A Web-mediated follow-up application (MoovcareTM) improves advanced lung cancer survival, according to a French multicentre randomised phase III study.
Researchers analysed the association and evolution of self-reported clinical symptoms over time.
The median overall survival of patients who used the application was 19 months, compared to 12 months for those who received standard follow-up care.
Patient quality of life was also better among patients who used the application.
“Through personalised follow-up using this convenient and simple online application, we can detect complications and signs of relapse and offer appropriate care earlier,” said lead study author Dr Fabrice Denis, MD, PhD, a researcher at the Institut Inter-regional de Cancérologie Jean Bernard in Le Mans, France.
After completing initial chemotherapy, radiation therapy, or surgery, 133 patients with stage III/IV lung cancer were randomly assigned to Web-mediated follow-up or standard follow-up.
The standard follow-up included doctor visits and patients in the Web-application group had the same schedule of planned doctor visits but three times fewer scheduled scans.
They used the Web application to self-assess symptoms weekly. Caregivers could also enter data on behalf of the patients.
The application analysed 12 symptoms and reported results to the oncologist.
An algorithm assessed specific changes in symptoms and triggered email alerts for the doctor, who would then confirm the need of anticipated exams/visits to adapt cancer treatment, including supportive care options.
At one year, 75% of patients were still alive in the Web-application group, compared to 49% in the standard follow-up group.
Relapse rates were similar in both groups: 51% and 49% in the standard and Web-application groups, respectively.
The general well-being of patient (performance status) at the time of relapse was good in the Web-application group, so the majority (74%) of those patients were able to receive the full recommended treatment for the recurrence.
In contrast, only one-third of patients in the standard follow-up group were well enough to receive optimal treatment for cancer recurrence.
Overall quality of life, assessed using standard quality-of-life questionnaires FACT-L, FACT G, and TOI, was better in the Web-application group. Web-application follow-up also reduced by 50% the average number of imaging tests per patient per year.
The findings are consistent with the results of two other studies using tele-health follow-up. However, according to the authors, this is the first randomised trial showing a major improvement in survival with Web-mediated follow-up versus standard follow-up. It is also the first time that an algorithm for early detection of a symptomatic relapse or complication was used to trigger early supportive care or treatment.
In addition, review of patient-reported symptoms did not add burden to the doctors: on average, it took oncologists only 15 minutes per week to follow 60 patient and automated decreased the frequency of patient phone calls to the office.