Web-based applications have invaded mainstream culture and grabbed the attention of multitudes of people around the world. According to a study presented at the 2016 ASCO Annual Meeting, an app may also contribute to extending the lives of people with cancer and, at the same time, reduce unnecessary utilization of resources.1
Use of a Web-based app prolonged survival in patients with advanced lung cancer who reported their symptom status electronically every week. At 1 year, 75% of patients were still alive in the app group vs 49% who received standard follow-up care.
Further, patients randomly assigned to the app group required 50% fewer scans and a reduced number of office visits compared with standard follow-up. Moreover, use of the app did not impose an extra time burden on oncologists.
‘New Era of Follow-up’
The app triggers access to care earlier, when patients are healthier and can derive greater benefit from care.— Fabrice Denis, MD, PhD
“If we had a drug that works this well, it would be practice-changing,” said lead author Fabrice Denis, MD, PhD, a researcher at the Institut Inter-regional de Cancérologie Jean Bernard in Le Mans, France.
“Through personalized follow-up, we can detect complications and signs of relapse and offer optimal care earlier. This approach introduces a new era of follow-up in which patients [and caregivers] can give and receive continuous feedback between visits to their oncologists,” Dr. Denis said.
The rationale for developing the app (called MoovCare) was that relapses do not occur during a planned visit to the doctor. According to Dr. Denis, relapsing patients often wait many weeks after symptoms emerge to go to the doctor, and this closes the window of opportunity to give treatment as early as possible when they are still feeling well enough to benefit.
The app can be used on a smartphone, tablet, or personal computer. MoovCare is a prototype in development and is not commercially available yet, Dr. Denis said. It has been assessed in two prospective trials, showing a sensitivity of 86% to 100%, he added.
The phase III multicenter randomized study was conducted at 5 centers and enrolled 133 patients with stage IIA (node-positive)/IV non–small cell or small cell lung cancer who had completed primary therapy with chemotherapy, radiation, or surgery. In each group, 4% of patients had stage IIA disease. They were randomly assigned to Web-mediated follow-up with the app or nonpersonalized standard follow-up consisting of visits to the oncologist and computed tomography (CT) scans every 3 to 6 months or more often, depending on the oncologist’s judgment.
Patients in the app group were assigned to the same number of oncologist visits but fewer scheduled scans (one scan/year in stage IIIB/IV patients). The app was used to report the status of 12 symptoms every week, including cough, asthenia, dyspnea, and anorexia, and caregivers were able to enter data for the patients if necessary. An algorithm assessed association and changes in symptom status and triggered e-mail alerts to the oncologist, who would then confirm the need for an exam to adjust cancer treatment and supportive care options.
The doctors reported that it took an average of 15 minutes of their time each week to follow 60 patients. That said, the app decreased the number of phone calls per patient to the office.
At 1 year, 75% of patients were alive in the app group vs 49% in the standard care group, for a significant absolute difference of 26% (P = .0025). At relapse, 77% in the app group had good performance status, enabling them to receive the full recommended treatment for recurrence, vs 33% in the standard care group (P < .001).
“The app triggers access to care earlier, when patients are healthier and can derive greater benefit from care…. There is a survival benefit from earlier detection, earlier supportive care, and earlier delivery of optimal care,” Dr. Denis stated. “This is high-level evidence for earlier personalized follow-up care,” he noted.
Dr. Denis and colleagues are also studying the app in lymphoma patients, now that CT scans are being used for that malignancy. ■
Disclosure: Dr. Denis has received travel support from Roche/Genentech.
1. Denis F, Lethrosne C, Pourel N, et al: Overall survival in patients with lung cancer using a web-application-guided follow-up compared to standard modalities: Results of a phase III randomized trial. 2016 ASCO Annual Meeting. Abstract LBA9006. Presented June 6, 2016.