A Review of Digital Innovations in Cancer Treatment: A Recap from ESMO 2021

A Review of Digital Innovations Emerging in Oncology

In this session on “Digital Innovations in Health,” presenters navigated a variety of tools and digital developments that are shaping the field of oncology.

To begin, Dr. Androniki Ioannou, an oncologist at the University of Cyprus, demonstrated how virtual reality can facilitate the navigation of patients through active treatment.

Dr. Ioannou explained that standard treatment of cancer, typically chemotherapy, has many negative side effects, including fatigue, nausea-vomiting, pain, feeling sick, and mood disturbances, but that virtual reality may be the solution that we’ve been looking for.

She demonstrated this through a study aiming to test whether virtual reality is effective in reducing mood changes, improving nausea, pain, and feeling sick, and maintaining normal biophysical parameters in cancer patients compared to when they experience a GI, or guided imagery, intervention during chemotherapy treatment.

To conclude, Dr. Ioannou took a look at the results of the trial, which showed that virtual reality was able to alleviate chemotherapy-related psychological distress and POMS sub-scales. From a biophysical perspective, she found that patients saw a reduction in blood pressure and heart rate and a decrease in anxiety and pain. Patients also saw minor improvements in nausea, pain, and feeling sick.

According to Dr. Ioannou, these results have proven that virtual reality is an effective non-pharmacological adjunct to promote positive mood and relaxation and can be an added benefit in the clinical setting.

Following Dr. Ioannou, Dr. Roma Maguire, a Professor of Digital Health and Care at the University of Strathclyde, shared the results of the eSMART project: a European, multicenter, randomized controlled trial using real-time remote symptom monitoring of patients with cancer receiving chemotherapy.

Dr. Maguire began by explaining how poorly controlled and undertreated chemotherapy-related symptoms can lead to impaired quality of life, and that current mechanisms of symptom management rely too heavily on patients self-reporting and recognizing their own symptoms.

The solution–according to Dr. Maguire—is “connected health,” or the use of remote monitoring systems to provide real-time, rapid insights rather than retrospective assessment. This solution also allows for a daily assessment of symptoms.

She aimed to demonstrate this in the eSMART study, to evaluate the effects of remote monitoring of adjuvant chemotherapy-related side effects via ASyMS, a mobile advanced symptom management system.

After reviewing the results of the study, Dr. Maguire concluded with these final takeaways:

• The results of eSmart suggest that ASyMS is an effective intervention for reducing symptom burden and improving health-related quality of life during adjuvant chemotherapy across a range of cancer
• The use of ASyMS was associated with a significant reduction in anxiety and improvements in several supportive cancer needs and self-efficacy domains
• The study’s success with implementing the ASyMS across several diverse health systems suggests that the system can be easily scaled up and adapted for use in the various international systems

Then, Andre Lopes, Ph.D. candidate at the University of Lausanne, showcased the development of an ePRO-based model of care for patients treated with immune-checkpoint inhibitors.

Lopes highlighted the need for this type of technology due to some of the immune-related adverse events of immune-checkpoint inhibitors. These side effects can be heterogeneous and involve any organ, can be very frequent and can be long-lasting and difficult to anticipate.

According to Lopes, implementing an electronic device to monitor patient-reported outcomes and to help manage adverse events can improve symptom interference and health-related quality of life, and can improve patient participation in the healthcare process, access to supportive care, patient satisfaction, and intervention efficacy.

Lopes then walked used through the five pillars of immune-checkpoint inhibitor toxicity management, which included:

• Monitor – Keep kinetic resolution, relapse, recurrence, and immunosuppression in mind
• Prevent – Know the immunitary toxicity spectrum, identify risk factors for dysimmune toxicities, and inform and educate patients, families, and healthcare providers
• Anticipate – Provide baseline checkups, follow-up during treatment, and follow-up outside of treatment
• Detect – Identify baseline values and reference values, limit progression, and always consider dysimmune toxicities
• Treat – Treat symptoms, inform and educate patients, and discuss treatment and follow-up options

Lopes expects that the ePRO technology will lead to benefits in the areas of cancer research, clinical practice, and nursing education.

Continuing on the theme of digital innovations in nursing education, Dr. Adeline Duflot Boukobza then investigated the optimization of remote monitoring by Nurse Navigators, or NNs. She walked us through the CAPRI trial, a random phase 3 trial exploring the impact of an intervention combining NNs and a mobile application.

The primary endpoints were achieved, and the patient experience was improved with the combination of NN and mobile app intervention.

Based on the clinical trial results, Boukobza found that NN’s activities combine clinical and organizational activities, and in collaboration with the oncologist, NNs can have a greater impact on intervention and care beyond the standard applications of care. NNs are autonomous, and the implementation of new procedures can help limit requests for treating oncologists and empower NNs.

And finally, Dr. Jayesh Desai, a Medical Oncologist at the Royal Melbourne Hospital, demonstrated the use of ROPRO, or real-world data prognostic score, to address patient performance status.

Prognostic scores can help with patient satisfaction and enrichment strategies, and artificial intelligence may lead to an improvement in prognostic scores.

The ROPRO combines 27 different collected parameters (lifestyle, host, and tumor-specific), and combines them into one score to supplement different levels of risk and improve prediction of survival and overall survival. ROPRO can be used in two settings for clinical decision making:

• Baseline ROPRO can be used for patient selection by providing quantitative and unbiased decision support to investigators to determine 12-week life expectancy
• Longitudinal ROPRO analysis can help clinicians detect treatment benefits or progression early

With the inclusion of this new technology, Dr. Desai concluded by saying that clinicians can improve the selection of candidates for phase I trials and improve prediction of treatment effects allowing for earlier clinical decision-making.

These digital innovations have transformed the treatment landscape for oncology, but several challenges remain. However, with continued research and efforts, the development of these new technologies will lead to improved clinical results and patient outcomes.