A RANDOMIZED clinical trial evaluating the use of mobile and sensor technology to remotely monitor symptoms in patients receiving radiation therapy for head and neck cancer found that use of this technology reduced the severity of symptoms related to cancer and its treatment compared with usual care. According to the investigators, using sensor and mobile technology may facilitate rapid clinical decision-making about care and may help improve quality of life and health outcomes. The study was presented during a press briefing in advance of the 2018 ASCO Annual Meeting and was reported by Susan K. Peterson, PhD, MPH, Professor in the Department of Behavioral Science at The University of Texas MD Anderson Cancer Center, and colleagues at ASCO 2018.1
“Our next steps would be to explore ways to implement this as part of clinical care, including in community cancer centers, where most patients receive their care.”— Susan K. Peterson, MD, MPH
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IN THIS STUDY, the researchers used a technology system called CYCORE (Cyberinfrastructure for Comparative Effectiveness Research). The CYCORE system utilizes sensor and mobile technology, including a Bluetooth-enabled weight scale, a Bluetooth-enabled blood pressure cuff, and a mobile tablet with a symptom-tracking application.
The researchers randomized 357 patients with head and neck cancer receiving radiation therapy to receive either CYCORE (n = 169) or usual care (n = 188), which consisted of weekly clinic visits with health-care providers. Patients ranged in age from 25 to 86 years; 21% were female, and 85% were white.
In addition to Bluetooth-enabled sensors, patients in the CYCORE arm received mobile tablets with proprietary Wi-Fi and an in-home wide-area network hub/router, which transmitted patients’ sensor readouts. The mobile app transmitted patients’ symptom data through a back-end cyber-infrastructure to secure firewall-protected computers at The University of Texas MD Anderson Cancer Center to ensure patient confidentiality.
The health-care providers reviewed data received from the app and sensor transmissions each weekday and could intervene in their patients’ care if necessary. Patients in both the CYCORE group and the usual-care group had weekly in-person physician visits.
At the start of radiation therapy, the study participants completed a 28-item MD Anderson Symptom Inventory (MDASI) survey regarding their health, including symptoms such as pain, fatigue, nausea, difficulty swallowing or chewing, skin pain/burning/ rash, and problems tasting food, as well as questions about their daily activities. The study participants completed a similar survey at the end of radiation therapy (usually 6 to 7 weeks later) and a final survey 6 to 8 weeks after radiation therapy ended. Symptom severity and interference were rated on scales of 0 to 10; lower scores indicated better outcomes.
THE RESEARCHERS found that baseline MDASI mean scores were similar in both groups of patients. Mean scores on the severity of general and head and neck cancer–specific symptoms were lower in the CYCORE vs usual-care group at the completion of radiation therapy (2.92 vs 3.4, P = .003; 4.21 vs 4.83, P = .009) and at 6 to 8 weeks after the completion of radiotherapy (1.69 vs 1.96; P = .003; 1.78 vs 2.11, P = .009). Mean scores on symptom interference in daily life were similar in both groups across time.
“WE BELIEVE that good patient adherence, plus the fact this [technology] posed a minimal burden on clinicians to do the monitoring, supports the use of systems like CYCORE during intensive treatment periods in cancer care,” said Dr. Peterson during the press briefing. “Using sensor-mobile technology to monitor patients during critical peak treatments of outpatient care can provide a timely source of information for clinical decision-making and may ultimately improve quality of life and health outcomes. We believe this is the first and largest study of its kind in head and neck cancer, and our next steps would be to explore ways to implement this as part of clinical care, including in community cancer centers, where most patients receive their care.”
DISCLOSURE: Dr. Peterson reported no conflicts of interest. Funding for this study was provided by the National Institutes of Health. Renata Ferrarotto, MD, reported a consulting or advisory role with Ayala Pharmaceuticals and has received institutional research funding from OncoMed, G1 Therapeutics, AstraZeneca/ MedImmune, EMD Serono, Genentech/Roche, and Merck Serono. The other study authors reported no conflicts of interest. ■
1. Peterson SK, Garden AS, Shinn EH, et al: Using mobile and sensor technology to identify early dehydration risk in head and neck cancer patients undergoing radiation treatment: Impact on symptoms. 2018 ASCO Annual Meeting. Abstract 6063. Presented June 2, 2018.
Bruce E. Johnson, MD, FASCO
ASCO PRESIDENT Bruce E. Johnson, MD, FASCO, commented on these study findings during the press briefing.
“This study adds to a growing body of knowledge showing the value of integrating patient-reported outcomes into routine oncology practice for symptom...!-->!-->