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J Med Internet Res. 2016 Nov 25;18(11):e305.

Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European Project.

Author information

1
Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.
2
Department of Oncology, Queen Elizabeth Hospital, Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom.
3
French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.
4
Laboratory of Signals and Systems (L2S), Unit 8506, Gif-sur-Yvette, France.
5
Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.
6
Ramsay Générale de Santé, Mousseau Clinics, Evry, France.
7
St Georges Hospital, National Health Service Foundation Trust, London, United Kingdom.
8
AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France.
9
Faculty of Medicine, Paris South University, Le Kremlin-Bicêtre, France.
10
Chorleywood Health Centre, Chorleywood, United Kingdom.
11
Telefónica Research and Development, Barcelona, Spain.

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.

KEYWORDS:

MDASI; actigraphy; chronotherapy; domomedicine; telemonitoring

PMID:
27888171
PMCID:
PMC5148811
DOI:
10.2196/jmir.6303
[Indexed for MEDLINE]
Free PMC Article

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