Article Text
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.
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.
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