools aimed to support patients during active cancer treatment. CONCLUSION There are a small number of digital health tools for head and neck cancer patients; however, there is a lack of well-designed randomised, controlled trials to demonstrate effectiveness.
Collapse
Affiliation(s)
- Kate Hulse
- ENT Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Lucy Qian Li
- ENT Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Anja Lowit
- Speech and Language Therapy Department, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, UK
| | - Roma Maguire
- Digital Health and Care, University of Strathclyde, Glasgow, Scotland, UK
| | - Catriona Douglas
- ENT Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| |
Collapse
|
11
|
Hughes J, Flood T. Patients' experiences of engaging with electronic Patient Reported Outcome Measures (PROMs) after the completion of radiation therapy for breast cancer: a pilot service evaluation. J Med Radiat Sci 2023; 70:424-435. [PMID: 37550951 PMCID: PMC10715367 DOI: 10.1002/jmrs.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/21/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Over 60 % of people who develop breast cancer will receive radiation therapy (RT) as part of their treatment. Side effects of RT may include inflammation, erythema, desquamation and fatigue. Electronic Patient Reported Outcomes Measures (ePROMs) enable patients to report side effects prior to their scheduled post-RT appointment. This pilot service evaluation aims to explore patients' perceptions regarding the value of the ePROM system, ease of its use and barriers to using the system, after breast irradiation. METHODS From July-November 2021, evaluation surveys were posted to 100 people who had received RT to their breast to explore their experience of using the ePROM. Ethical approval was obtained through Ulster University and the Western Health and Social Care Trust (WHSCT), Northern Ireland. RESULTS Fifty-two people responded to the survey, of which 27 respondents indicated that they had accessed the ePROM. Despite few participants experiencing significant side effects, the majority of participants recommended the ePROM indicating that it was an important source of support. Those who experienced significant side effects found the system to be prompt and effective. Barriers to accessing the ePROM included technical issues with the link, concerns about confidentiality and forgetting to access the link. Access to the ePROM increased with higher education levels. CONCLUSIONS This pilot service evaluation demonstrated that ePROMs are valued by patients and can provide rapid real-time access to support, offering individual care and reassurance. For patients with longer RT schedules (>10 fractions), the introduction of ePROMs during RT was viewed favourably by participants. All patients may benefit from the option of receiving ePROMs post-RT.
Collapse
Affiliation(s)
- Jane Hughes
- North West Cancer Centre, Altnagelvin HospitalWestern Health and Social Care TrustDerryUK
| | | |
Collapse
|
12
|
Mohseni M, Ayatollahi H, Arefpour AM. Electronic patient-reported outcome (ePRO) application for patients with prostate cancer. PLoS One 2023; 18:e0289974. [PMID: 37566604 PMCID: PMC10420387 DOI: 10.1371/journal.pone.0289974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Cancer patients experience different complications and outcomes during or after medical treatments. Electronic reporting of the outcomes by patients is a solution that facilitates communication with physicians and improve patient health status. The aim of this study was to develop a smartphone-based application for electronic reporting of outcomes by patients with prostate cancer. METHODS The present research was conducted in 2021 in two phases. In the first phase, initially, users' requirements were identified based on reviewing the related literature, existing applications, and guidelines. Then, a questionnaire was designed and the specialists' opinions about the users' requirements were investigated. The specialties included urologists, hemato-oncologists, uro-oncologists, and radiotherapists (n = 15). In the second phase, the application was designed, and patients with prostate cancer (n = 21) and specialists (n = 10) evaluated it using the post-study system usability questionnaire (PSSUQ). Data were analyzed using descriptive statistics. RESULTS The findings of the first phase of the research showed that out of 108 data elements and functions proposed for the application, 91 items were found essential by the specialists. Data elements were categorized into the patient data, general complications of prostate cancer and side effects of drug therapy, surgery, chemotherapy, cryotherapy, radiation therapy, and hormone therapy. Necessary functions for the application included presenting a patient care summary, communication between the patient and the specialist, free text explanation for complications and sides effects, generating reports, reminder and alert, completing quality of life questionnaire, and calculating the score for the questionnaire. In the second phase of the research, the application was developed and evaluated. The mean value for user satisfaction was (5.95 ± 0.55) out of 7. CONCLUSION The developed application can help to accelerate communication with the specialists. It can improve quality of care, reduce unnecessary treatment visits and side effects, and improve timely data collection for a variety of research purposes. However, further research on the cost-effectiveness and usefulness of the collected data is recommended.
Collapse
Affiliation(s)
- Majid Mohseni
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Mohammad Arefpour
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Casà C, Corvari B, Cellini F, Cornacchione P, D’Aviero A, Reina S, Di Franco S, Salvati A, Colloca GF, Cesario A, Patarnello S, Balducci M, Morganti AG, Valentini V, Gambacorta MA, Tagliaferri L. KIT 1 (Keep in Touch) Project-Televisits for Cancer Patients during Italian Lockdown for COVID-19 Pandemic: The Real-World Experience of Establishing a Telemedicine System. Healthcare (Basel) 2023; 11:1950. [PMID: 37444784 PMCID: PMC10340416 DOI: 10.3390/healthcare11131950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
UNLABELLED To evaluate the adoption of an integrated eHealth platform for televisit/monitoring/consultation during the COVID-19 pandemic. METHODS During the lockdown imposed by the Italian government during the COVID19 pandemic spread, a dedicated multi-professional working group was set up in the Radiation Oncology Department with the primary aim of reducing patients' exposure to COVID-19 by adopting de-centralized/remote consultation methodologies. Each patient's clinical history was screened before the visit to assess if a traditional clinical visit would be recommended or if a remote evaluation was to be preferred. Real world data (RWD) in the form of patient-reported outcomes (PROMs) and patient reported experiences (PREMs) were collected from patients who underwent televisit/teleconsultation through the eHealth platform. RESULTS During the lockdown period (from 8 March to 4 May 2020) a total of 1956 visits were managed. A total of 983 (50.26%) of these visits were performed via email (to apply for and to upload of documents) and phone call management; 31 visits (1.58%) were performed using the eHealth system. Substantially, all patients found the eHealth platform useful and user-friendly, consistently indicating that this type of service would also be useful after the pandemic. CONCLUSIONS The rapid implementation of an eHealth system was feasible and well-accepted by the patients during the pandemic. However, we believe that further evidence is to be generated to further support large-scale adoption.
Collapse
Affiliation(s)
- Calogero Casà
- Fatebenefratelli Isola Tiberina-Gemelli Isola, Via di Ponte Quattro Capi 39, 00186 Rome, Italy;
| | - Barbara Corvari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
| | - Francesco Cellini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
| | - Patrizia Cornacchione
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
| | - Andrea D’Aviero
- Mater Olbia Hospital, SS 125 Orientale Sarda, 07026 Olbia, Italy;
| | - Sara Reina
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (S.R.); (S.D.F.); (A.S.)
| | - Silvia Di Franco
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (S.R.); (S.D.F.); (A.S.)
| | - Alessandra Salvati
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (S.R.); (S.D.F.); (A.S.)
| | - Giuseppe Ferdinando Colloca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
| | - Alfredo Cesario
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
| | - Stefano Patarnello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
| | - Mario Balducci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Via Zamboni 33, 40126 Bologna, Italy;
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (S.R.); (S.D.F.); (A.S.)
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (S.R.); (S.D.F.); (A.S.)
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (B.C.); (F.C.); (G.F.C.); (A.C.); (S.P.); (M.B.); (V.V.); (M.A.G.); (L.T.)
| |
Collapse
|
14
|
Lopez CJ, Teggart K, Ahmed M, Borhani A, Kong J, Fazelzad R, Langelier DM, Campbell KL, Reiman T, Greenland J, Jones JM, Neil-Sztramko SE. Implementation of electronic prospective surveillance models in cancer care: a scoping review. Implement Sci 2023; 18:11. [PMID: 37101231 PMCID: PMC10134630 DOI: 10.1186/s13012-023-01265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Electronic prospective surveillance models (ePSMs) for cancer rehabilitation include routine monitoring of the development of treatment toxicities and impairments via electronic patient-reported outcomes. Implementing ePSMs to address the knowledge-to-practice gap between the high incidence of impairments and low uptake of rehabilitation services is a top priority in cancer care. METHODS We conducted a scoping review to understand the state of the evidence concerning the implementation of ePSMs in oncology. Seven electronic databases were searched from inception to February 2021. All articles were screened and extracted by two independent reviewers. Data regarding the implementation strategies, outcomes, and determinants were extracted. The Expert Recommendations for Implementing Change taxonomy and the implementation outcomes taxonomy guided the synthesis of the implementation strategies and outcomes, respectively. The Consolidated Framework for Implementation Research guided the synthesis of determinants based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process). RESULTS Of the 5122 records identified, 46 interventions met inclusion criteria. The common implementation strategies employed were "conduct educational meetings," "distribute educational materials," "change record systems," and "intervene with patients to enhance uptake and adherence." Feasibility and acceptability were the prominent outcomes used to assess implementation. The complexity, relative advantage, design quality, and packaging were major implementation determinants at the intervention level. Knowledge was key at the individual level. At the inner setting level, major determinants were the implementation climate and readiness for implementation. At the outer setting level, meeting the needs of patients was the primary determinant. Engaging various stakeholders was key at the process level. CONCLUSIONS This review provides a comprehensive summary of what is known concerning the implementation of ePSMs. The results can inform future implementation and evaluation of ePSMs, including planning for key determinants, selecting implementation strategies, and considering outcomes alongside local contextual factors to guide the implementation process.
Collapse
Affiliation(s)
- Christian J. Lopez
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kylie Teggart
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mohammed Ahmed
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Anita Borhani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jeffrey Kong
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, Canada
| | - David M. Langelier
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kristin L. Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Tony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, Canada
| | - Jonathan Greenland
- Faculty of Medicine, Memorial University of Newfoundland, St John’s, Canada
| | - Jennifer M. Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sarah E. Neil-Sztramko
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| |
Collapse
|
15
|
Janssen S, El Shafie RA, Ruder AM, Buergy D, Scafa D, Giordano FA, Nicolay NH, Vogel MME, Combs SE, Fahlbusch FB, Rades D, Käsmann L. Mobile applications in radiation oncology-current choices and future potentials. Strahlenther Onkol 2023; 199:337-349. [PMID: 36810957 PMCID: PMC9943039 DOI: 10.1007/s00066-023-02048-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/15/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To review existing scientific literature on mobile applications (apps) in the field of radiation oncology and to evaluate characteristics of commercially available apps across different platforms. METHODS A systematic review of the literature for publications presenting apps in the field of radiation oncology was carried out using the PubMed database, Cochrane library, Google Scholar, and annual meetings of major radiation oncology societies. Additionally, the two major marketplaces for apps, App Store and Play Store, were searched for available radiation oncology apps for patients and health care professionals (HCP). RESULTS A total of 38 original publications which met the inclusion criteria were identified. Within those publications, 32 apps were developed for patients and 6 for HCP. The vast majority of patient apps focused on documenting electronic patient-reported outcomes (ePROs). In the two major marketplaces, 26 apps were found, mainly supporting HCP with dose calculations. CONCLUSION Apps used in (and for) scientific research in radiation oncology are rarely available for patients and HCP in common marketplaces.
Collapse
Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
- Private Practice of Radiation Oncology, Hannover, Germany.
| | - Rami A El Shafie
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Arne M Ruder
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- Institute for Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- Institute for Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Partner Site Munich, German Cancer Consortium (DKTK), Munich, Germany
| |
Collapse
|
16
|
Consolo L, Castellini G, Cilluffo S, Basile I, Lusignani M. Electronic patient-reported outcomes (e-PROMs) in palliative cancer care: a scoping review. J Patient Rep Outcomes 2022; 6:102. [PMID: 36138279 PMCID: PMC9500127 DOI: 10.1186/s41687-022-00509-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In palliative oncology settings, electronic patient-reported outcome (PRO) assessment can play an important role in supporting clinical activities for clinicians and patients. This scoping review aims to map the technological innovation of electronic patient-reported outcome measures (e-PROMs) in cancer palliative care and how PRO data collected through e-PROMs can influence the monitoring and management of symptoms and enable better communication between health professionals and patients. METHODS A scoping review study was designed according to the Arksey and O'Malley framework. Medline, Embase, Web of Science, SCOPUS, PsycINFO and CINAHL and gray literature sources were consulted. The inclusion criteria were people over 18 years old receiving palliative and/or end-of-life care using e-PROMs. RESULTS Thirteen primary studies were included: nine quantitative studies, two qualitative studies, and two mixed-method studies. The recently developed software that supports e-PROMs allows patients to receive feedback on their symptoms, helps clinicians prioritize care needs and monitors patients' conditions as their symptoms change. Electronic PRO data prompt difficult, end-of-life communication between clinicians and patients to better organize care in the last phase of life. CONCLUSION This work shows that electronic PRO data assessment provides valuable tools for patients' well-being and the management of symptoms; only one study reported conflicting results. However, with studies lacking on how clinicians can use these tools to improve communication with patients, more research is needed.
Collapse
Affiliation(s)
- Letteria Consolo
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Bachelor School of Nursing, IRCCS, National Cancer Institute, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Silvia Cilluffo
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, University, Milan, Italy
| | - Ilaria Basile
- Palliative Care, Pain Therapy and Rehabilitation Unit, IRCCS, National Cancer Institute, Milan, Italy
| | - Maura Lusignani
- Associate Professor, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
17
|
Acceptance of physical activity monitoring in cancer patients during radiotherapy, the GIROfit phase 2 pilot trial. Tech Innov Patient Support Radiat Oncol 2022; 22:16-21. [PMID: 35402741 PMCID: PMC8991372 DOI: 10.1016/j.tipsro.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 12/04/2022] Open
Abstract
Activity trackers were well accepted and regularly worn by cancer patients during treatment. In some patients a decrease in step counts correlated with the onset of side effects or quality of life impairments. Activity trackers may be a useful tool to remotely identify patients who are in need of supportive care.
Background In radiotherapy the timely identification of patients needing intervention and supportive care due to side effects is an important task especially in the outpatient setting. Activity trackers as an increasingly used lifestyle device may enable physicians to monitor patient’s physical activity (PA) and to intervene early during the course of radiotherapy. Objective The primary aim of this trial was to assess patient acceptance of PA monitoring in an outpatient setting and to correlate changes in PA with toxicity and changes in quality of life. Methods Patients undergoing radio(chemo-)therapy with a curative intent were eligible to participate in this prospective pilot phase II trial. Patients were instructed to wear a commercially available activity tracker during the course of radiotherapy and four weeks afterwards. Quality of life (QoL) and fatigue was scored using the Functional assessment of Chronic Illness Therapy questionnaire. A linear regression was performed to determine baseline activity and changes in step counts during radiotherapy. Results We included 23 patients in this trial. Two withdrew consent before the start of treatment, two patients were excluded after prophylactic feeding tube placement and prolonged recovery. Compliance in the remaining 19 patients was high, with availability of step-counts on 92% of the days. Baseline step counts were 6274 for breast cancer patients and 3621 for patients with other entities. Decreasing activity during radiotherapy coincided with the development of side effects and declines in quality of life. Conclusions Activity trackers as tool to monitor PA during and after radiotherapy were accepted by a majority of the patients included in the current trial. Observed changes in PA correlated with patient reported side effects and QoL in some of the patients.
Collapse
|
18
|
Silveira A, Sequeira T, Gonçalves J, Lopes Ferreira P. Patient reported outcomes in oncology: changing perspectives-a systematic review. Health Qual Life Outcomes 2022; 20:82. [PMID: 35597948 PMCID: PMC9124403 DOI: 10.1186/s12955-022-01987-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022] Open
Abstract
In public health context, oncology is associated with severe negative impact on patients and on their relatives’ quality of life. Over the last decades, survival has remained at 50% worldwide for some tumor locations. Patient reported outcomes (PROs) assessment and, the corresponding use in clinical practice, help establishing patient individualized profiling involving caregivers. The purpose of this systematic review was to examine critical success factors for PROs assessment in daily clinical oncology practice. Additionally, we investigated how PROs collection can change oncology perspectives for patients and caregivers. According to PRISMA guidelines, 83 studies were included in this systematic review, whether related with implementation in daily clinical practice or associated with its use in oncology. PROs assessment gathers multi-professional teams, biomedical and clinical expertise, patients, families and caregivers. Institutional involvement, first line for caregiver’s adherence, team continuous formation, encompassing training and support, design of clear workflows, continuous monitoring, and data analysis are crucial for implementation. PROs measures are decisive in oncology. Several items were improved, including caregiver–patient–physician communication, patient risk groups identification, unmet problems and needs detection, disease course and treatment tracking, prognostic markers, cost-effectiveness measurement and comfort/support provision for both patients and caregivers. Routine assessment and implementation of PROs in clinical practice are a major challenge and a paradigm transformation for future.
Collapse
Affiliation(s)
- Augusta Silveira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal
| | - Teresa Sequeira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal
| | - Joaquim Gonçalves
- 2Ai - Applied Artificial Intelligence Laboratory, School of Technology of Polytechnic Institute of Cávado and Ave, R. de São Martinho, 4750-810, Vila Frescainha, Barcelos, Portugal
| | - Pedro Lopes Ferreira
- Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal. .,Faculty of Economics, University of Coimbra, Av. Dr. Dias da Silva, 165, 3004-512, Coimbra, Portugal.
| |
Collapse
|
19
|
Underwood J, McCloskey S, Raldow A, Kishan A, Zalkin C, Navarro D, Holt LS, Webb A, Lynch KA, Atkinson TM. Developing a Mobile Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Administration System to Capture Postradiation Toxicity in Oncology: Usability and Feasibility Study. JMIR Form Res 2022; 6:e27775. [PMID: 35412466 PMCID: PMC9044154 DOI: 10.2196/27775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/13/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Accurate self-reported symptomatic toxicity documentation via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is essential throughout cancer treatment to ensure safety and understand therapeutic efficacy. However, the capture of accurate toxicities from patients undergoing radiation therapy is challenging because this is generally provided only at the time of scheduled visits. Objective This study seeks to establish the usability and feasibility of a mobile PRO-CTCAE Administration System (mPROS) to capture toxicities related to radiation therapy. Methods English-speaking adult patients who were undergoing radiation therapy for cancer were enrolled and given a brief demonstration of the Say All Your Symptoms (SAYS) and Symptom Tracking Entry Program (STEP) interfaces of the mPROS app, followed by a patient-use phase where patient actions were observed as they navigated mPROS to enter toxicities. Patient feedback was captured via a semistructured interview and brief questionnaire. Results We enrolled 25 patients (age: mean 60.7 years; females: n=13, 52%; White patients: n=13; 52%; non-Hispanic patients: n=19, 76%; college graduates: n=17, 68%). Patients almost equally preferred the SAYS (n=14, 56%) or STEP (n=11, 44%) interfaces, with 21 patients (84%) agreeing that they would use mPROS to report their symptoms to their health care team and 19 patients (76%) agreeing that they would recommend mPROS to others. Conclusions The mPROS app is usable and feasible for facilitating the patient reporting of radiation therapy–related symptomatic toxicities. A revised version of mPROS that incorporates patient input and includes electronic health record integration is being developed and validated as part of a multicenter trial.
Collapse
Affiliation(s)
- Jody Underwood
- Intelligent Automation, Inc, Rockville, MD, United States
| | - Susan McCloskey
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Ann Raldow
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Amar Kishan
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Chad Zalkin
- Intelligent Automation, Inc, Rockville, MD, United States
| | - Daniel Navarro
- Intelligent Automation, Inc, Rockville, MD, United States
| | | | - Andrew Webb
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kathleen A Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| |
Collapse
|
20
|
Nurse-Led Consultation and Symptom Burden in Patients with Head and Neck Cancer: A Comparative Analysis of Routine Clinical Data. Cancers (Basel) 2022; 14:cancers14051227. [PMID: 35267536 PMCID: PMC8909718 DOI: 10.3390/cancers14051227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Head and neck cancer (HNC) patients experience distressing symptoms that can significantly impact their health-related quality of life (HRQoL). We analyzed the implementation of a nurse-led consultation (NLC) and explored potential associations with symptom burden in HNC patients. Methods: We retrospectively analyzed routinely collected data to describe the implementation of the nurse-led interventions and the evolution of the M.D. Anderson Symptom Inventory scores as patient-reported outcome measures (PROMs). Patients who received routine care (n = 72) were compared with patients in the NLC group (n = 62) at a radiation oncology unit between 2017 and 2019. PROMs were measured at T0 (between simulation and the first week of radiotherapy), T1 (week 3−4), and T2 (week 5−6). Results: Screening for nutrition, smoking, oral cavity status, and capacity for swallowing/chewing, but not for pain, was applied in >80% of patients in the NLC group from T0 to T1. Education (16%) and care coordination (7%) were implemented to a lesser extent. Symptom burden increased over time with no significant differences between groups. Conclusions: The nurse-led consultation was not associated with symptom burden over time. A larger implementation study including a detailed process evaluation, larger sample size, and a focus on long-term effects is needed.
Collapse
|
21
|
Kudel I, Perry T. Exploring Noona Using Passively-Collected Data and Satisfaction/Loyalty Ratings. JMIR Cancer 2022; 8:e29292. [PMID: 35175206 PMCID: PMC9107057 DOI: 10.2196/29292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Electronic patient-reported outcomes’ real time communication of treatment-related symptoms is increasingly associated with better outcomes including longer survival and less health care resource use, but the primary method of collecting this information, static questionnaires, has not evolved. Objective The aim of this paper is to describe the use of Noona’s three methods of communicating treatment-related symptoms, which are as follows: (1) Noona symptom questionnaires (NSQ), which incorporate branching logic; (2) a diary; and (3) secure messaging, the last two of which have NSQ reporting functionality. It also aims to explore, using multivariable analyses, whether patients find value using these features. Methods Noona users (N=1081) who have an active account for more than 30 days, who responded to the satisfaction/loyalty item, and who were undergoing active cancer treatment (systemic or radiotherapy) in the United States were included in this study. All study data were collected via software embedded within Noona code. This includes metadata, patient activities (measured in clicks), and responses to a satisfaction/loyalty question (“How likely are you to recommend Noona to another patient”) displayed on the Noona home page. Results Noona users expressed a high degree of satisfaction/loyalty when asked to rate how likely they would recommend Noona to another patient. Multivariable analyses indicate small but significant effects for some of the analyses. Use of NSQs were significantly related to satisfaction/loyalty, users of NSQs had significantly higher satisfaction/loyalty than those who did not use any, and secure communication use was significantly higher for those who rated the app highly compared to those who did not. These relationships will likely be further explicated with the use of satisfaction/loyalty questions that focus specifically on feature use. Conclusions Noona is well liked by respondents, and exploratory multivariable analyses demonstrate the potential for using passively and minimally invasive data to demonstrate value.
Collapse
|
22
|
Møller PK, Pappot H, Bernchou U, Schytte T, Mortensen ZV, Brúnni MFÁ, Dieperink KB. Feasibility, usability and acceptance of weekly electronic patient-reported outcomes among patients receiving pelvic CT- or online MR-guided radiotherapy - A prospective pilot study. Tech Innov Patient Support Radiat Oncol 2022; 21:8-15. [PMID: 34977367 PMCID: PMC8686059 DOI: 10.1016/j.tipsro.2021.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/11/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
Recruitment for weekly self-reporting of symptoms in radiotherapy is feasible. The frequency and time spent on responding to 18 symptomatic AEs weekly is feasible. Adherence to weekly self-reporting is high in a population with a sizable proportion of patients age 70 or above. Real-time feedback from clinicians is requested by the patients.
Introduction The potential of patient symptoms being monitored longitudinally in radiotherapy (RT) is still unexploited. When novel technologies like online adaptive MR-guided radiotherapy (MRgRT) are evaluated, weekly electronic patient-reported outcomes (ePROs) may add knowledge about the symptom trajectory. This study aimed at evaluating feasibility, usability and acceptance of weekly ePRO among patients receiving pelvic radiotherapy. Materials and Methods In a mixed-methods convergent design, a prospective pilot study enrolled patients referred to pelvic radiotherapy with curative intent. Patients used their own device at home to self-report PRO weekly during and four weeks following radiotherapy and week 8, 12, and 24 (paper-questionnaire as an alternative). Feasibility was extracted from the ePRO software. The Patient Feedback Form and patient interviews were used to explore usability and patient acceptance. Patients were informed that clinicians had no access to PRO responses. Results In total, 40 patients were included; 32 patients with prostate cancer and 8 with cervical cancer (consent rate 87%), median age 68 (36–76). The majority did digital reporting (93%). 85% of patients responded to ≥80% of the weekly questionnaires with 91% average adherence to weekly completion (60% for follow-up), although lower for patients ≥age 70. Time spent on ePRO (97%) and frequency of reporting (92%) was considered appropriate. Interviews (n = 14) revealed the application was usable and the patients requested real-time feedback from the clinicians. Conclusion Recruitment for ePRO during radiotherapy was feasible and adherence to weekly self-reporting high. The digital application was usable and weekly frequency and time spent acceptable. Real-time feedback from the clinicians is requested by the patients.
Collapse
Key Words
- AE, Adverse event
- Acceptance
- CTCAE, Common Terminology Criteria of Adverse Events
- ECOG, Eastern Cooperative Oncology Group
- EORTC, European Organization for Research and Treatment of Cancer
- Feasibility
- Gy, Gray
- MR, Magnetic resonance
- MRgRT, Magnetic resonance guided radiotherapy
- NCI, National Cancer Institute
- Online MRgRT
- PRO, Patient-Reported Outcome
- PRO-CTCAE, Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events
- Patient-reported outcome (PRO)
- QLQ-C30, EORTC general core module
- QoL, Quality of life
- RT, Radiotherapy
- Radiotherapy
- Usability
- WHO, World Health Organization Performance Status
- ePRO, Electronic Patient-Reported Outcome
Collapse
Affiliation(s)
- P K Møller
- Department of Oncology, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - U Bernchou
- Department of Clinical Research, University of Southern Denmark, Denmark.,Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - T Schytte
- Department of Oncology, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Z V Mortensen
- Department of Oncology, Odense University Hospital, Denmark
| | - M F Á Brúnni
- Department of Oncology, Odense University Hospital, Denmark
| | - K B Dieperink
- Department of Oncology, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| |
Collapse
|
23
|
Hauth F, Gehler B, Nieß AM, Fischer K, Toepell A, Heinrich V, Roesel I, Peter A, Renovanz M, Hartkopf A, Stengel A, Zips D, Gani C. An Activity Tracker-Guided Physical Activity Program for Patients Undergoing Radiotherapy: Protocol for a Prospective Phase III Trial (OnkoFit I and II Trials). JMIR Res Protoc 2021; 10:e28524. [PMID: 34550079 PMCID: PMC8495573 DOI: 10.2196/28524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 12/31/2022] Open
Abstract
Background The positive impact that physical activity has on patients with cancer has been shown in several studies over recent years. However, supervised physical activity programs have several limitations, including costs and availability. Therefore, our study proposes a novel approach for the implementation of a patient-executed, activity tracker–guided exercise program to bridge this gap. Objective Our trial aims to investigate the impact that an activity tracker–guided, patient-executed exercise program for patients undergoing radiotherapy has on cancer-related fatigue, health-related quality of life, and preoperative health status. Methods Patients receiving postoperative radiotherapy for breast cancer (OnkoFit I trial) or neoadjuvant, definitive, or postoperative treatment for other types of solid tumors (OnkoFit II trial) will be randomized (1:1:1) into 3-arm studies. Target accrual is 201 patients in each trial (50 patients per year). After providing informed consent, patients will be randomized into a standard care arm (arm A) or 1 of 2 interventional arms (arms B and C). Patients in arms B and C will wear an activity tracker and record their daily step count in a diary. Patients in arm C will receive personalized weekly targets for their physical activity. No further instructions will be given to patients in arm B. The target daily step goals for patients in arm C will be adjusted weekly and will be increased by 10% of the average daily step count of the past week until they reach a maximum of 6000 steps per day. Patients in arm A will not be provided with an activity tracker. The primary end point of the OnkoFit I trial is cancer-related fatigue at 3 months after the completion of radiotherapy. This will be measured by the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire. For the OnkoFit II trial, the primary end point is the overall quality of life, which will be assessed with the Functional Assessment of Cancer Therapy-General sum score at 6 months after treatment to allow for recovery after possible surgery. In parallel, blood samples from before, during, and after treatment will be collected in order to assess inflammatory markers. Results Recruitment for both trials started on August 1, 2020, and to date, 49 and 12 patients have been included in the OnkoFit I and OnkoFit II trials, respectively. Both trials were approved by the institutional review board prior to their initiation. Conclusions The OnkoFit trials test an innovative, personalized approach for the implementation of an activity tracker–guided training program for patients with cancer during radiotherapy. The program requires only a limited amount of resources. Trial Registration ClinicalTrials.gov NCT04506476; https://clinicaltrials.gov/ct2/show/NCT04506476. ClinicalTrials.gov NCT04517019; https://clinicaltrials.gov/ct2/show/NCT04517019. International Registered Report Identifier (IRRID) DERR1-10.2196/28524
Collapse
Affiliation(s)
- Franziska Hauth
- Department of Radiation Oncology, University Hospital Tübingen, Tuebingen, Germany.,Edwin L Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Barbara Gehler
- Department of Radiation Oncology, University Hospital Tübingen, Tuebingen, Germany
| | | | - Katharina Fischer
- Department of Sports Medicine, University Medicine Tübingen, Tuebingen, Germany
| | - Andreas Toepell
- Department of Radiation Oncology, University Hospital Tübingen, Tuebingen, Germany
| | - Vanessa Heinrich
- Department of Radiation Oncology, University Hospital Tübingen, Tuebingen, Germany
| | - Inka Roesel
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital of Tübingen, Tuebingen, Germany
| | - Andreas Peter
- Department of Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital of Tübingen, Tuebingen, Germany
| | - Mirjam Renovanz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Tuebingen, Germany
| | - Andreas Hartkopf
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Tuebingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tuebingen, Germany.,Comprehensive Cancer Center, Section Psychooncology, University Hospital Tuebingen, Tuebingen, Germany.,Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, Tuebingen, Germany.,German Cancer Research Center Heidelberg and German Consortium for Translational Cancer Research, Partner Site Tübingen, Tuebingen, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital Tübingen, Tuebingen, Germany.,German Cancer Research Center Heidelberg and German Consortium for Translational Cancer Research, Partner Site Tübingen, Tuebingen, Germany
| |
Collapse
|
24
|
Kowalchuk RO, Hillman D, Daniels TB, Vargas CE, Rwigema JCM, Wong WW, Stish BJ, Dueck AC, Choo R. Assessing concordance between patient-reported and investigator-reported CTCAE after proton beam therapy for prostate cancer. Clin Transl Radiat Oncol 2021; 31:34-41. [PMID: 34604551 PMCID: PMC8463742 DOI: 10.1016/j.ctro.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We report acute patient-reported outcomes using CTCAE (PRO-CTCAE) of proton beam radiotherapy for high-risk or unfavorable intermediate-risk prostate cancer in a prospective clinical trial. PRO-CTCAE were correlated with investigator reported-CTCAE (IR-CTCAE) to assess the degree of concordance. METHODS AND MATERIALS 11 PRO-CTCAE questions assessed gastrointestinal (GI), genitourinary (GU), or erectile function side effects. The correlation scheme between PRO-CTCAE and IR-CTCAE was independently developed by two physicians. Analyses of PRO-CTCAE and IR-CTCAE were conducted using both descriptive terms and the converted grade scores. The Kappa statistic described the degree of concordance. RESULTS 55 patients were included. IR-CTCAE underestimated diarrhea compared to PRO-CTCAE at the end of treatment (EOT), with a 28% rate of underestimation (11% by ≥ 2 toxicity grades). Similarly, urinary tract pain was underestimated in 45% of cases (17% by ≥ 2 grades) at EOT. Differences were less pronounced at baseline or 3 months after radiotherapy. The incidence of urinary urgency and frequency tended to be overestimated prior to treatment (36% and 24%, respectively) but underestimated at EOT (35% and 31%, respectively). The degree of interference with daily activities was consistently overestimated by investigators (45%-85%). Finally, erectile dysfunction showed a 36-56% rate of discordance by ≥ 2 toxicity grades. CONCLUSIONS Our study shows a low agreement between IR-CTCAE and PRO-CTCAE in the setting of proton therapy for prostate cancer. Compared to patient-reported outcomes, physicians underestimated the frequency and severity of urinary symptoms and diarrhea at the end of treatment. Continued use of PROs should be strongly encouraged.
Collapse
Affiliation(s)
| | - David Hillman
- Department of Statistics, Mayo Clinic, Rochester, MN, USA
| | - Thomas B. Daniels
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Carlos E. Vargas
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jean-Claude M. Rwigema
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - William W. Wong
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA,Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Bradley J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA,Corresponding author at: Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA.
| |
Collapse
|
25
|
Gani C, Lo Russo M, Boeke S, Wegener D, Gatidis S, Butzer S, Boldt J, Mönnich D, Thorwarth D, Nikolaou K, Zips D, Nachbar M. A novel approach for radiotherapy dose escalation in rectal cancer using online MR-guidance and rectal ultrasound gel filling - Rationale and first in human. Radiother Oncol 2021; 164:37-42. [PMID: 34534612 DOI: 10.1016/j.radonc.2021.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dose escalated radiotherapy has previously been investigated as a strategy to increase complete response rates in rectal cancer. However large safety margins are required using cone-beam computed tomography guided radiotherapy leading to high doses to organs at risk or insufficient target volume coverage in order to keep dose constraints. We herein present the first clinical application of a new technique for dose escalation in rectal cancer using online magnetic resonance (MR)-guidance and rectal ultrasound gel filling. METHODS A 73-year-old patient with distal cT3a cN0 cM0 rectal cancer was referred for definitive radiochemotherapy with the goal of organ preservation after multidisciplinary discussion. A dose of 45 Gy in 25 fractions with a stereotactic integrated boost to the primary tumor of 50 Gy with concomitant 5-fluorouracil was prescribed. Furthermore, a boost to the primary tumor with 3 Gy per fraction using the adapt-to-shape workflow on a 1.5 T MR-Linac was planned once weekly. For the boost fractions 100 cc of ultrasound gel was applied rectally in order to improve tumor visibility and distancing of uninvolved rectal mucosa. In order to determine the required planning target volume margin diagnostic scans of ten rectal cancer patients conducted with rectal ultrasound gel filling were studied. RESULTS Based on the ten diagnostic scans an average isotropic margin of 4 mm was found to be sufficient to cover 95% of the target volume during an online adaptive workflow. Three boost fractions were applied, mean treatment duration was 22:34 min. Treatment was well tolerated by the patient with no more than PRO-CTCAE grade I° toxicity of any kind. The rectal ultrasound gel filling resulted in superior visibility of the tumor and reduced the dose to the involved mucosa especially in the high dose range compared with a boost plan calculated without any filling. A considerable tumor shrinkage was observed during treatment from 17.43 cc at baseline to 4 cc in week four. CONCLUSION This novel method appears to be a simple but effective strategy for dose escalated radiotherapy in rectal cancer. Based on the encouraging observation, a prospective trial is currently under preparation.
Collapse
Affiliation(s)
- Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany; German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Monica Lo Russo
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany
| | - Simon Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany
| | - Daniel Wegener
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University, Tübingen, Germany
| | - Sarah Butzer
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany
| | - Jessica Boldt
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany
| | - David Mönnich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany; German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany
| |
Collapse
|
26
|
Cho Y, Zhang H, Harris MR, Gong Y, Smith EL, Jiang Y. Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review. J Med Internet Res 2021; 23:e24638. [PMID: 33709929 PMCID: PMC7998328 DOI: 10.2196/24638] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electronic symptom self-reporting systems (e-SRS) have been shown to improve symptoms and survival in patients with cancer. However, patient engagement in using e-SRS for voluntary symptom self-reporting is less optimal. Multiple factors can potentially affect patients' acceptance and engagement in using home-based e-SRS. However, such factors have not been fully explored in cancer populations. OBJECTIVE The aim of this study is to understand the acceptance and use of home-based e-SRS by patients with cancer and identify associated facilitators and barriers. METHODS PubMed, CINAHL, Scopus, and PsycINFO (January 2010 to March 2020) were searched using a combination of Medical Subject Headings (MeSH) terms and keywords such as symptom self-reporting, electronic/technology, cancer, and their synonyms. Included studies focused on the use of home-based e-SRS by patients with cancer and their families. Studies on patients' use of e-SRS in clinical settings only were excluded. Of the 3740 papers retrieved, 33 were included in the final review. Factors associated with patient acceptance and use of e-SRS were extracted and synthesized. RESULTS Most e-SRS were web based (22/33, 66%) or mobile app based (9/33, 27%). The e-SRS initial acceptance, represented by patient enrollment rates, ranged from 40% (22/55) to 100% (100/100). High e-SRS acceptance was rated by 69% (59/85) to 77.6% (337/434) of the patients after they used the system. The e-SRS use, measured by patients' response rates to questionnaires (ranging from 1596/3521, 45.33% to 92%) or system log-on rates (ranging from 4/12, 33% to 99/100, 99%), declined over time in general patterns. Few studies (n=7) reported e-SRS use beyond 6 months, with the response rates ranging from 62% (40/64) to 85.1% (541/636) and the log-on rates ranging from 63.6% (103/162) to 77% (49/64). The availability of compatible devices and technical support, interactive system features, information accessibility, privacy, questionnaire quality, patient physical/psychosocial status, and age were associated with patient acceptance and use of home-based e-SRS. CONCLUSIONS Acceptance and use of home-based e-SRS by patients with cancer varied significantly across studies, as assessed by a variety of approaches. The lack of access to technology has remained a barrier to e-SRS adoption. Interactive system features and personalized questionnaires may increase patient engagement. More studies are needed to further understand patients' long-term use of home-based e-SRS behavior patterns to develop personalized interventions to support symptom self-management and self-reporting of patients with cancer for optimal health outcomes.
Collapse
Affiliation(s)
- Youmin Cho
- University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Huiting Zhang
- University of Michigan School of Nursing, Ann Arbor, MI, United States
| | | | - Yang Gong
- University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, TX, United States
| | | | - Yun Jiang
- University of Michigan School of Nursing, Ann Arbor, MI, United States
| |
Collapse
|
27
|
Romani C, Conlon M, Oliver M, Leszczynski K, Hunter M, Lam K, Spadafora S, Pearce A. The Operation of Canada's Only Virtually Operated Radiation Oncology Service During the COVID-19 Pandemic. Adv Radiat Oncol 2020; 6:100634. [PMID: 33748545 PMCID: PMC7966849 DOI: 10.1016/j.adro.2020.100634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Our institution operates a remote radiation oncology service in Northern Ontario, Canada. Since the start of the coronavirus disease 2019 pandemic, this center has operated without radiation oncologists on site owing to safety precautions, and this study seeks to understand the effect of this shift. Methods and Materials Departmental level data reports were used to investigate differences in metrics between April to May of 2019 and April to May 2020. These metrics include the total number of referrals received, average wait time from referral to consult, the number of cases that underwent peer review before beginning treatment, the total number of fractions given over each period, patient-reported outcomes, and patient satisfaction. We also examined the importance of physical examinations and the use of SABR treatment. Results There was an observed decrease in the number of referrals received, total number of fractions administered, and number of patients providing patient-reported outcomes. We observed no change in patient wait times, cases undergoing peer review before commencing treatment, or overall patient satisfaction. Challenges were identified in the collection of patient- reported outcomes and the conduction of physical examinations. Conclusions This paper provides proof of concept that a radiation clinic can function entirely virtually in the short term without sacrificing patient satisfaction, efficiency, or safety.
Collapse
Affiliation(s)
| | | | - Mike Oliver
- Health Sciences North, Sudbury, Ontario.,Northern Ontario School of Medicine, Sudbury, Ontario
| | - Konrad Leszczynski
- Health Sciences North, Sudbury, Ontario.,Northern Ontario School of Medicine, Sudbury, Ontario
| | - Michele Hunter
- Health Sciences North, Sudbury, Ontario.,Sault Area Hospital, Sault Ste Marie, Ontario
| | - Kevin Lam
- Health Sciences North, Sudbury, Ontario
| | - Silvana Spadafora
- Northern Ontario School of Medicine, Sudbury, Ontario.,Sault Area Hospital, Sault Ste Marie, Ontario
| | - Andrew Pearce
- Health Sciences North, Sudbury, Ontario.,Northern Ontario School of Medicine, Sudbury, Ontario.,Sault Area Hospital, Sault Ste Marie, Ontario
| |
Collapse
|
28
|
Electronic Patient-reported Outcomes During Breast Cancer Adjuvant Radiotherapy. Clin Breast Cancer 2020; 21:e252-e270. [PMID: 33229222 DOI: 10.1016/j.clbc.2020.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/21/2020] [Accepted: 10/14/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) have become extremely important in following patients' health-related quality of life during cancer treatments. The aim of this study was to assess the usefulness of electronic PROs (ePROs) during adjuvant radiotherapy (RT) in patients with early breast cancer. MATERIALS AND METHODS A registry trial was conducted with a total of 253 patients with breast cancer receiving RT. Adverse event data were collected from 9 items on the ePRO questionnaires that were administered before RT (N = 253), at the end of RT (± 3 days; N = 234), 1 month after RT (N = 230), and 3 months (N = 225) after RT. The patient characteristics and treatment details were collected from the medical records. RESULTS The patients have started actively using the ePRO system, and the response rates were high (82.6%). During RT, 39.3% of the ePRO responses were about symptoms, and 60.7% were about treatment-related questions or advice. Patients treated with hypofractionated RT reported fewer local adverse events such as skin symptoms (P = .001) and pain (P = .002) than those who received conventional RT. One of the main findings of this study was that tiredness, fatigue, and anxiety were commonly reported on the patients' ePRO questionnaires, but they were rarely recorded in the medical records. CONCLUSION Patients were motivated to use the ePRO system, and the response rates were high. Additionally, patients seemed to find that the ePRO system was an easy way to contact their own health care professionals. More attention should be paid to mental well-being during visits to the clinic.
Collapse
|
29
|
Quality of life and fatigue before and after radiotherapy in breast cancer patients. Strahlenther Onkol 2020; 197:281-287. [PMID: 33211138 DOI: 10.1007/s00066-020-01700-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Cancer-related fatigue (CRF) is a common side effect of cancer treatment, particularly in breast cancer patients. Over the past decade, the multimodal management of breast cancer has undergone several changes, such as the establishment of postoperative hypofractionated radiotherapy (RT) as a new standard protocol and the reduced use of chemotherapy. The aim of the current study was to investigate the impact of these changes on quality of life (QoL) and CRF. METHODS A total of 66 patients was assessed for QoL and CRF using the FACIT‑F questionnaire. Patients were asked to complete the paper-based questionnaire before (TP1) and at the end of radiotherapy (TP2) as well as at follow-up (TP3). Subgroups were compared based on fractionation and previous application of chemotherapy. RESULTS For the entire cohort, no significant changes in the severity of fatigue were seen. A mild decrease of physical wellbeing (PWB) from TP1 to TP2 was observed (22.2 vs. 20.7, p = 0.007). Fatigue at TP1 was more severe in patients receiving chemotherapy before RT (37.9 vs. 30.5, p = 0.041). Only patients without preceding chemotherapy showed a significant worsening of fatigue from TP1 to TP2 (37.9 vs 34.8, p = 0.005). The same is true for physical wellbeing (PWB), with a decrease from TP1 to TP2 in chemotherapy-naïve patients only (23.5 vs. 21.4, p = 0.002). Fractionation did not impact any of the investigated endpoints. CONCLUSION Patients undergoing postoperative RT for breast cancer constitute a heterogeneous patient population with varying risks of developing CRF influenced by previous treatments. Therefore, patient selection seems to be critical when interventional studies addressing CRF during radiotherapy are designed.
Collapse
|
30
|
Finazzi T, Papachristofilou A, Zimmermann F. "Connection Failed": A Word of Caution on Telemedicine in Radiation Oncology. Int J Radiat Oncol Biol Phys 2020; 108:435-437. [PMID: 32890527 PMCID: PMC7462966 DOI: 10.1016/j.ijrobp.2020.06.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Tobias Finazzi
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | | | - Frank Zimmermann
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
31
|
Hou J, Li Q, Yu M, Li F, Tang Y, Long Y, Alike Y, Zhang Y, Ali MI, Zhang C, Li W, Yang R. Validation of a Mobile Version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form: An Observational Randomized Crossover Trial. JMIR Mhealth Uhealth 2020; 8:e16758. [PMID: 32706731 PMCID: PMC7395247 DOI: 10.2196/16758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/26/2020] [Accepted: 06/03/2020] [Indexed: 01/09/2023] Open
Abstract
Background The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) questionnaire is an effective tool for evaluating shoulder joint function. The development and usage of a mobile version of the ASES questionnaire has the potential to save time, money, and effort. Objective The aim of this study is to assess the equivalence between the paper and mobile versions of the ASES questionnaire and their acceptability among patients. Methods The paper and mobile versions of the ASES questionnaire were used to evaluate the shoulder joint function of 50 patients with shoulder pain. This study included patients from the shoulder clinic of Sun Yat-sen Memorial Hospital. The intraclass correlation coefficient (ICC) and Bland-Altman method were used to evaluate the agreement (reliability) of the scores obtained by the two methods (paper versus mobile). Results Of the 50 patients recruited from March 2018 to May 2019, 46 (92%) completed the study. There was a high agreement between the paper and mobile versions of the ASES questionnaire (ICC=0.979, 95% CI 0.943-0.987; P<.001). The mean difference between the scores of the mobile and paper versions was 1.0, and only 1/46 (2%) had a difference greater than the minimal clinically important difference of 12 points. About 75% of patients preferred the mobile version to the paper version. Conclusions Our study shows that the mobile version of the ASES questionnaire is comparable to the paper version, and has a higher patient preference. This could prove to be a useful tool for epidemiological studies and patient follow-up over longer periods of time.
Collapse
Affiliation(s)
- Jingyi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qingyue Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Menglei Yu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fangqi Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiyong Tang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Long
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yamuhanmode Alike
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuanhao Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Maslah Idiris Ali
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Congda Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiping Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
32
|
Penedo FJ, Oswald LB, Kronenfeld JP, Garcia SF, Cella D, Yanez B. The increasing value of eHealth in the delivery of patient-centred cancer care. Lancet Oncol 2020; 21:e240-e251. [PMID: 32359500 PMCID: PMC7643123 DOI: 10.1016/s1470-2045(20)30021-8] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 12/23/2022]
Abstract
The increasing use of eHealth has ushered in a new era of patient-centred cancer care that moves beyond the traditional in-person care model to real-time, dynamic, and technology-assisted assessments and interventions. eHealth has the potential to better the delivery of cancer care through improved patient-provider communication, enhanced symptom and toxicity assessment and management, and optimised patient engagement across the cancer care continuum. In this Review, we provide a brief, narrative appraisal of the peer reviewed literature over the past 10 years related to the uses of patient-centred eHealth to improve cancer care delivery. These uses include the addressal of symptom management, health-related quality of life, and other patient-reported outcomes across cancer care. In addition, we discuss the challenges of, and opportunities for, accessibility, scalability, and implementation of these technologies, important areas for further development, and future research directions.
Collapse
Affiliation(s)
- Frank J Penedo
- Department of Psychology, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Laura B Oswald
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| |
Collapse
|