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      Pilot implementation to assess the feasibility and care team impact of an app-based interactive care plan to remotely monitor breast cancer survivors

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          Abstract

          Purpose

          To assess the feasibility of an app-based, electronic health record (EHR)-integrated, interactive care plan (ICP) for breast cancer (BC) survivors.

          Methods

          A single-arm pilot study was conducted with female BC survivors. ICP tasks included quarterly quality of life (QOL) questionnaire; monthly assessments of fatigue, insomnia, sexual dysfunction, hot flashes, and recurrence symptoms; and daily activity reminders. Embedded decision trees escalated recurrence symptoms to providers. On-demand education was available for self-management of treatment-related toxicities. The primary objective was to assess patients’ engagement with ICP tasks against feasibility thresholds of 75% completion rate. Secondary objectives were evaluation of the system’s functionality to track and escalate symptoms appropriately, and care team impact measured by volume of escalation messages generated. We report preliminary results 6 months after the last patient enrolled.

          Results

          Twenty-three patients enrolled August to November 2020. Mean age was 50.1 years. All patients engaged with at least one ICP task. The monthly average task completion rates were 62% for the QOL questionnaire, 59% for symptom assessments, and 37% for activity reminders. Task completion rate decreased over time. Eleven of 253 symptoms and QOL questionnaires (4.3%) generated messages for care escalation.

          Conclusion

          Implementation of an app-based, EHR-integrated ICP in BC survivors was feasible and created minimal provider burden; however, patient engagement was below the feasibility threshold suggesting that changes may enhance broad implementation and adoption.

          Implications for Cancer Survivors

          An ICP may facilitate remote monitoring, symptom control, and recurrence surveillance for cancer survivors as strategies to enhance patient engagement are applied.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s11764-021-01136-1.

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          Most cited references29

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          Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

          Hyuna Sung, Jacques Ferlay, Rebecca Siegel … (2021)
          This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
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            Cancer treatment and survivorship statistics, 2019

            Kimberly D Miller, Leticia Nogueira, Angela Mariotto … (2019)
            The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
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              Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial.

              Ethan Basch, Allison M Deal, Mark Kris … (2016)
              There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited.
              Article 0 comments Cited 523 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tufia C. Haddad: haddad.tufia@mayo.edu
                Journal
                Journal ID (nlm-ta): J Cancer Surviv
                Journal ID (iso-abbrev): J Cancer Surviv
                Title: Journal of Cancer Survivorship
                Publisher: Springer US (New York )
                ISSN (Print): 1932-2259
                ISSN (Electronic): 1932-2267
                Publication date (Electronic): 2 February 2022
                Publication date PMC-release: 2 February 2022
                Pages: 1-11
                Affiliations
                [1 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, General Internal Medicine, , Mayo Clinic, ; 200 First Street SW, Rochester, MN 55905 USA
                [2 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Kern Center for the Science of Health Care Delivery, , Mayo Clinic, ; 200 First Street SW, Rochester, MN 55905 USA
                [3 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Center for Digital Health, , Mayo Clinic, ; 200 First Street SW, Rochester, MN 55905 USA
                [4 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Family Medicine, , Mayo Clinic, ; 200 First Street SW, Rochester, MN 55905 USA
                [5 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Medical Oncology, , Mayo Clinic, ; 200 First Street SW, Rochester, MN 55905 USA
                Article
                Publisher ID: 1136
                DOI: 10.1007/s11764-021-01136-1
                PMC ID: 8809246
                PubMed ID: 35107791
                SO-VID: 2557bcca-cf93-45b1-bf95-9dc76f51eaa8
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 13 September 2021
                Date accepted : 6 November 2021
                Funding
                Funded by: Mayo Clinic Department of Family Practice
                Award ID: Research Award
                Award Recipient :
                Funded by: Mayo Clinic Center for Digital Health
                Award ID: Noaber Award
                Award Recipient :
                Categories
                Subject: Article

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: interactive care plan,cancer survivorship,self-management,remote patient monitoring,symptom control,mobile application
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: interactive care plan, cancer survivorship, self-management, remote patient monitoring, symptom control, mobile application

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