Developing & integrating a mobile application tool into a survivorship clinic for esophageal cancer patients

Abstract

Esophageal cancer (EC) patients are living longer due to enhanced screening and novel therapeutics, however, the post-esophagectomy long-term management remains challenging for patients, caregivers, and providers. Patients experience significant morbidity and have difficulty managing symptoms.Providers struggle to manage symptoms, affecting patients' quality of life and complicating care coordination between surgical teams and primary care providers. To address these patient unique needs and create a standardized method for evaluating patient reported long-term outcomes after esophagectomy for EC, our team developed the Upper Digestive Disease Assessment tool, which evolved to become a mobile application. This mobile application is designed to monitor symptom burden, direct assessment, and quantify data for patient outcome analysis after foregut (upper digestive) surgery, including esophagectomy. It is available to the public and enables virtual and remote access to survivorship care. Patients using the Upper Digestive Disease Application (UDD App) must consent to enroll, agree to terms of use, and acknowledge use of health-related information prior to gaining access to the UDD App. The results of patients scores can be utilized for triage and assessment. Care pathways can guide management of severe symptoms in a scalable and standardized method. Here we describe the history, process, and methodology for developing a patientcentric remote monitoring program to improve survivorship after EC. Programs like this that facilitate patient-centered survivorship should be an integral part of comprehensive cancer patient care.

PRO-Angoff method for remote standard setting: establishing clinical thresholds for the upper digestive disease tool

“…This tool is intended to be used no sooner than 30 days after the surgery for esophagectomy patients but possibly sooner for other foregut procedures. Repeated assessments are recommended every 90 days during the first-year post-surgery, bi-annually for the second year, and then once a year thereafter indefinitely [ 4 ].…”

“…Working with a panel of experts in esophageal reconstruction, we conducted a standard setting exercise to establish clinical thresholds for CONDUIT domain scores to categorize patients post-reconstruction into three clinically meaningful groups of “good” (no action; green), “moderate” (patient education on symptom self-management; yellow), and “poor” (care team contact; red) [ 3 ]. We collaborated with the Mayo Clinic Center for Connected Care to develop an app based on the CONDUIT tool, with automatic score reporting and color-coded severity communication to facilitate interpretation by the clinical team [ 4 , 5 ]. Given success of the project, we recently expanded the tool, which was renamed the Upper Digestive Disease (UDD) Tool™ to better reflect the expanded content and intended population beyond esophagectomy to foregut reconstruction including gastrectomy, pancreatectomy, bariatric, and possibly other diseases.…”