1531P - Detection of health-related warning signals through daily telemonitoring of cancer patients on multidrug chemotherapy at home (European Project inC...

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Supportive Care
Presenter Alexandre Arbaud
Citation Annals of Oncology (2014) 25 (suppl_4): iv517-iv541. 10.1093/annonc/mdu356
Authors A. Arbaud1, P. Innominato2, A. Mohammad-Djafari3, A. Ulusakarya2, R. Bossevot-Desmaris4, V. Plessis4, M. Mocquery4, D. Bouchoucha4, J. Beau1, M. Bouchahda2, A. Karaboue2, J. Morère4, J. Fursse5, M. Caprino6, F. Levi2
  • 1Rythmes Biologiques Et Cancers, INSERM U776, 94800 - VILLEJUIF/FR
  • 2Medical Oncology, INSERM U776 AND PAUL BROUSSE HOSPITAL, 94800 - VILLEJUIF/FR
  • 3Laboratoire Des Signaux & SystÈmes, CNRS Unité mixte de recherche 08506, 91192 - GIF-SUR-YVETTE/FR
  • 4Medical Oncology, Chronotherapy Unit, PAUL BROUSSE HOSPITAL, 94800 - VILLEJUIF/FR
  • 5Chc, Chorleywood Health Centre, WD35EA - Chorleywood/GB
  • 6Reply, Santer Reply, 10147 - Torino/IT

Abstract

Aim

Chemotherapy can be safely administered at home through chronomodulated delivery over the 24 hours via a programmable pump, with improved tolerability and efficacy (Lévi F, Annu Rev Pharm Toxicol 2010). The purpose of the study was to further increment safety through the detection of early warning signals predicting for hospitalization through daily telemonitoring of multidimensional objective and subjective data.

Methods

Telemonitoring involved daily self-assessment of body weight, symptoms (M.D. Anderson Symptom Inventory, MDASI), and recording of circadian rest-activity rhythm through a wrist accelerometer (AMI). Data were received in a server, and visualized daily by the medical/nursing staff using a web app. Alarm thresholds were adjusted according to body weight loss, weighted MDASI symptoms according to sparse linear discriminant analysis SLDA, and dichotomy index I

Results

37 patients (Male/Female, 57% / 43%), aged 35-91 years were followed for a median duration of 63 (34-246) days from October 2011 to August 2013. The majority of patients had been previously treated for metastatic cancer of the colon (43%), pancreas (26%) or breast (13%). Out of 98 chrono-chemotherapy courses at home (1-16 per patient; chronoFOLFIRINOX for 46% patients), 12 led to emergency hospitalizations in 6/37 patients (16%). Hospitalizations lasted a cumulated span of 72 days (2-9 per patient) among 2330 patient-days on study (3.1%). Retrospective analysis identified 3 relevant alerts within the 7 days before hospitalization: body weight loss ≥5%; I4. The combination of circadian disruption and high weighted MDASI score predicted hospitalization for 4/6 patients (67%) and occurred in 0/31 non-hospitalized patients (Fisher's exact test p < 0.003).

Conclusions

Multidimensional telemonitoring of circadian rest-activity rhythm and weighted symptoms provided effective detection of risk for emergency hospitalization in patients on chronomodulated chemotherapy at home. These biomarkers are integrated for validation in a multicenter patient-centered prospective assessment of domomedicine (PiCADo).

Disclosure

All authors have declared no conflicts of interest.