Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European Project

Abstract

BackgroundTelehealth solutions can improve the safety of ambulatory chemotherapy, contributing to the maintenance of patients at their home, hence improving their well-being, all the while reducing health care costs. There is, however, need for a practicable multilevel monitoring solution, encompassing relevant outputs involved in the pathophysiology of chemotherapy-induced toxicity. Domomedicine embraces the delivery of complex care and medical procedures at the patient’s home based on modern technologies, and thus it offers an integrated approach for increasing the safety of cancer patients on chemotherapy.ObjectiveThe objective was to evaluate patient compliance and clinical relevance of a novel integrated multiparametric telemonitoring domomedicine platform in cancer patients receiving multidrug chemotherapy at home.MethodsSelf-measured body weight, self-rated symptoms using the 19-item MD Anderson Symptom Inventory (MDASI), and circadian rest-activity rhythm recording with a wrist accelerometer (actigraph) were transmitted daily by patients to a server via the Internet, using a dedicated platform installed at home. Daily body weight changes, individual MDASI scores, and relative percentage of activity in-bed versus out-of-bed (I<O) were computed. Chemotherapy was administered according to the patient medical condition. Compliance was evaluated according to the proportions of (1) patient-days with all data available (full) and (2) patient-days with at least one parameter available (minimal). Acceptability was assessed using the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire. Linear discriminant analysis was used to identify the combination of parameters associated with subsequent unplanned hospitalization.ResultsA total of 31 patients (males: 55% [17/31]; World Health Organization Performance Status=0: 29% (9/31); age range: 35-91 years) participated for a median of 58 days (38-313). They received a total of 102 chemotherapy courses (64.7% as outpatients). Overall full compliance was 59.7% (522/874), with at least one data available for 830/874 patient-days (95.0%), during the 30-day per-protocol span. Missing data rates were similar for each parameter. Patients were altogether satisfied with the use of the platform. Ten toxicity-related hospitalizations occurred in 6 patients. The combination of weighted circadian function (actigraphy parameter I<O), body weight change, and MDASI scores predicted for ensuing emergency hospitalization within 3 days, with an accuracy of 94%.ConclusionsMultidimensional daily telemonitoring of body weight, circadian rest-activity rhythm, and patient-reported symptoms was feasible, satisfactory, and clinically relevant in patients on chemotherapy. This domomedicine platform constitutes a unique tool for the further development of safe home-based chemotherapy administration.

Relevance of a Mobile Internet Platform for Capturing Inter- and Intrasubject Variabilities in Circadian Coordination During Daily Routine: Pilot Study (Preprint)

“…Indeed, valid time series were extracted from the server, and amenable to longitudinal statistical analyses. These results are in line with previous ones obtained in 31 cancer patients through a fixed internet platform within the inCASA European project [26]. The current PiCADo platform was developed in order to bypass the limitations of the inCASA platform, through mobile technology, and multi-rhythm monitoring, including skin temperature.…”

“…Time-varying features of the spectrum were also estimated, through the application of the same method to 3-day windows, which were moved along each time series with 1-h shifts. The clinically-relevant Dichotomy Index I<O was further computed, over consecutive 3 day-spans, with 24-h shifts [26,51]. Strikingly different circadian patterns, rhythm parameters, and I<O values were identified among the 55 healthy subjects (Fig.…”

“…Moreover, such remote monitoring provided early warning signals of patient deterioration at home that resulted in emergency hospitalization 3 days later. Circadian disruption played a prominent role in the determination of such early warning signaling [26]. Here, we aimed at improving circadian timing disorders detection through combining rest-activity and temperature monitoring, while being also able to integrate self-rated symtoms and body weight measurements, using a mobile, rather than fixed platform.…”

“…Furthermore, circadian rest-activity disruption, as measured with an I<O of 97.5% or less, in patients receiving cancer chemotherapy could indeed represent an early warning signal of deterioration and emergency hospitalisation [25,26]. However, I<O values did not correlate with sex, both in healthy subjects or in cancer patients or with efficacy of a standardized chronomodulated chemotherapy protocol in cancer patients [19,20,27], whilst the latter profoundly differed between men and women [28].…”

“…Nevertheless, a first fixed e-health internet platform was developed within the inCASA European project combining telemetric activity monitoring with self-rated symptoms and self-measured body weight. Testing of the platform in 31 cancer patients on chronotherapy at home demonstrated a per protocol compliance rate of ~85% over one month, and enabled prediction of emergency hospitalization due to treatment toxicity three days in advance [26].…”