San Francisco, CA—Belgian researchers have developed an interactive cell phone–based tool that patients on oral chemotherapy can use daily to report adherence, adverse events, and other concerns.
“We had the impression that the reporting of toxicity and other concerns with oral drugs is difficult. With this e-tool, you have a perfect idea on a daily basis what is happening in your patient population,” Marc Peeters, MD, PhD, of Antwerp University Hospital, one of the study’s authors, said in an interview with The Oncology Nurse-APN/PA at the 2016 Gastrointestinal Cancers Symposium.
“It provides a means to register compliance, early symptoms of disease, and toxicity of treatment,” said Dr Peeters. The study’s first author was Marika Rasschaert, MD.
Health information technology is being increasingly integrated into clinical cancer care. At the same time, routine assessment of patient-reported outcomes has been shown to reliably improve symptom management, help identify psychosocial problems, and enhance patient–provider communication, the researchers stated on their poster.
Programmed Cell Phone
The device is a programmed cell phone—but in the future will become an app on the patient’s own phone—that allows real-time data collection and communication with other care providers via a central platform. The toxicity data are processed by an algorithm that stratifies the information into different grades according to international standards of care and clinical importance.
The e-PRO system can be programmed to gather whatever information is of interest, such as dosing, drug-related toxicities, pain, and nutrition intake.
“The information is reported to a common platform at the hospital, and behind this we have an algorithm that lets the patient know who is in charge. When there appears to be a grade 3 or higher toxicity, the nurse calls the patient immediately. We are trying to avoid the patient coming to the emergency department with high-grade toxicities and emergencies,” Dr Peeters said.
To validate the benefit of the e-PRO, Dr Peeters and colleagues examined their single-center experience with 31 patients on oral chemotherapy (median age, 58 years), most of whom were treated with regorafenib (42%) or capecitabine (39%), but also pazopanib, sunitinib, everolimus, and tegafur/S-1.
The patients recorded medication intake and whatever was relevant of 17 clinical parameters.
Toxicities Identified Early
“Patient acceptance of the e-tool was good,” Dr Peeters reported. Patients were most likely to report asthenia, pain, hand-foot syndrome, cough, and arthralgia, but also listed almost a dozen adverse events of different types.
Intervention by trained oncology nurses for grade 3 toxicities led to hospitalizations in 26% of patients who reported them. These toxicities included asthenia, mucositis, nausea, and fever; one patient had signs of progressive disease and was hospitalized.
Dr Peeters noted that patients “feel much safer” with this tool in their hands. “They have the impression that they’ve got a direct line for help, and they know who is in charge when something happens,” he said. “We believe it also improves adherence. If patients do not report taking their medication within 2 hours of the prescribed time, it triggers a reminder.”
“Our study confirmed the feasibility of the program in an outpatient setting,” he said. Compliance with the e-PRO tool will be confirmed in a multicenter, randomized trial. The researchers plan to further evaluate quality of life and to explore the relationship between optimal pharmacovigilance and improved patient outcomes.
“We will be randomizing patients between e-tool support and conventional support, and we believe we will prove this is better,” Dr Peeters said.
Rasschaert MA, Van den Brande J, Papadimitriou K, et al. Evaluation of an interactive electronic patient reported outcome (e-PRO) system in outpatients with oral chemotherapy. Poster presented at: 2016 Gastrointestinal Cancers Symposium; January 21-23, 2016; San Francisco, CA. Abstract 696.