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Clinical relevance of the first domomedicine platform securing multidrug chronotherapy delivery in metastatic cancer patients at home : the inCASA European project
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Innominato, Pasquale F., Komarzynski, Sandra, Mohammad-Djafari, Ali, Arbaud, Alexandre, Ulusakarya, Ayhan, Bouchahda, Mohamed, Haydar, Mazen, Bossevot-Desmaris, Rachel, Plessis, Virginie, Mocquery, Magali, Bouchoucha, Davina, Afshar, Mehran, Beau, Jacques, Karaboué, Abdoulaye, Morère, Jean-François, Fursse, Joanna, Rovira Simon, Jordi and Lévi, Francis A. (2016) Clinical relevance of the first domomedicine platform securing multidrug chronotherapy delivery in metastatic cancer patients at home : the inCASA European project. Journal of Medical Internet Research, 18 (11). e305. doi:10.2196/jmir.6303
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Official URL: http://dx.doi.org/10.2196/jmir.6303
Abstract
Background: Telehealth 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.
Objective: The 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.
Methods: Self-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.
Results: A 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%.
Conclusions: Multidimensional 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.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Medical telematics , Cancer -- Patients -- Treatment, Cancer -- Patients -- Home care, Chemotherapy | ||||||
| Journal or Publication Title: | Journal of Medical Internet Research | ||||||
| Publisher: | Journal of Medical Internet Research | ||||||
| ISSN: | 1438-8871 | ||||||
| Official Date: | 25 November 2016 | ||||||
| Dates: |
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| Date of first compliant deposit: | 18 January 2017 | ||||||
| Volume: | 18 | ||||||
| Number: | 11 | ||||||
| Article Number: | e305 | ||||||
| DOI: | 10.2196/jmir.6303 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||
| Funder: | Seventh Framework Programme (European Commission) (FP7), France. Conseil Régional d’Ile de France [Regional Council of Ile de France], OSEO services France (Firm), France. Fonds unique interministériel [Single Interdepartmental Fund] (FUI), Institut de recherche en santé publique [Institute of Public Health Research] (IReSP) | ||||||
| Grant number: | Contract CIP 250505 (FP7), Contract PiCADo (FUI), Contract CLOCK-DOM1, CASyM (Coordinating Action Systems Medicine) (IReSP) |
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