AMTRA: a multicentered experience of a web-based monitoring and tailored toxicity management system for cancer patients

• Published in: Supportive care in cancer Vol. 29; no. 2; pp. 859 - 867
• Main Authors: Rasschaert, Marika, Vulsteke, Christof, De Keersmaeker, Sven, Vandenborne, Kathleen, Dias, Stefanie, Verschaeve, Vincent, Vuylsteke, Peter, Brussel, Ilse Van, Ravelingien, Jo, Dam, Peter Van, Segelov, Eva, Peeters, Marc
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2021; Springer; Springer Nature B.V
• Subjects: Adult; Biometry; Cancer; Cancer patients; Cancer therapies; Care and treatment; Chemotherapy; Cohort Studies; Cytotoxicity; Drug Monitoring - methods; Health aspects; Humans; Internet; Male; Medication Therapy Management; Medicine; Medicine & Public Health; Middle Aged; Monitoring systems; Monitoring, Ambulatory - methods; Neoplasms - drug therapy; Nurses; Nursing; Nursing Research; Oncology; Original Article; Pain; Pain Medicine; Patient Reported Outcome Measures; Prospective Studies; Rehabilitation Medicine; Self Report; Self-Management; Telemedicine; Transmural care; Toxicity self-management; Patient-reported outcome (PRO); Toxicity self-assessment; Cancer
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-020-05550-6

Background Technology-based interventions are increasingly being introduced in routine clinical cancer care. There is a need for reliable systems to monitor treatment-related toxicity in a standardized manner. Such electronic tools bridge the gap in providing quality home-based monitoring. Methods From July 2017 to December 2017, we performed a multicentered, non-randomized prospective cohort analysis with patients who were receiving routine chemotherapy for various solid tumors, using a web-based patient-reported toxicity registration, management, and intervention system called AMTRA (ambulatory Monitoring of cancer Therapy using an interactive Application) linked to the homecare nursing organization Remedus®. Twelve common toxicities plus pain and two biometrics could be registered daily or more frequently as required. These were processed centrally to generate tailored advice for lesser symptoms or a phone call from a dedicated nurse in case of severe or prolonged toxicity. A compliance tool to monitor oral therapies was incorporated in the system. Results One hundred sixty-eight patients (92%) were enrolled, with 31,514 registrations analyzed. One hundred eight patients reported severe toxicity (> 1461 registrations), resulting in 102 clinical interventions ranging from self-management advice, supplemental consultations to hospitalizations. Compliance to oral chemotherapy was high using AMTRA with a median of 98.7% (95 confidence interval (CI) [93.5–100.0%]). Seventy-nine percent of patients stated that the availability of AMTRA self-reports was useful in communication with the care provider, while 75% felt more in control while managing their treatment. Conclusions The application of an interactive PRO-system in routine symptom management of cancer patients allowed standardized documentation of toxicities and recorded a high compliance with oral treatment. It allows for rapid interaction for toxicities and cancer-related symptoms experienced at home.