| Abstract: |
iCARE aims at creating a technology-aided framework to enable a reliable implementation of cancer targeted therapy at home, addressing underlying challenges, and to make available the monitoring data to enable studies for therapy refinements and reduction of symptoms and side effects.The fight against metastatic cancer nowadays knows a new era with the introduction of new generation drugs designated to hit therapeutic targets expressed by the tumor cells, the so-called targeted therapy. Since tumour cells play a critical role in tumor growth and development of distant metastases, this kind of therapy achieves a greater anti-tumor specificity, with reduced toxicity w.r.t. traditional chemotherapy, and allows physicians to individualize the treatment according to the biological characteristics of the tumor. Targeted therapies quickly became the preferred choice of most physicians and patients, due to the significant measured benefits they provide in terms of therapy’s effectiveness
and survival rate, and to the great improvement of the quality of life of patients, thanks to home treatment.
Due to the lack of reliable statistics, being these drugs introduced quite recently, symptoms and duration of side effects are highly varying and still not fully predictable. The management of these side effects and symptoms related to both the treatment and the disease in non-traditional settings, i.e. at home, relying on the patient’s selfadministration without supervision, may affect patient’s adherence. Therefore, it is mandatory to implement protocols to monitor compliance, side effects and treatment or disease related symptoms. The assessment of adherence is nowadays made by obtaining prescription refill histories and performing pill counts; compliance is promoted by counseling patients, asking patients to keep a diary of doses and side effects, and following up with patients at clinic visits or through telephone contacts. To date, side effects of treatments and symptoms of patients treated at home are evaluated at hospital in an outpatient or ambulatory basis. This approach has several
drawbacks: mostly, this evaluation it is not timely and reliable in many cases, because it is based on data reported by the patient and/or caregivers periodically, once per month, typically. The ICT technologies may offer methods to evaluate patients treated at home timely, with more objective and validated instruments. Few studies evaluated the positive impact of new technologies to measure and rapidly manage chemotherapy side effects.
iCARE will propose new organizational models to strengthen the cooperation and interaction between health professionals, social carers, informal caregivers and patients to support new patient pathways emerging from the increased application of cancer targeted therapies at home. The complexity of the management of side effects of oral chemotherapy drugs in non-conventional settings (i.e., at home) is mainly due to the drugs specificity, to the administration mode, and to the difficulty of the patient to correlate temporally the assumption of the drug with the onset of side effects, which may lead to poor adherence to therapy. The necessity of guaranteeing the adherence to the therapy and providing the close monitoring of possible toxicity stems from the fact that while the possible toxicity of conventional chemotherapies can be predicted, within certain limits, those of new therapies based on biological target are not yet known, especially over the long-term, and are much more
variable. According to expert opinion, the type of activity carried out within the existing structures of dayhospital is not sufficient to control the above criticalities, due to the turnover of patients and the distribution of workloads to the medical staff. Thus, the development of new patient pathways is required to respond adequately to the expected increase of the number of patients in treatment with target therapies in the future, as well as new organizational models to improve the coordination of care services. Home cancer targeted therapies treatments will be enabled only if new models for cooperation and interaction between health professionals, social carers, informal caregivers and patients will be provided. Starting from Weaver’s research, the ICT technologies seem to offer methods to evaluate patients treated at home timely and with more objective and validated instruments.
iCARE project aims at developing a new cost-effective mobile system for home monitoring of patients in treatment with oral drugs. The key device is the medical smart box. It will be designed and prototyped within the project to constantly monitor the compliance to the therapy and will be interfaced to the patient’s smartphone and smart gear. Authentication procedures will ensure the correct monitoring of patient’s compliance. The patient’s smartphone establishes a connection to the medical unit periodically, to record relevant data about compliance and side effects. Feedbacks from the patients about side effects will be collected by means of daily questionnaires that the patient will fill in through the smartphone’s novel APP, specifically designed according to the relevant cancer medical protocols. A Server with web interface will host the database of gathered data. A Notification System will prevent the non-compliant behaviors, sending alarms to the patients and the
oncologists. Personalization of care management and a timely evaluation of side-effects of treatment and disease-related symptoms will be constantly provided through the comparison between relevant feedbacks of patients, i.e. the daily questionnaires, and data from face-to-face periodical meetings. Relevant data will be collected for further analysis by the Clinical Collection Interface. |