Comparing Radiation and Systemic Therapy Patients’ Longitudinal Satisfaction of a Cloud-Based Bidirectional App Used for Real-Time Communication of Patient-Reported Cancer Treatment Symptoms

Abstract

Purpose/Objective(s)

A cloud-based bidirectional app (ePRO) communicating real-time patient-reported cancer treatment symptom(s) and clinical care team (CCT) recommendation(s) can lessen treatment burden. However, symptoms manifest differently for radiation therapy (RT) and systemic therapies (ST) and CCTs require one solution to be effective for both groups across time. This study tests whether there is a longitudinal difference in app satisfaction scores, a proxy for overall app utility, between these two groups.

Materials/Methods

The study focuses on a subgroup of Noona users who have reported app satisfaction 2 or more times (n = 7,202). They, and all other patients, have access to three primary features. In the first, the CCT uses the software to administer CTCAE-derived items at a cadence based on the treatment regimen (e.g., weekly for radiation therapy). Patients can also complete it ad hoc. When patients report moderate or severe symptoms, they receive programmed recommendations and the software triages patient in order of urgency on a clinic-facing dashboard so that a team member can efficiently follow-up with additional questions or instructions. The app also includes a diary patients can use to record any personal information, as well as a secure communication feature which facilitates exchange of additional medical and non-medical information with the CCT. Data used for this study include passively collected, anonymized information and a patient satisfaction item that randomly asked those with active accounts > 30 days, “How likely are you to recommend (software name) to another patient” using an 11-point scale. Data are reported descriptively and analyzed using a linear mixed model with patient as a random effect and repeated measurements with an autoregressive covariance structure.

Results

Most patients were from the United States (n = 4,941; 12 sites), followed by Canada (n = 1,700; 4 sites) and Europe (n = 561; sites = 5). The mean age was 61.7 (SD = 11.8). Most were English speakers (n = 6,794; 94.3%), used a smartphone (n = 5,480; 76.1%), and were, based on the module they were assigned, receiving systemic therapy (n = 6,468; 89.8%). The mean number of times a patient reported app satisfaction was 3.1 (SD = 1.6; range = 2-13). The mean of the patients’ first satisfaction score was 8.5 (SD = 2.5) and 5,704 (79.2%) rated the app ≥ 8. The satisfaction level was generally maintained across subsequent ratings. The regression model found that satisfaction levels for patients receiving radiation did not significantly differ (B = 0.205; P = 0.835) from those receiving systemic therapy after adjusting for the other 5 variables indicating that, over time, patients regardless of the treatment reported similar app satisfaction scores.

Conclusion

A single solution for cancer patients was highly rated by patients regardless of treatment and suggests that ePRO use helps address a critical, unmet need throughout their cancer journey.