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Electronic malignant bowel obstruction symptom monitoring smartphone application for patients with gynecologic cancers
  1. Ainhoa Madariaga1,2,
  2. Nazlin Jivraj1,
  3. Pamela Soberanis Pina1,
  4. Faiza Somji3,
  5. Tran Truong3,
  6. Sheena Melwani3,
  7. Mike Lovas3,
  8. Terri-Ann Gogos4,
  9. Katrina Sajewycz5,
  10. Gita Bhat1,
  11. Husam Alqaisi1,
  12. Eduardo Gonzalez-Ochoa1,
  13. Ana Veneziani1,
  14. Vikas Garg1,
  15. Neesha C Dhani1,
  16. Robert Grant1,
  17. Valerie Bowering1,
  18. Amit M Oza1,
  19. Lisa Wang6,
  20. Alejandro Berlin3,7 and
  21. Stephanie Lheureux1
    1. 1Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
    2. 2Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
    3. 3Cancer Digital Intelligence, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
    4. 4Patient Advocate, Toronto, Ontario, Canada
    5. 5Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    6. 6Department of Biostatistics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
    7. 7Radiation Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
    1. Correspondence to Dr Stephanie Lheureux, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2C4, Canada; Stephanie.Lheureux{at}uhn.ca

    Abstract

    Objectives Implementation of an interprofessional program at Princess Margaret Cancer Centre, including nurse-led proactive calls to support patients with gynecologic cancers with malignant bowel obstruction, demonstrated improved outcomes compared with historical controls. The aim of the study was to convert the proactive calls into an electronic monitoring program to assess it’s feasibility and scalability in patients with gynecologic cancers with or at risk of malignant bowel obstruction.

    Methods ‘My Bowels on Track’ smartphone application included weekly/biweekly electronic patient-reported outcomes (PROs), educational materials, and a secure messaging system. Based on PRO answers, an alerting system flagged patients with symptoms or uncompleted PROs. Nurses tracked and called patients on receiving clinical or compliance alerts. The primary objective was to assess adherence (≥70% PRO completion per patient considered an adherent patient) in the first 2 months on the program. A secondary objective was to assess the positive predictive value (PPV) of the alerts to trigger recommendations.

    Results Forty patients were enrolled between August 2021 and September 2022. Median age was 64.5 years (range 29–79 years). Primary diagnosis was ovarian (75%), endometrial (17.5%), or cervical (7.5%) cancer, and 92.5% of patients were receiving systemic therapy. Median duration on the program was 55 days (range 8–121 days). The 2-month adherence was 65% (95% CI 50% to 80%) and the overall adherence was 60% (95% CI 43% to 75%). Sixty-five symptom-related alerts (75% severe, 25% moderate) were reported in 60% (24/40) of patients. There were 59 recommendations triggered by the alerts. The PPV of the alerts to trigger actions was 72% (95% CI 58% to 82%).

    Conclusions This pilot electronic malignant bowel obstruction monitoring program with real-time PRO assessment was feasible, and 65% of participants were adherent during the first 2 months on the program. The PRO response-based alerting system flagged concerning symptoms in 60% of participants, with a PPV of 72% to trigger nurse-led actions and/or management recommendations.

    Trial Registration Number NCT03260647.

    • Ovarian Cancer
    • Uterine Cancer
    • Cervical Cancer
    • Palliative Care
    • Quality of Life

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @AinhoaMada, @lalo_glez8a, @stephanielheur5

    • AM and NJ contributed equally.

    • Presented at The study findings were presented at the European Society of Medical Oncology (ESMO) annual meeting in October 2023.

    • Contributors Conceptualization: AM, NJ, FS, SM, ML, AB, SL. Methodology: AM, NJ, FS, SM, ML, AB, SL. Data curation: AM, NJ, PS-P, FS, TT, SM, ML, AB, SL. Formal analysis: AM, NJ, PS-P, FS, TT, LW. Writing – original draft: AM, NJ, PS-P. Writing – review and editing: all authors. Resources: all authors. Supervision: AMO, AB, SL. Guarantor: AM, SL.

    • Disclaimer AM declares honoraria from AstraZeneca, MSD, GSK, Clovis. and PharmaMar. RCG received a graduate scholarship from Pfizer and provided consulting or advisory roles for AstraZeneca, Tempus, Eisai, Incyte, Knight Therapeutics, Guardant Health, and Ipsen. AMO declared participation in advisory or monitoring boards of AstraZeneca and Morphosys. He declared an uncompensated advisory role with AstraZeneca, GSK, Clovis (ended 2023). SL declared consulting fees from AstraZeneca, GSK, Merck, Eisai, Roche, Schrodinger, and Seagen. She declared honoraria from GSK, AstraZeneca, Roche, Eisai, and Merck; and research grants from GSK, AstraZeneca, Roche, Merck, and Repare Therapeutics. The remaining authors declare no other competing interests. The remaining authors have no conflicts of interest to disclose.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.