Digital Health Applications in Oncology

An Opportunity to Seize

Ravi B. Parikh, MD, MPP; Karen M. Basen-Enquist, PhD, MPH; Cathy Bradley, PhD; Deborah Estrin, PhD; Mia Levy, MD, PhD; J. Leonard Lichtenfeld, MD, MACP; Bradley Malin, PhD; Deven McGraw, JD, MPH; Neal J. Meropol, MD; Randall A. Oyer, MD; Lisa Kennedy Sheldon, PhD, APRN-BC, AOCNP; Lawrence N. Shulman, MD

Disclosures

J Natl Cancer Inst. 2022;114(10):1338-1339. 

In This Article

Abstract and Introduction

Abstract

Digital health advances have transformed many clinical areas including psychiatric and cardiovascular care. However, digital health innovation is relatively nascent in cancer care, which represents the fastest growing area of health-care spending. Opportunities for digital health innovation in oncology include patient-facing technologies that improve patient experience, safety, and patient-clinician interactions; clinician-facing technologies that improve their ability to diagnose pathology and predict adverse events; and quality of care and research infrastructure to improve clinical workflows, documentation, decision support, and clinical trial monitoring. The COVID-19 pandemic and associated shifts of care to the home and community dramatically accelerated the integration of digital health technologies into virtually every aspect of oncology care. However, the pandemic has also exposed potential flaws in the digital health ecosystem, namely in clinical integration strategies; data access, quality, and security; and regulatory oversight and reimbursement for digital health technologies. Stemming from the proceedings of a 2020 workshop convened by the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine, this article summarizes the current state of digital health technologies in medical practice and strategies to improve clinical utility and integration. These recommendations, with calls to action for clinicians, health systems, technology innovators, and policy makers, will facilitate efficient yet safe integration of digital health technologies into cancer care.

Introduction

Mr Brown and Mr Jones are 2 males who underwent chemoradiation with high-dose cisplatin for locally advanced head and neck cancer. Mr Brown was treated in the early 2000s. He experienced substantialnausea and dehydration after his first dose of cisplatin, resulting in an emergency department visit for intravenous fluids. Toward the end of his 6-week radiation course, he had lost approximately 40 pounds. He eventually required a feeding tube and had persistent difficulty swallowing even several months after his course ended.

Mr Jones was treated in 2019. Prior to this therapy, he enrolled in a text-based patient-reported outcomes (PRO) reporting program. He and his family caregiver were sent daily symptom surveys based on the PROs version of the Common Terminology Criteria for Adverse Events[1] and reported decreased oral intake during the first week of cisplatin. This information was automatically fed into the electronic health record (EHR). His oncology care team responded by ordering regular intravenous (IV) fluid infusions in the outpatient and home settings, avoiding an emergency department visit. Despite living nearly an hour from his oncology clinic, his oncology team had twice-weekly video appointments via a secure telemedicine platform and recorded his weight using a wireless scale. Owing to early reporting of his appetite loss and nausea, he was referred for palliative care and nutrition consultation early in the course of his radiation and did not require a feeding tube.

The vastly different experiences of these 2 patients demonstrate the potential for digital health innovations to shape the oncology patient care experience. Digital health encompasses health content, interventions, and applications such as communication and remote monitoring tools to improve and personalize care delivery and enhance patient quality of life.[2] The COVID-19 pandemic presented an unprecedented opportunity to accelerate integration of digital health technologies to increase the likelihood that patients would receive high-quality cancer care outside of the clinic or hospital.[3] These opportunities are most salient in patient- and family-facing solutions that include access to health records, symptom management, and telemedicine visits; clinician-facing decision and diagnostic support; and dissemination of clinical trials into the community. Data standardization, privacy and security, and adequate reimbursement models remain persistent barriers to the advancement of digital health infrastructure in oncology.

Based on proceedings of a 2020 workshop convened by the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine,[4] we characterize the current state of digital health applications in oncology practice and research, highlight barriers to further implementation, and offer strategies to improve equitable use of digital health technologies to maximally improve outcomes for patients with cancer.

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