Annual Meeting Proceedings Part 1 - American Society of Clinical ...

TPS9154 General Poster Session (Board #52D), Sat, 8:00 AM-12:00 PM
The European InCASA telecare-telehealth electronic platform (ICT-FP7) for
the daily assessment of symptoms, weight, and activity in cancer patients
on chronotherapy at home. Presenting Author: Francis Levi, INSERM
U776, Paul Brousse Hospital, Villejuif, France
Background: Self-rated symptoms contribute to the Quality of Life (QoL) of
cancer patients (pts) and impact on prognosis. Behavioural functions are
controlled by the circadian timing system (CTS), through a network of
molecular clocks that time cellular proliferation and drug metabolism (Lévi
et al. ARPT 2010). Chronotherapy aims at the reduction of treatmentrelated
symptoms through the adjustment of chemotherapy delivery to the
CTS. Cancer chronotherapy is delivered at home using programmable
pumps, and avoids familial and social disruption. Telemedicine tools can
provide continuous information on symptoms, behavior, QoL and CTS from
non hospitalized pts. Methods: The inCASA platform enables telemonitoring
of multiple functions in order to help physicians to detect early warning
signals in pt condition at home, and prompt adequate and timely interventions.
Our pilot site investigates the clinical relevance of daily teletransmitted
self assessed symptoms, body weight and rest-activity circadian rhythm
in cancer pts. This system was first well understood and accepted by 14 pts
(9 male, 5 female, 43-77 years) at the outpt clinic, then used by 5 pts (4
male, 1 female, 61�13 years) at home daily for 6� weeks, while receiving
chronotherapy. The pilot phase will accrue 30 pts receiving chronotherapy
at home from 03/01/2012. Pts will fill in the M.D. Anderson Symptom
Inventory scale on a touch-screen device, measure their body weight using
a Bluetooth scale and record their circadian rest-activity rhythm using an
infrared wrist-watch accelerometer over 6-weeks. The data are transmitted
to the platform, then to a web portal with secured access to be daily
inspected by the oncology nursing and medical team. The modelling of
these continuous records will define alert thresholds for nurse-controlled
graded intervention decisions. Conclusion: The assessment criteria set
forth for the inCASA solution will address the issues of pt autonomy, CTS
entrainment in the pt usual environment, safety of chronotherapy delivery
at home and treatment costs. Its use should induce important organisational
changes and perception in healthcare professionals.
Patient and Survivor Care
605s
TPS9155 General Poster Session (Board #52E), Sat, 8:00 AM-12:00 PM
Assessing clinical appropriateness on a population basis within a regional
cancer network. Presenting Author: Paolo Giovanni Casali, Fondazione
IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Background: The Lombardia Cancer Network (ROL: “Rete Oncologica
Lombarda”) connects all cancer resources of the Lombardia region, with
9,000,000-plus citizens, to improve quality of cancer care and patient
data sharing. Assessment of appropriateness of cancer care on a population
basis is an aim. Implementation of electronic records is partial and
heterogeneous. However, clinical discharge reports for both inpatients and
oupatients are released as “pdf” files onto a secure regional health care
information system, accessible by physicians. Methods: ROL includes 58
oncology premises. Clinical practice guidelines are annually updated
within this oncology community. For each solid cancer, guidelines enlist all
main clinical presentations (“disease phases”), along with their “treatment
options” (either “standard”, “individualized”, or “investigational”). ROL
upgraded the existing non-structured electronic clinical discharge report
into a field-based resource, with both free-text (17) and codified (25) fields.
Two codified fields enlist, respectively, disease phases as per guidelines,
and the corresponding treatment options. If they match, the strategic
medical decision is considered tentatively “appropriate”. Even the report of
a single encounter within a disease phase is enough to make this work.
Results: Currently, the instrument is being incorporated stepwisely within
the information systems of all oncology facilities, though a central
web-based tool is also available. More than 36,000 reports were released in
2011. Appropriateness assessment proved feasible on a pilot set of
patients. A research project is underway to detect causes of mistakes and
mismatches, by automatically analyzing free-text fields. A training effort is
ongoing to improve clinicians’ learning curve on semantics. Conclusions:
To assess clinical appropriateness on a population basis in a large region,
we exploited two key bottlenecks: 1) the electronic discharge report, within
patient information flows, to cope with a variety of local information
systems; 2) the disease phase, within the cancer-specific clinical decisionmaking
process, to cope with a likely lack of reports from a substantial
proportion of encounters.
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