Self-reporting with sensor and mobile technology may reduce symptom burden for head and neck cancer patients undergoing radiation treatment
MD Anderson News Release May 16, 2018
A study led by researchers at The University of Texas MD Anderson Cancer Center found that the use of at-home sensor and mobile technology by head and neck cancer (HNC) patients could help reduce their general and cancer-related symptoms associated with radiation treatment, including their risk for dehydration.
The study, presented by Susan Peterson, Ph.D., professor, Behavioral Science, in advance of the American Society of Clinical Oncology (ASCO) Annual Meeting may serve as a model for care in oncology, to improve health outcomes and quality of life.
According to the American Cancer Society, more than 51,540 people will be diagnosed with HNC in 2018 and more than 10,030 people are expected to die from the disease. Symptoms associated with treating the disease can be quite severe, explained Peterson.
“Head and neck cancer is a highly curable disease, but patients can suffer from traumatic symptom burden during radiation treatment, and for quite some time after. They can have pain from tissue damage done to the mucus-producing organs of the mouth, develop mucositis, difficulty swallowing and ultimately become dehydrated,” said Peterson, the study’s principle investigator.
MD Anderson researchers, in collaboration with three other institutions, created a system that uses sensors and mobile applications to gather data from patients daily and send the information to their health care teams. The system, called CYCORE (CYberinfrastructure for COmparative effectiveness REsearch), collects weight, blood pressure and patient-reported outcomes through a variety of devices, including tablets with proprietary WiFi, as well as blood pressure cuffs and weight scales, both Bluetooth enabled. Significant infrastructure was developed and implemented to ensure patient information remained confidential and secure.
Previous research led by Peterson with the CYCORE technology confirmed the feasibility of the monitoring and indicated that implementing the system was acceptable to patients and clinicians. The researchers also found the technology could help HNC patients self-monitor their personal risk for dehydration during radiation treatment so future studies could identify this side effect in real time.
For this federally-funded, prospective trial, 357 MD Anderson HNC patients were enrolled between 2015 and 2018; participants were randomized to either receive usual care (188), or use the CYCORE system (169). Those randomized to CYCORE monitored themselves during radiation treatment, five days a week. Both CYCORE and usual care patients had standard weekly visits with their physicians.
Study participants completed a 28-item survey about their health and well-being at the following times: the start of radiation therapy, the end of treatment (six-to-seven weeks later), and six-to-eight weeks post-treatment. Symptoms were scaled from 0 (no symptoms) to 10 (highest degree of severity).
Peterson was impressed with the engagement by both participants and physicians – with an 85 percent recruitment uptake, and more than 80 percent patient adherence, even when they were at their sickest, she said. Physicians monitored the patients’ data daily from the app and sensor transmissions and intervened when medically necessary.
There was no difference in symptoms between the two groups at the start of the treatment. At the completion of treatment, patients enrolled in the CYCORE arm reported significantly lower scores for both general (2.92 to 3.4, respectively) and HNC-related symptoms, compared to those in the usual care arm, (4.21 to 4.83, respectively).
At six-to-eight weeks post-therapy, CYCORE participants again reported less severe general and cancer-related symptoms, scoring significantly lower for both relative to the usual care arm.
“These findings suggest that home monitoring and early intervention by physicians could potentially result in better outcomes for our patients. Less severe symptoms means patients may be tolerating their treatment better, and hopefully have better outcomes,” said Peterson.
Peterson and colleagues are now analyzing to see if there is reduction in hospital stays and emergency visits associated with the monitoring.
“We feel our study is a demonstration of a potentially useful model for care in oncology, if we find the treatment periods or appropriate times during survivorship when this this type of monitoring could be effective – where both patients and clinicians can derive value and where it can make an impact on care.
Peterson notes that the devices are a few hundred dollars – a relatively small investment to improve patient outcomes, she explained.
The study was funded by the National Cancer Institute of Health, R01CA177914, and will be presented in full in a poster session at the upcoming Annual Meeting on June 2, 2018, 1:15-4:45 pm.
In addition to Peterson, other authors on the study include, from MD Anderson: Adam S. Garden, M.D., Radiation Oncology; Eileen H. Shinn, Ph.D., Maria Camero and George Baum, all of Behavioral Science; Sanjay Shete, Ph.D. Biostatistics; Stephanie L. Martch, Lymphoma/Myeloma; and, Renata Ferrarotto, M.D., Thoracic/Head and Neck Medical Oncology; Emilia Farcas, Kai Lin, Ph.D., Frederic Raab, Viswanath Nandigam, Yan Yan, Kevin Patrick, M.D., Job Godino, Ph.D., all of University of California, San Diego, and Beth Michelle Beadle, M.D., Ph.D., Stanford University.