Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings

Abstract

Background: mobile applications (apps) facilitate cancer pain ecological momentary assessment (EMA) and provide more reliable data than retrospective monitoring. The aims of this study are (a) to describe the status of persons with cancer pain when assessed ecologically, (b) to analyze the utility of clinical alarms integrated into the app, and (c) to test the feasibility of implementing an app for daily oncological pain monitoring. Methods: in this feasibility study, 21 patients (mean age = 56.95 years, SD = 10.53, 81.0% men) responded to an app-based evaluation of physical status (baseline and breakthrough cancer pain (BTcP)) and mental health variables (fatigue, mood, and coping) daily during 30 days. Results: cancer pain characterization with the app was similar to data from the literature using retrospective assessments in terms of BTcP duration and perceived medication effectiveness. However, BTcP was less frequent when evaluated ecologically. Pain, fatigue, and mood were comparable in the morning and evening. Passive coping strategies were the most employed daily. Clinical alarms appear to be useful to detect and address adverse events. App implementation was feasible and acceptable. Conclusion: apps reduce recall bias and facilitate a rapid response to adverse events in oncological care. Future efforts should be addressed to integrate EMA and ecological momentary interventions to facilitate pain self-management via apps.

Deploying the Behavioral and Environmental Sensing and Intervention for Cancer Smart Health System to Support Patients and Family Caregivers in Managing Pain: Feasibility and Acceptability Study

“…This is an important finding, as prior work has demonstrated challenges in ensuring health care providers understand and act upon patient-reported outcome data [ 61 ]. Given this reality, we concur with Villegas et al [ 48 ] and suggest that a more effective (or at least equally important) strategy is to focus on how remote monitoring data can inform real-time intervention strategies delivered directly to patients and caregivers for more empowered symptom self-management. We hypothesize that different “buckets” of data exist, and who needs access to these data—when, and how, and in what ways—will vary, temporally and by end user.…”

“…This is a noteworthy finding given the severity of illness experienced by palliative care patient populations, which can make data collection extremely difficult or impossible [ 53 - 55 ]. We believe this underscores and confirms the value patients and caregivers place on meaningful self-reported outcomes [ 44 , 56 , 57 ] and validates other work seeking to use EMAs to collect data about cancer pain [ 48 ]. We also believe that participants’ acceptance of answering EMAs about pain in real time was enhanced by our intentional choice to use smart watches versus a mobile phone app.…”

“…Importantly, our findings suggest an innovative approach to supporting home-based symptom self-management for cancer pain, promoting patient and caregiver self-efficacy, and strengthening the relationship between caregivers and care recipients—all critical and persistent gaps in oncology care [ 41 , 42 ]. More specifically, our research contributes to advancing the science of remote oncology care [ 43 - 47 ] and extends current efforts to leverage technology to monitor and manage cancer pain [ 48 - 51 ] by providing data that can inform future interventions. For example, by monitoring environmental and contextual factors in the home that may influence pain, BESI-C could prompt a patient or caregiver to implement a low-burden, high-impact environmental modification to reduce pain, such as adjusting the room temperature.…”

mHealth for the Monitoring of Brace Compliance and Wellbeing in Adolescents with Idiopathic Scoliosis: Study Protocol for a Feasibility Study

“…Additionally, in relation to the feasibility results, we anticipate that the participants will be very satisfied with the app in terms of acceptability and usability (i.e., "I needed to learn many things before I could start using the system"). Based on previous similar research [45,46], we also anticipate that the clinicians will be satisfied with the app in terms of perceived utility, low burden, and high intention to use. Regarding the clinical utility of the app, we also hypothesized that the app would allow early detection of low brace adherence, brace-related side effects, and psychological distress associated with brace use.…”

Multidimensional Statistical Technique for Interpreting the Spontaneous Breakthrough Cancer Pain Phenomenon. A Secondary Analysis from the IOPS-MS Study

“…If adequate resources are available, even the so-called best phenotypes (P1 and P2) can benefit from telemedicine. The experience accumulated in the management of patients with cancer pain during the pandemic suggests that many episodes of NP-BTcP are not reported during periodic consultations but are recorded by the patient in the monitoring system [29]. In other words, the impact on quality of life is always present, but both patients and clinicians tend to underestimate the effect [30,31].…”