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Home-based e-Health platform for multidimensional telemonitoring of symptoms, body weight, sleep, and circadian activity : relevance for chronomodulated administration of irinotecan, fluorouracil-leucovorin, and oxaliplatin at home—results From a pilot study
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Innominato, Pasquale F., Komarzynski, Sandra, Karaboué, Abdoulaye, Ulusakarya, Ayhan, Bouchahda, Mohamed, Haydar, Mazen, Bossevot-Desmaris, Rachel, Mocquery, Magali, Plessis, Virginie and Lévi, Francis A. (2018) Home-based e-Health platform for multidimensional telemonitoring of symptoms, body weight, sleep, and circadian activity : relevance for chronomodulated administration of irinotecan, fluorouracil-leucovorin, and oxaliplatin at home—results From a pilot study. JCO Clinical Cancer Informatics . doi:10.1200/CCI.17.00125 ISSN 2473-4276.
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Official URL: http://dx.doi.org/10.1200/CCI.17.00125
Abstract
Purpose:
To assess the impact of chronomodulated irinotecan fluorouracil-leucovorin and oxaliplatin (chronoIFLO4) delivered at home on the daily life of patients with cancer in real time using a home-based e-Health multifunction and multiuser platform. This involved multidimensional telemonitoring of circadian rest-activity rhythm (CircAct), sleep, patient-reported outcome measures, and body weight changes (BWCs).
Patients and Methods:
Patients received chronoIFLO4 fortnightly at home. Patients completed the 19-item MD Anderson Symptom Inventory on an interactive electronic screen, weighed themselves on a dedicated scale, and continuously wore a wrist accelerometer for CircAct and sleep monitoring. Daily data were securely teletransmitted to a specific server accessible by the hospital team. The clinically relevant CircAct parameter dichotomy index I < O and sleep efficiency (SE) were calculated. The dynamic patterns over time of patient-reported outcome measures, BWC, I < O, and SE informed the oncology team on tolerance in real time.
Results:
The platform was installed in the home of 11 patients (48 to 72 years of age; 45% men; 27% with performance status = 0), who were instructed on its use on site. They received 26 cycles and provided 5,891 data points of 8,736 expected (67.4%). The most severe MD Anderson Symptom Inventory scores were: interference with work (mean: 5.1 of 10) or general activity (4.9), fatigue (4.9), distress (4.2), and appetite loss (3.6). Mean BWC was −0.9%, and mean SE remained > 82%. CircAct disruption (I < O ≤ 97.5%) was observed in four (15%) cycles before chronoIFLO4 start and in five (19%) cycles at day 14.
Conclusion:
The patient-centered multidimensional telemonitoring solution implemented here was well accepted by patients receiving multidrug chemotherapy at home. Moreover, it demonstrated that chronoIFLO4 was a safe therapeutic option. Such integrated technology allows the design of innovative management approaches, ultimately improving patients’ experience with chemotherapy, wellbeing, and outcomes.
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