Remote Tracking Reduces Symptoms in Head and Neck Cancer

Roxanne Nelson, BSN, RN

May 18, 2018

Patients with head and neck cancer who undergo radiation treatment have a high symptom burden and are at an increased risk for dehydration. When such patients were given a remote tracking system to record their symptoms, they subsequently recorded less severity in their symptoms than did a control group of patients who were followed with usual care.

These results, from a randomized trial in 357 patients, were discussed recently at a press briefing held in advance of the annual meeting of the American Society of Clinical Oncology (ASCO), where the study will be presented on June 2 (abstract 6063).

Lead author, Susan K. Peterson, PhD, professor, Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, explained that her team developed the remote tracking system, known as CYCORE (CYberinfrastructure for COmparative effectiveness Research), as a means of gathering data (weight, blood pressure, patient-reported outcomes) daily.

The data are collected on a range of tools, including tablets with proprietary WiFi. It uses an in-home wide area network (WAN) hub/router that transmits sensor readouts, and a mobile app can relay symptom data through a back-end cyber-infrastructure to secure firewall-protected computers at MD Anderson, in order to ensure confidentiality, she explained.

The daily report from the remote tracking system allowed physicians caring for these patients to detect concerning symptoms early and respond quickly to alleviate them.

 "Using sensor and mobile technology to monitor patients during critical periods of outpatient treatment can provide timely information for clinical decision making and may improve quality of life and health outcomes," Peterson commented.

 "Good patient adherence, plus minimal clinician burden, supports the implementation of systems like CYCORE during intensive treatment periods in cancer care," she added.

"Internet of Patients"

Approached by Medscape Medical News for an independent comment, Jorge Nieva, MD, an associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California, Los Angeles, noted that "Dr Peterson's study of CYCORE technology is a demonstration that the 'Internet of Things' can also be the 'Internet of Patients.'"

"Knowing what is happening at home means earlier interventions, fewer symptoms, and overall better care for patients who can use the technology," he said.

He remarked that because healthcare is generally a technology-driven industry, "it is surprising that we as an industry are lagging behind other more mundane fields like taxi service and home sprinklers that have readily adopted to 'Internet of Things' and simplified customers' lives."

"Perhaps physicians do not feel empowered to analyze the readouts from real-time monitoring and make medical decisions," said Nieva. "Or perhaps the issue is that constant health monitoring is not in a physician's current scope of work."

Looking ahead, he pointed out that one challenge will be ensuring that the benefits of new technology are not limited to the young, technology-savvy, highly literate patients who are wealthy enough to have an at-home WiFi network.

Less Severe Symptoms

In this prospective randomized trial, the authors compared longitudinal symptom data in 357 patients with head and neck cancer. Patients randomly assigned to CYCORE monitored themselves during radiation treatment, and both groups had standard weekly visits with their oncologists.

All patients completed the 28-item MD Anderson Symptom Inventory (MDASI) at baseline, at completion of 6 to 7 weeks of radiation therapy, and at 6 to 8 weeks post-radiation therapy completion. The MDASI includes general cancer symptoms, such as pain, fatigue, nausea, and those more specific to head and neck cancer (difficulty swallowing, skin pain/burning/rash). The symptom severity and interference are rated on a 0-to-10 scale, with lower scores indicating better outcomes.

Symptoms did not differ between the two groups at the beginning of treatment.

However, when therapy was completed, patients in the CYCORE cohort reported significantly lower scores than did those in the usual care group for both general symptoms (2.92 vs 3.4; P = .003) and head and neck cancer symptoms (4.21 vs 4.83; P = .009). The mean scores on symptom interference in daily life were similar for both study groups across time periods.

The mean age in the cohort was 60 years (range, 25 to 86 years). The study showed that new technology can be used in older patients, Peterson explained.

Daily adherence to CYCORE was good while the patients were undergoing radiation therapy, with 87% of patients adhering to blood pressure monitoring, 86% to weight tracking, and 80% to symptom inventory.

 "We believe that 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," said Peterson.

This study received funding from the National Institutes of Health. Peterson has disclosed no relevant financial relationships. Nieva reports research funding from Merck and consultant arrangements with Genentech and Astra-Zeneca, and is also a shareholder in Epic Sciences; none of these are relevant to the research discussed.

American Society of Clinical Oncology (ASCO) Annual Meeting. Abstract 6063. To be presented June 2, 2018.

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