Impact of a mobile application (reminder app) on acute toxicity during radiotherapy of head-and-neck cancer – results of a randomized phase III trial (RAREST-02)

Abstract

Background Radiotherapy of head-and-neck cancer (SCCHN) is often associated with acute toxicity. In a previous trial, daily reminders by staff members to perform skin care resulted in less dermatitis. This randomized trial investigated whether a mobile application can replace these reminders. Methods Patients were stratified according to tumor site, treatment and center. Fifty-three patients were eligible for per-protocol-set (25 with, 28 without app). Primary endpoint was grade ≥ 2 dermatitis until 60 Gy. Secondary endpoints included dermatitis grade ≥ 2 until end of radiotherapy (EOT), dermatitis grade ≥ 3, and mucositis grade ≥ 2 and ≥ 3. Results After an interim analysis, the study was terminated (delayed and slow accrual). Until 60 Gy, grade ≥ 2 dermatitis rates were 72% with vs. 82% without app (p = 0.38), grade ≥ 3 dermatitis rates 20% vs. 11% (p = 0.45). Until EOT, grade ≥ 2 and ≥ 3 dermatitis rates were 72% vs. 86% (p = 0.22) and 24% vs. 18% (p = 0.58). Until 60 Gy, grade ≥ 2 and ≥ 3 mucositis rates were 76% vs. 82% (p = 0.58) and 20% vs. 36% (p = 0.20). Until EOT, corresponding mucositis rates were 76% vs. 82% (p = 0.58) and 28% vs. 43% (p = 0.26). Conclusion Given the limitations of this trial, the reminder app led to non-significant reduction of grade ≥ 2 dermatitis, grade ≥ 2 mucositis and ≥ 3 mucositis. Additional studies are required to define the value of reminder apps during radiotherapy for SCCHN.

Mobile applications in radiation oncology—current choices and future potentials

“…2017 [ 64 ] Activity monitoring and pain/QoL (sensor-equipped bracelet and app) 12 weeks in follow-up Single arm 30 Palliative cancer patients b Remote monitoring of health care status in palliative cancer patients is feasible, mostly positive feedback (bracelet was worn in 53%, smartphone was used in 85% of the study) No Rades et al. 2020 [ 13 ] and 2022 [ 66 ] Reminder app for skin care (4 times daily; RAREST-02) Prospective, two arms 25/28 Head and neck cancer patients receiving RCT (curative) The reminder app was associated with significantly less grade ≥ 2 dermatitis in patients receiving RCT and nonsignificantly less grade ≥ 2 dermatitis and mucositis (grade ≥ 2 and ≥ 3) in the entire cohort No Starmer et al. 2017 [ 25 ] Support adherence to swallowing therapy during RT (exercise videos, educational content, reminder, interaction with HCP possible; Vibrent) Single arm 36 Head and neck cancer patients undergoing RT (curative) App is feasibly integrated into patient care practices.…”

The role of dermocosmetics in the management of cancer-related skin toxicities: international expert consensus

“…Erythema and desquamation were also more common in those who used skincare less frequently ( p < 0.05) [ 54 ]. In addition, a mobile application (app) for daily use of skincare was associated with a trend toward reduced cases of radiation dermatitis above grade 2 [ 55 ]. Daily use of an emollient containing an extract of Aquaphilus dolomiae reduced xerosis severity and improved quality of life score in an observational study of 319 cancer patients with xerosis [ 56 ].…”