Technology has also revolutionized patient access to healthcare tools that can make it easier for people to manage care at home. Conduct a Google search for “cancer apps” and instantly you have many options—care advisers, medication trackers, symptom checkers, support groups, treatment reminders, memory boosters, insomnia busters, meditation guides, and audio diaries are all available with a simple point and click. When it comes to healthcare help, there really is an app for that. Thanks to technology, nurses, researchers, and patients have more options and access than once thought possible.
Along with those technological advances come changes in care delivery. At-home symptom monitoring is rapidly becoming a reality, and for patients with cancer, novel technologies can improve quality of life by putting more power in their hands. As cancer care increasingly takes place in outpatient settings, the complex task of managing the effects of chemotherapy creates a heavy burden for patients. Despite the best efforts of oncology nurses and other clinicians to ensure that patients have the information they need to manage nausea, insomnia, pain, loss of appetite, and other debilitating symptoms, patients frequently end up in the emergency department or are admitted to the hospital because they didn’t know what to do regarding an adverse event or when to act.
Kathi Mooney, PhD, RN, FAAN, is a distinguished professor of nursing at the University of Utah and coleader of the Cancer Control and Population Sciences Program at Huntsman Cancer Institute in Salt Lake City. In a recent interview with Oncology Nursing News®, she spoke about how one new technology, SymptomCare@Home (SCH), can significantly reduce symptom burden.
“SCH relieves patients of the need to remember instructions they received days or weeks ago. Instead, they’re reminded immediately when reporting a problem, such as nausea,” Mooney said. “They don’t need to know the sequence of what they should do or remember where they put their folder of information. They hear what they need to do when they need to do it.”
The tandem of automated coaching and provider response follows a stepped approach to symptom management, Mooney said. Patients access the system via a web-based platform or mobile application or by telephone. Using a complex algorithm, SCH assesses patient symptoms according to type, severity, and frequency.
Then, based on patient input, the app provides tailored coaching. With nausea, for example, patients are asked if they’ve taken antinausea medication regularly and, if not, why not. In addition to providing on-the-spot instructions, this assessment and coaching technology can help guide discussions in clinic and prompt provider adjustments to plans of care as needed.
Results of a study on the effectiveness of SCH showed that patients in the intervention group had significantly better symptom management than those in the usual care group.1 The platform is user-friendly, specific to patient needs, and immediately responsive, which helps patients manage their care more independently and efficiently. Although SCH has thus far been used for research purposes only, programmers are readying the system for integration into clinical practice at Huntsman Cancer Institute this summer. Mooney said they are willing to work with providers interested in the technology.
“Altering the coaching to fit a specific approach doesn’t require a specialized programmer,” she said.
Other novel symptom support and management technologies are being developed, and the possibilities for future innovation seem limitless. One promising prototype for patients with cancer aims to detect severe neutropenia through optical imaging of nail-fold microcirculation.2 This technology is in its infancy, but developers hope that one day portable units will quickly, effectively, and noninvasively identify life-threatening white blood cells counts earlier on.
Disease-specific innovations are also making headway, such as the Personal Patient Profile– Prostate (P3P) application, which aims to ease decisional conflict regarding treatment options using an internet-based support system.3 The system incorporates individualized coaching through text and video education. Studies have demonstrated that P3P aids patient decision making for prostate cancer treatment.
The iCancerHealth app is yet another symptom assessment and management tool that complements in-clinic patient education by instructing patients on how to conduct self-assessments, self-administer medications, and manage symptoms.4 The goal of this and many of the novel technologies in the works is to empower patients to better manage their care, which in turn will improve quality of life, reduce the need for emergency care and hospitalization, and intervene early on when intensified care is needed.
Oncology nurses are positioned to influence these technology advances by staying informed, participating in the development of clinically sound algorithms, advocating for implementation of strategies that improve patient care, and embracing the benefits they offer.
- Mooney KH, Beck SL, Wong B, et al. Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT. Cancer Med. 2017;6(3):537-546. doi: 10.1002/cam4.1002.
- Bourquard A, Pablo-Trinidad A, Butterworth I, et al. Non-invasive detection of severe neutropenia in chemotherapy patients by optical imaging of nailfold microcirculation. Scientific Reports. 2018;8(1):5301. doi: 10.1038/s41598-018-23591-0.
- Berry DL, Hong F, Halpenny B, et al. Decision support with the Personal Patient Profile-Prostate: a multicenter randomized trial. J Urol. 2018;199(1):89-97. doi: 0.1016/j.juro.2017.07.076.
- Berry DL, Blonquist TM, Nayak MM, Grenon N, Momani TG, McCleary NJ. Self-care support for patients with gastrointestinal cancer: iCancerHealth. Appl Clin Inform. 2018;9(4):833-340. doi: 10.1055/s-0038-1675810.