COMMENTARY

Innovative Mobile Phone App Helps to Deliver Palliative Care in Sub-Saharan Africa

David J. Kerr, CBE, MD, DSc

Disclosures

October 11, 2021

This transcript has been edited for clarity.

Hello. I'm David Kerr, a professor of cancer medicine from the University of Oxford. I'd like to talk today about a study I picked up from the Journal of Global Oncology, led by Mamsau Ngoma and her excellent colleagues from the Ocean Road Cancer Center in Dar es Salaam, Tanzania, and Muhimbili University. It’s an excellent group. The study concerns an interesting mobile phone application for delivering palliative care to patients with advanced cancer in East Africa.

We know that the vast majority of patients in sub-Saharan Africa still present with stage IV disease, often with a very large tumor burden, in which institution of palliative care is frankly the best treatment that one could deliver. We know that palliative care, in addition to symptom control and easing end of life, can improve overall survival if instituted at an early stage by a quality team, such as the team from the Ocean Road Cancer Center.

This is a well-designed, randomized pilot study. In this new age that we are embracing of advanced information communication technology — I would have to say it is accelerated by the COVID pandemic — all of us are using remote means of delivering cancer care, such as video conferencing and teleconferencing. I think it is a modality that is here to stay.

They've adopted and adapted this, and they've developed a mobile phone app that allows collection of palliative outcome scale data. They have patients who are being looked after for end-of-life care. All of them have, at least, a minimum of 4 months of life left. They download an app on to their mobile phone. This allows them twice a week to enter the palliative outcomes scores, which is a symptom measure that has been adapted for use in Africa. It is widely used and well used.

These data are available in the cloud. The palliative care team in Ocean Road Cancer Center linked to local healthcare workers can interrogate these data and act upon them. If there are symptoms heading the wrong way or if there are symptoms are emerging, then they can access and deal with it.

It's a randomized study with 49 patients in each group. The control group had a telephone call twice a week from the same palliative care team, and the palliative outcomes scale data were collected during this telephone call.

This was a pilot study designed to see how well accepted the mobile phone data were. I remember visiting Ghana in sub-Saharan Africa and finding that mobile phone connectivity there was better than in middle England. There's no doubt that our African brothers and sisters have embraced mobile phone technology, and the coverage tends to be very good. It’s an exciting technology to move forward.

Interestingly (and slightly surprisingly), in this study, they found that the degree of symptom control was better in the group who had the twice-weekly telephone calls. It was a small study, so there may have been some imbalances in the randomization. There was a slight excess of patients who had greater morphine use or greater baseline symptomatic problems in the mobile phone group. This is what happens in a small, randomized study of this sort.

It was a little puzzling — but perhaps not. Twice a week, there was a human voice. The individuals who were being looked after were speaking to the people that were caring for them. That thread of human contact made a difference. 

This study is an early one. It's a pilot study that showed the technology works; that the mobile phone app was effective; and that the degree of satisfaction in both cohorts, in terms of the care they received, was high and equivalent. Therefore, I think we need more studies to be able to demonstrate the wider applicability. Remember that, in Tanzania, 60% of the population is rural and is geographically dispersed. We do need better means of remote monitoring and looking after patients.

It’s not a warning shot exactly, but the twice-weekly comfort of a human voice perhaps made a difference in this small study. Of course, with information communication technology, we can be the face or the voice behind any mode of consultation. It was a very interesting study.

I'm sure the team will follow up with wider, larger studies designed to look at this innovative mobile phone technology. This is something that I would be supportive of, but larger studies are required to find a cohort of patients that would benefit most from this more remote data collection than those who respond to the warmth of a human voice.

Thanks for listening, as always. I’m very keen on any comments that you might have. For the time being, Medscapers, ahoy. I should say, “Over and out,” shouldn't I? Goodbye, and thank you.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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