The HOPE Pilot Study: Harnessing Patient-Reported Outcomes and Biometric Data to Enhance Cancer Care

Abstract

Purpose: Integrating patient-reported outcomes (PROs) into clinical practice is an increasingly promising strategy for improving patients’ symptoms, communication, and clinical outcomes. The objective of this study was to assess the feasibility, acceptability, and perceived effectiveness of a mobile health intervention designed to collect PROs and activity data as a measure of health status. Patients and Methods: Pilot intervention with 10 patients with gynecologic cancers receiving palliative chemotherapy. The HOPE (Helping Our Patients Excel) study used wearable accelerometers to assess physical activity and the Beiwe research platform to collect PROs, risk stratify patient responses, provide tailored symptom management, and notify patients and clinicians of high-risk symptoms. Feasibility and acceptability were assessed through enrollment and adherence rates; perceived effectiveness was evaluated by patients and oncologists at study completion. Results: The approach-to-consent rate was 100% and participants were 90% and 70% adherent, respectively, to the wearable accelerometers and smartphone surveys. Participants’ mean daily step count was 4,040 (SD=2,270) and increased from week 1 (mean=3,520, SD=1578) to week 3 (mean=4,136, SD=1,578). Active monitoring of participants’ heart rates, daily steps, and PROs throughout the study identified anomalies in participants’ behavior patterns that suggested poor health for 20% (2 patients). Patients and clinicians indicated that the intervention improved physical activity, communication, and symptom management. Conclusion and Relevance: A mobile health intervention that collects PROs and activity data as a measure of health status is feasible, acceptable, and was perceived to be effective in improving symptom management patients with advanced gynecologic cancers. A larger, multisite randomized clinical trial to assess the efficacy of the HOPE intervention on patients’ symptoms, health-related quality of life, clinical outcomes, and health care utilization is warranted.

Age differences in patterns and confidence of using internet and social media for cancer-care among cancer survivors

“…Older cancer survivors may benefit from newer technology (i.e., internet, social media, wearables) for cancer care [21]. In addition to the potential informational benefits, remote symptom monitoring, online support groups, and selfmanagement applications may all help to improve both the quality of life and care for cancer survivors, especially older cancer survivors who may not be able to easily attend as many appointments or visits [46][47][48][49].…”

Feasibility and Usability Aspects of Continuous Remote Monitoring of Health Status in Palliative Cancer Patients Using Wearables

“…However, no details on usability aspects and acceptance were given. Wright et al [24] evaluated an accelerometer-based monitoring system over a period of 30 days in 10 gynecological patients undergoing palliative chemotherapy focusing on feasibility, acceptability, and perceived effectiveness. These patients used a smartphone with the Beiwe research platform (also a tool for the collection of data) on it and two accelerometers.…”

Harnessing consumer smartphone and wearable sensors for clinical cancer research

“…In a sample of seven breast cancer patients in active treatment, more time at home or at locations of friends and family members was associated with better mood and less anxiety and depression while more time spent at hospitals and clinics was associated with worse mood 45 . In a sample of 10 gynecologic cancer patients, Fitbit and smartphone sensor data were actively monitored for anomalies; this led the research team to identify a patient with severe nausea and vomiting whose symptoms were then able to be managed over the phone as well as a patient who took fewer steps and spent less time away from home prior to an emergency department visit 46 . Finally, a recent study collected both smartphone and wearable sensor data as well as patient-reported pain and distress ratings and quality of life measures in 25 palliative cancer patients 47 .…”

“…We identified 14 prospective studies since 2016 that have examined a variety of oncology populations before, during, and after cancer treatment and have included a range of consumer wearable devices and smartphone sensing frameworks (see Table 1 ). Most studies have included very small samples (median n = 34.5, range 7–71), and only a handful have used real-time sensor data to inform clinical care 42 , 46 . Larger-scale longitudinal studies that implement mobile sensing in clinical settings are needed.…”

“…If mobile sensing data are monitored in real-time or used in combination with algorithms that trigger notifications to clinicians when preset thresholds are exceeded or trajectories suggest significant anomalies or changes over time, they can be used for remote monitoring of toxicities and symptoms 57 , 65 . These symptom monitoring systems could also trigger symptom self-management interventions for patients and caregivers or support patients in making timely decisions about when to seek care 42 , 46 . In the post-treatment survivorship phase, when clinical encounters become less frequent but treatment sequelae like fatigue, insomnia, and cognitive difficulties remain common, passive monitoring could be useful in evaluating quality of life, personalizing survivorship care, and gaining insight into the long-term effects of cancer and its treatments 64 .…”