Assessing the Value of Digital Health Technology in Cancer Care

The increased availability of wearable technologies has enabled patients to track and report their health outcomes, and, in ­theory, has helped healthcare providers manage their patients’ symptoms and utilize resources more effectively.

However, according to Doris Howell, RN, PhD, Senior Scientist, Princess Margaret Cancer Centre, University of Toronto, Canada, the ultimate measure of the value of digital health technology is whether it can be widely implemented into clinical practice and the everyday lives of patients.

At the Association of Community Cancer Centers 45th Annual Meeting and Cancer Center Business Summit, a panel of experts discussed the intersection of digital health, technology, and value, and educated providers on harnessing the power of digital health and informatics to improve the lives of patients.

A New Era of Care

According to Adam P. Dicker, MD, PhD, FASTRO, Professor, Senior Vice President and Chair, Enterprise Radiation Oncology, Professor of Radiation Oncology, Pharmacology, & Experimental Therapeutics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, the current healthcare landscape is reactive. Patients seek out healthcare services when they are feeling ill, they sort through different care options, and data are then captured to confirm a diagnosis.

However, a predictive environment better serves patients and providers. In this type of environment, he explained, data on a patient are captured via medical-grade wearable technology. This gives providers access to a historical data set of relevant biomarkers and genetic predispositions, which enables them to reach out to patients if there is an anomaly.

“That is really the aspiration,” said Dr Dicker. “To combine medical grade wearable technology and predictive diagnostics.”

The convergence of human and artificial intelligence (AI) in the field of medicine is an explosive area of research, facilitated in part by the fact that the US Food and Drug Administration recently published a fast-track approval plan for AI medical algorithms.

The expanding digital health landscape includes products such as fitness trackers, medication adherence apps, electronic medical record systems, biometric sensors, remote patient monitoring, and telemedicine virtual visits.

“It’s not the Apple watch that’s FDA approved as a class 2 medical device; it’s the algorithm in the watch,” he noted. “And this is undoubtedly going to have an impact on oncology.”

However, the jury is still out as to whether the use of these technologies provides value, he noted, and healthcare training silos present challenges to the utilization of these types of technologies.

In response to this issue, Dr Dicker and his colleagues have introduced coursework through the Jefferson Center for Digital Health that allows healthcare providers to become cross-trained in various aspects of digital health.

“I think everyone needs to know the basics of AI, and for those healthcare providers or administrators who want to learn more, there are more advanced courses,” he said.

His team also introduced a digital health course for medical students. “We give them activity trackers, we aggregate the data, and we show them how to analyze it,” he explained. “It’s been really profound in terms of opening their eyes to what you can do with some of this technology.”

According to Dr Dicker, digitalization in healthcare should not detract from the empathy that is nec­essary in oncology, but should ultimately serve to provide better patient care by making healthcare operations more efficient.

“The goal for much of this technology is to better utilize resources so we can spend more time with patients,” he said.

Integrating Remote Symptom Monitoring Into “Real World” Care

Treatments for cancer are becoming more complex, which can lead to significant treatment-related toxicities. Patients are often expected to manage these adverse effects in their home environment with very little support or education.

According to Dr Howell, the use of digital technologies, and more specifically, remote monitoring, has become the “Holy Grail” solution for achieving the goals of the Institute for Healthcare Improvement’s Triple Aim. Although the literature has shown that remote symptom monitoring leads to improvements in patient experience, symptom severity, and quality of life, adoption in the real world remains a problem.

This can be partially attributed to the fact that digital healthcare technologies have disrupted the routinized models of care and delivery. This calls attention to the importance of high-quality implementation science when introducing these technologies to a team, with the goal of technology adoption to the extent that it is actually used in patient management, Dr Howell stressed.

“We sometimes think that if we implement remote monitoring technology, somehow patients and practices will do something different and these things will translate into better health outcomes,” she said. “But, these things need management, they need facilitation, and they need really good implementation science in order to translate the knowledge we have into better practice.”

Sweating the “Small Stuff”

Facilitating uptake of these technologies requires strategic alignment and a collaborative effort on the part of the entire healthcare team, including input from patients. “At the end of the day, it’s patients who shoulder the responsibility of symptom management,” Dr Howell noted.

For example, when should an alert regarding an adverse event be handled by a nurse, and when should it be escalated to the oncologist? When a call is made to the patient regarding an alert, is it a meaningful interaction?

Team members should also be on the same page regarding the types of patient-reported outcomes being collected: are they disease-specific, toxicity-specific, or generic to allow for comparison across populations?

At the same time, providers must also consider the patient’s perspective. Patients may already be feeling overwhelmed by their cancer treatment. How will they respond when they are asked to track and report on their symptoms every day? How will they integrate these devices into their daily lives? Consider the personal agency and motivation of the patient, and how this will align with his or her personal values and concerns about privacy, Dr Howell said.

The tool itself should also be considered. Is it health literate? Does it provide actionable information to engage the patient in self-management?

“We’ve actually found that very simple devices work really well with most of our patients, because they address the issues of health literacy as well as some of the issues of social determinants of health,” Dr Howell noted.

She warned of potential bias and ageism when it comes to digital devices, noting that providers at Princess Margaret Cancer Centre found higher rates of adherence among older patients. “We actually found it’s our younger patients who don’t engage as well because they’re so busy,” she said.

According to Dr Howell, digital technology should ultimately address the human side of cancer if it is to be deemed valuable. It should help patients to recover from acute cancer, to live well with chronic disease, and to face the end of life with dignity.

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