The increasing value of eHealth in the delivery of patient-centred cancer care

Frank J Penedo, Laura B Oswald, Joshua P Kronenfeld, Sofia F Garcia, David Cella, Betina Yanez, Frank J Penedo, Laura B Oswald, Joshua P Kronenfeld, Sofia F Garcia, David Cella, Betina Yanez

Abstract

The increasing use of eHealth has ushered in a new era of patient-centred cancer care that moves beyond the traditional in-person care model to real-time, dynamic, and technology-assisted assessments and interventions. eHealth has the potential to better the delivery of cancer care through improved patient-provider communication, enhanced symptom and toxicity assessment and management, and optimised patient engagement across the cancer care continuum. In this Review, we provide a brief, narrative appraisal of the peer reviewed literature over the past 10 years related to the uses of patient-centred eHealth to improve cancer care delivery. These uses include the addressal of symptom management, health-related quality of life, and other patient-reported outcomes across cancer care. In addition, we discuss the challenges of, and opportunities for, accessibility, scalability, and implementation of these technologies, important areas for further development, and future research directions.

Conflict of interest statement

Declaration of interests

BY declares a grant from Bristol-Myers Squibb, which contributed to a funded American Cancer Society grant used to investigate the use of health information technologies for monitoring toxic effects. All other authors declare no competing interests.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Figures

Figure:. Flow of information during the monitoring…
Figure:. Flow of information during the monitoring of cancer survivors with PROs integrated with health information technologies
EHR=electronic health record. PRO=patient-reported outcome.

References

    1. The National Cancer Institute. NCI dictionary of cancer terms. (accessed Oct 15, 2019).
    1. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev 2016; 25: 1029–36.
    1. Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term and late effects of cancer. Cancer 2008; 112 (suppl 11): 2577–92.
    1. Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It’s not over when it’s over: long-term symptoms in cancer survivors—a systematic review. Int J Psychiatry Med 2010; 40: 163–81.
    1. Carlson LE, Angen M, Cullum J, et al. High levels of untreated distress and fatigue in cancer patients. Br J Cancer 2004; 90: 2297–304.
    1. Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer Epidemiol Biomarkers Prev 2011; 20: 1996–2005.
    1. Avis NE, Deimling GT. Cancer survivorship and aging. Cancer 2008; 113 (suppl 12): 3519–29.
    1. Institute of Medicine and National Research Council. From cancer patient to cancer survivor: lost in transition. 2006. (accessed March 3, 2020).
    1. National Academy of Medicine. Cancer care for the whole patient: meeting psychosocial health needs. Washington, DC: National Academy of Sciences, 2008.
    1. Miriovsky BJ, Shulman LN, Abernethy AP. Importance of health information technology, electronic health records, and continuously aggregating data to comparative effectiveness research and learning health care. J Clin Oncol 2012; 30: 4243–48.
    1. Janssen A, Brunner M, Keep M, et al. Interdisciplinary eHealth practice in cancer care: a review of the literature. Int J Environ Res Public Health 2017; 14: E1289.
    1. Judson TJ, Bennett AV, Rogak LJ, et al. Feasibility of long-term patient self-reporting of toxicities from home via the Internet during routine chemotherapy. J Clin Oncol 2013; 31: 2580–85.
    1. Girgis A, Durcinoska I, Levesque JV, et al. eHealth system for collecting and utilizing patient reported outcome measures for personalized treatment and care (PROMPT-Care) among cancer patients: mixed methods approach to evaluate feasibility and acceptability. J Med Internet Res 2017; 19: e330.
    1. Bae WK, Kwon J, Lee HW, et al. Feasibility and accessibility of electronic patient-reported outcome measures using a smartphone during routine chemotherapy: a pilot study. Support Care Cancer 2018; 26: 3721–28.
    1. Hauth F, Bizu V, App R, et al. Electronic patient-reported outcome measures in radiation oncology: initial experience after workflow implementation. JMIR Mhealth Uhealth 2019; 7: e12345.
    1. Klagholz SD, Ross A, Wehrlen L, Bedoya SZ, Wiener L, Bevans MF. Assessing the feasibility of an electronic patient-reported outcome (ePRO) collection system in caregivers of cancer patients. Psychooncology 2018; 27: 1350–52.
    1. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 2016; 34: 557–65.
    1. Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA 2017; 318: 197–98.
    1. Denis F, Lethrosne C, Pourel N, et al. Randomized trial comparing a web-mediated follow-up with routine surveillance in lung cancer patients. J Natl Cancer Inst 2017; 109: 1.
    1. Nixon NA, Spackman E, Clement F, Verma S, Manns B. Cost-effectiveness of symptom monitoring with patient-reported outcomes during routine cancer treatment. J Cancer Policy 2018; 15: 32–36.
    1. Lizée T, Basch E, Trémolières P, et al. Cost-effectiveness of web-based patient-reported outcome surveillance in patients with lung cancer. J Thorac Oncol 2019; 14: 1012–20.
    1. Wagner LI, Schink J, Bass M, et al. Bringing PROMIS to practice: brief and precise symptom screening in ambulatory cancer care. Cancer 2015; 121: 927–34.
    1. Garcia SF, Wortman K, Cella D, et al. Implementing electronic health record-integrated screening of patient-reported symptoms and supportive care needs in a comprehensive cancer center. Cancer 2019; 125: 4059–68.
    1. Somers TJ, Abernethy AP, Edmond SN, et al. A pilot study of a mobile health pain coping skills training protocol for patients with persistent cancer pain. J Pain Symptom Manage 2015; 50: 553–58.
    1. Somers TJ, Kelleher SA, Westbrook KW, et al. A small randomized controlled pilot trial comparing mobile and traditional pain coping skills training protocols for cancer patients with pain. Pain Res Treat 2016; 2016: 2473629.
    1. Kelleher SA, Winger JG, Dorfman CS, et al. A behavioral cancer pain intervention: a randomized noninferiority trial comparing in-person with videoconference delivery. Psychooncology 2019; 28: 1671–78.
    1. Somers TJ, Kelleher SA, Dorfman CS, et al. An mHealth pain coping skills training intervention for hematopoietic stem cell transplantation patients: development and pilot randomized controlled trial. JMIR Mhealth Uhealth 2018; 6: e66.
    1. Jim HSL, Hyland KA, Nelson AM, et al. Internet-assisted cognitive behavioral intervention for targeted therapy-related fatigue in chronic myeloid leukemia: results from a pilot randomized trial. Cancer 2020; 126: 174–80.
    1. Wu LM, Amidi A, Tanenbaum ML, et al. Computerized cognitive training in prostate cancer patients on androgen deprivation therapy: a pilot study. Support Care Cancer 2018; 26: 1917–26.
    1. Yanez B, McGinty HL, Mohr DC, et al. Feasibility, acceptability, and preliminary efficacy of a technology-assisted psychosocial intervention for racially diverse men with advanced prostate cancer. Cancer 2015; 121: 4407–15.
    1. Bouchard LC, Yanez B, Dahn JR, et al. Brief report of a tablet-delivered psychosocial intervention for men with advanced prostate cancer: acceptability and efficacy by race. Transl Behav Med 2018; 9: 8.
    1. Greer J, Jacobs JM, Pensak N, et al. Randomized trial of a cognitive-behavioral therapy mobile app for anxiety in patients with incurable cancer. J Clin Oncol 2017; 35 (suppl 31): 10022.
    1. Willems RA, Bolman CA, Mesters I, Kanera IM, Beaulen AA, Lechner L. Short-term effectiveness of a web-based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial. Psychooncology 2017; 26: 222–30.
    1. Cockle-Hearne J, Barnett D, Hicks J, Simpson M, White I, Faithfull S. A web-based intervention to reduce distress after prostate cancer treatment: development and feasibility of the getting down to coping program in two different clinical settings. JMIR Cancer 2018; 4: e8.
    1. Kinner EM, Armer JS, McGregor BA, et al. Internet-based group intervention for ovarian cancer survivors: feasibility and preliminary results. JMIR Cancer 2018; 4: e1.
    1. Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Farrell-Carnahan L, Baum LD. Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia. Psychooncology 2012; 21: 695–705.
    1. Baseman J, Revere D, Baldwin LM. A mobile breast cancer survivorship care app: pilot study. JMIR Cancer 2017; 3: e14.
    1. Buscemi J, Buitrago D, Iacobelli F, et al. Feasibility of a smartphone-based pilot intervention for Hispanic breast cancer survivors: a brief report. Transl Behav Med 2018; 9: 8.
    1. Yanez B, Oswald LB, Baik SH, et al. Brief culturally informed smartphone interventions decrease breast cancer symptom burden among Latina breast cancer survivors. Psychooncology 2020; 29: 195–203.
    1. Sanchez MA, Rabin BA, Gaglio B, et al. A systematic review of eHealth cancer prevention and control interventions: new technology, same methods and designs? Transl Behav Med 2013; 3: 392–401.
    1. Agboola SO, Ju W, Elfiky A, Kvedar JC, Jethwani K. The effect of technology-based interventions on pain, depression, and quality of life in patients with cancer: a systematic review of randomized controlled trials. J Med Internet Res 2015; 17: e65.
    1. Lewis J, Ray P, Liaw ST. Recent worldwide developments in eHealth and mHealth to more effectively manage cancer and other chronic diseases—a systematic review. Yearb Med Inform 2016; 1: 93–108.
    1. Moradian S, Voelker N, Brown C, Liu G, Howell D. Effectiveness of Internet-based interventions in managing chemotherapy-related symptoms in patients with cancer: a systematic literature review. Support Care Cancer 2018; 26: 361–74.
    1. Triberti S, Savioni L, Sebri V, Pravettoni G. eHealth for improving quality of life in breast cancer patients: a systematic review. Cancer Treat Rev 2019; 74: 1–14.
    1. FDA-NIH Biomarker Working Group. BEST (Biomarkers, EndpointS, and other Tools) resource. Silver Spring, MD: US: Food and Drug Administration, 2016.
    1. Atkinson TM, Ryan SJ, Bennett AV, et al. The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review. Support Care Cancer 2016; 24: 3669–76.
    1. Di Maio M, Gallo C, Leighl NB, et al. Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials. J Clin Oncol 2015; 33: 910–15.
    1. Panattoni L, Fedorenko C, Greenwood-Hickman MA, et al. Characterizing potentially preventable cancer- and chronic disease-related emergency department use in the year after treatment initiation: a regional study. J Oncol Pract 2018; 14: e176–85.
    1. Kotronoulas G, Kearney N, Maguire R, et al. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol 2014; 32: 1480–501.
    1. Yanez B, Bouchard LC, Cella D, et al. Patient-centered engagement and symptom/toxicity monitoring in the new era of tumor next-generation sequencing and immunotherapy: the OncoTool and OncoPRO platforms. Cancer 2019; 125: 2338–44.
    1. Chung A, Stover AM, Wagner LI, et al. Harmonization of patient-reported outcomes into EHRs at four cancer hospital outpatient clinics for patient care and quality assessment. J Clin Oncol 2017; 35 (suppl 8): 129.
    1. van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage 2016; 51: 1070–90.
    1. Mock V, Atkinson A, Barsevick A, et al. NCCN Practice guidelines for cancer-related fatigue. Oncology (Williston Park) 2000; 14: 151–61.
    1. Seiler A, Klaas V, Tröster G, Fagundes CP. eHealth and mHealth interventions in the treatment of fatigued cancer survivors: a systematic review and meta-analysis. Psychooncology 2017; 26: 1239–53.
    1. Efficace F, Baccarani M, Breccia M, et al. Chronic fatigue is the most important factor limiting health-related quality of life of chronic myeloid leukemia patients treated with imatinib. Leukemia 2013; 27: 1511–19.
    1. Kantarjian H, O’Brien S, Jabbour E, et al. Improved survival in chronic myeloid leukemia since the introduction of imatinib therapy: a single-institution historical experience. Blood 2012; 119:1981–87.
    1. Jean-Pierre P Management of cancer-related cognitive dysfunction—conceptualization challenges and implications for clinical research and practice. US Oncol 2010; 6: 9–12.
    1. Gonzalez BD, Jim HS, Booth-Jones M, et al. Course and predictors of cognitive function in patients with prostate cancer receiving androgen-deprivation therapy: a controlled comparison. J Clin Oncol 2015; 33: 2021–27.
    1. Bender JL, Yue RY, To MJ, Deacken L, Jadad AR. A lot of action, but not in the right direction: systematic review and content analysis of smartphone applications for the prevention, detection, and management of cancer. J Med Internet Res 2013; 15: e287.
    1. Vollmer Dahlke D, Fair K, Hong YA, Beaudoin CE, Pulczinski J, Ory MG. Apps seeking theories: results of a study on the use of health behavior change theories in cancer survivorship mobile apps. JMIR Mhealth Uhealth 2015; 3: e31.
    1. Hamel LM, Thompson HS, Albrecht TL, Harper FW. Designing and testing apps to support patients with cancer: looking to behavioral science to lead the way. JMIR Cancer 2019; 5: e12317.
    1. Sirintrapun SJ, Lopez AM. Telemedicine in cancer care, volume 38 New York, NY: American Society of Clinical Oncology, 2018: 540–45.
    1. Bobb MR, Van Heukelom PG, Faine BA, et al. Telemedicine provides noninferior research informed consent for remote study enrollment: a randomized controlled trial. Acad Emerg Med 2016; 23: 759–65.
    1. Clark JM, Heifetz LJ, Palmer D, Brown LM, Cooke DT, David EA. Telehealth allows for clinical trial participation and multimodality therapy in a rural patient with stage 4 non-small cell lung cancer. Cancer Treat Res Commun 2016; 9: 139–42.
    1. Galsky MD, Shahin M, Jia R, et al. Telemedicine-enabled clinical trial of metformin in patients with prostate cancer. JCO Clin Cancer Inform 2017; 1: 1–10.
    1. Arora SH, Hawk E. Ensuring equitable cancer care for all patients. May 10, 2017. (accessed March 3, 2020).
    1. Lopez MS, Baker ES, Milbourne AM, et al. Project ECHO: a telementoring program for cervical cancer prevention and treatment in low-resource settings. J Glob Oncol 2016; 3: 658–65.
    1. Hariprasad R, Arora S, Babu R, et al. Retention of knowledge levels of health care providers in cancer screening through telementoring. J Glob Oncol 2018; 4: 1–7.
    1. Nethan ST, Hariprasad R, Babu R, Kumar V, Sharma S, Mehrotra R. Project ECHO: a potential best-practice tool for training healthcare providers in oral cancer screening and tobacco cessation. J Cancer Educ 2019; published online May 23 DOI:10.1007/s13187-019-01549-8.
    1. Mayr M, Schmid RM. Pancreatic cancer and depression: myth and truth. BMC Cancer 2010; 10: 569.
    1. Geng Y, Myneni S. Patient engagement in cancer survivorship care through mHealth: a consumer-centered review of existing mobile applications. AMIA Annu Symp Proc 2015; 2015: 580–88.
    1. Floryan MR, Ritterband LM, Chow PI. Principles of gamification for Internet interventions. Transl Behav Med 2019; 9: 1131–38.
    1. Hesse BW, Shneiderman B. eHealth research from the user’s perspective. Am J Prev Med 2007; 32 (suppl 5): S97–103.
    1. Patel VL, Shortliffe EH, Stefanelli M, et al. The coming of age of artificial intelligence in medicine. Artif Intell Med 2009; 46: 5–17.
    1. Acampora G, Cook DJ, Rashidi P, Vasilakos AV. A survey on ambient intelligence in health care. Proc IEEE Inst Electr Electron Eng 2013; 101: 2470–94.
    1. Abbasi J Wearable digital thermometer improves fever detection. JAMA 2017; 318: 510.
    1. Jensen RE, Snyder CF, Abernethy AP, et al. Review of electronic patient-reported outcomes systems used in cancer clinical care. J Oncol Pract 2014; 10: e215–22.
    1. Bennett AV, Jensen RE, Basch E. Electronic patient-reported outcome systems in oncology clinical practice. CA Cancer J Clin 2012; 62: 337–47.
    1. Holch P, Warrington L, Bamforth LCA, et al. Development of an integrated electronic platform for patient self-report and management of adverse events during cancer treatment. Ann Oncol 2017; 28: 2305–11.
    1. Girgis A, Durcinoska I, Arnold A, Delaney GP. Interpreting and acting on the PRO scores from the Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) eHealth system. Med Care 2019; 57 (suppl 1, 5): S85–91.
    1. Norton WE, Kennedy AE, Chambers DA. Studying de-implementation in health: an analysis of funded research grants. Implement Sci 2017; 12: 144.
    1. Mohr DC, Cuijpers P, Lehman K. Supportive accountability: a model for providing human support to enhance adherence to eHealth interventions. J Med Internet Res 2011; 13: e30.
    1. Ritterband LM, Thorndike FP, Cox DJ, Kovatchev BP, Gonder-Frederick LA. A behavior change model for internet interventions. Ann Behav Med 2009; 38: 18–27.

Source: PubMed

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