The recent MASCC (Multinational Association of Supportive care in Cancer) Annual Meeting in San Francisco reflected the rise of the rapidly developing field of digital health by having sessions including a plenary session featuring many aspects of digital health and the utilisation of artificial intelligence. This included wearables and remote monitoring and seemed appropriate considering the meeting was at the home of Silicon Valley.
Digital health gives us platforms to enable better connected healthcare. As we collect information by increasingly reliable devices, we are amassing large volumes of data, but advances in artificial intelligence (AI) to mine data and machine learning enable processing of these data in real time.
There is no doubt that e-Health applications will allow monitoring of quality of life but will also result in personalised supportive care. A study from the Netherlands by Anja Van Der Hout randomised 627 cancer survivors who had been treated for breast cancer, colorectal cancer, head and neck cancer and lymphoma up to 5 years after treatment to a self-management App (called Oncokompas) which monitored health-related quality of life (HRQOL), or to usual care. They were then followed for 6 months. Significant differences were found for HRQOL (as measured by EORTC QLC-C30 summary score and the diarrhoea subscale) in favour of those who used the App. The App also provided help for tumour specific topics from which the patients could select.
PhD student Xiomara Skrabal-Ross wanted to improve the compliance with oral chemotherapy of particularly young adults with cancer. Her scoping study revealed that the main reasons for non-compliance were side effects, forgetfulness and poor knowledge of the treatment. She reported having developed a Smartphone-based self-management program where a website sent SMS messages to remind patients to take their tablets. Compliance was to be measured by Medication Event Monitoring System (MEMS) dosette boxes which record the date and time when tables are removed from them. A pilot qualitative study found that this would be acceptable to patients taking anti-cancer medication and a large study has begun.
One of the longest standing remote management strategies is teleoncology; delivering oncological services at a distance. A review of the literature showed that this can range from supervising chemotherapy, planning radiotherapy or supplementing expertise for remote multidisciplinary meetings to including diagnostic services such as telepathology and teleradiology. The lessons learned from the early studies were that there should be a grass roots need (rather than supplying the equipment and hoping that it is utilised), it should have a dedicated room where teleconferences can be scheduled at any time needed, and it should not interfere with usual practice. So, for example if pathologists don’t usually give instant opinions on a pathology slides then the slides should be transmitted in advance of a multidisciplinary meeting where the opinion is to be presented. Training on the equipment may be required, but it is becoming commonplace and simple to use. There were no ethical or governance barriers that couldn’t be overcome.
Later studies, particularly from Kansas and Townsville demonstrated both the clinical benefit and cost effectiveness of it use. Telemedicine consultations generally resulted in similar opinions to face to face consultations but a remote practitioner and to communicate the physical examination findings. Cost effectiveness increased with the remoteness of the distant site as the ongoing reduction in travel costs was a major saving after the equipment has been purchased. Obviously, a greater volume of patients using the equipment makes it more cost-effective.
The Clinical Oncological Society of Australia has produced evidence-based teleoncology guidelines and has introduced a model for using telemedicine to recruit rural and remote patients to clinical trials.
Teleoncology has been used for remote supervision of medical trainees. It also does not only help with rural and remote disparities but has been used to alleviate disparities in low- and middle-income countries where professional and political barriers to its use can be overcome.
With the presentations on AI and virtual and augmented reality painting an exciting picture of future oncological care, Sangeeta Agarwal asked the sobering question of whether AI increased or decreased closeness between clinician and patient from the perspective of each. There is a fear that a communication gap may become wider. They developed an AI nurse (Helpsy SAN) designed to add value by anticipating needs, educating and escalating care by allowing nurses to track patients in real time. The report of a pilot study showed that the use of smart templates like this made clinicians feel more connected to their patients by identifying their specific needs. In turn, patients were more engaged in their own symptom management. This technology actually bridged the communication gap
In supportive care as well as cancer treatment digital solutions are now science fact and no longer science fiction, and will supplement and facilitate better patient management into the future.