Jeffrey M. Friedman, MD, PhD
Head and neck cancer patients develop severe, debilitating symptoms during radiation therapy. Ecological momentary assessment (EMA) of patient-reported outcome measures (PROMs), such as pain, may improve provider awareness of morbidity and improve patient engagement and satisfaction in their care. We demonstrated the feasibility of an application (app) for Android and iOS named PrimeMD for four-times-daily monitoring of pain and severe symptoms in head and neck cancer patients.
Patients undergoing radiation therapy for head and neck cancer that owned and could use a smartphone were recruited from 1 academic medical center. Patient demographics were measured at enrollment. Patients entered pain ratings, use of pain medications, and the presence of severe symptoms for the duration of their radiation treatments. At the conclusion of radiotherapy patients gave an exit interview.
24 patients used the app. Mean age was 59; 46% were female, 92% identified as Caucasian. Forty-two percent had oropharyngeal disease, and all were lymph node positive. Median number of radiation fractions was 33 (range 25-35) with median dose of 6461 cGy; median treatment time 45 days (range 35-50). Median days of at least one use of the app was 12.5 (range 4-45). At the exit interview patients’ median satisfaction was 9/10 and usability was rated at 9.5/10.
Patients experiencing pain and severe symptoms from radiotherapy are able to use a smartphone app for real-time monitoring. Adherence may be improved by adjusting alarms to patient preferences and enabling two-way communication with providers.
Head and neck cancer is the sixth-most common cancer worldwide; there is a male preponderance and the median age of diagnosis is in the early 1960s.1
Patients undergoing definitive radiation treatment for locally-advanced head and neck cancer develop severe symptoms during the first 4 weeks of treatment. Radiation mucositis is a debilitating symptom of radiation treatment and affects about 80% of patients; sufferers may become unable to eat within days.2-4
Approximately half of patients eventually need feeding tube placement to maintain adequate nutrition, and some require hospitalization for supportive care.2,5
Patients are typically assessed by physicians once every 5 fractions while undergoing daily radiation treatment, sometimes allowing their pain to be untreated between assessments. Mobile smartphone or web-based remote monitoring, whereby patients use an application (app) on their personal devices at predetermined or self-selected intervals to report their symptoms, is a potential solution to improve patient engagement.6
The use of such patient-reported outcome monitoring (PROM) systems has been associated with improved symptom control and better engagement with care teams.7
One recent randomized control trial that monitored chemotherapy patients’ symptoms in-office as well as via weekly home emails reported improved health-related quality of life as well as fewer emergency department admissions and a longer duration of chemotherapy.8