Prevention of Chronic Diseases and Age-Related Disability by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783319965291
Publisher: Springer International Publishing

Fig. 10.2Decision tree of the web-mediated follow-up

For the first time in medicine, the primary endpoint of a e-health study was overall survival. From June 2014 to January 2016, 133 patients were enrolled. The median overall survival was 19 months in the experimental and 12 months in the control arm (p = 0.0014), with a hazard ratio equal to 0.325 (95% CI, 0.157–0.672; p = 0.0025) (Fig. 10.3). The Independent Data Monitoring Committee recommended to halt the study after the planned interim survival analysis. The performance status at first detected relapse was 0–1 for 77% of the patients in the experimental arm and for 33% of those in the control arm (p = 0.0006). Optimal treatment was initiated in 74% of the patients in the experimental arm and in 33% of those in the control arm (p = 0.0008). Six-month quality of life was also significantly better in experimental arm than in control arm. In both arms, 89% of the relapses were symptomatic. The relapse rate was 51% in the control arm and 49% in the experimental arm and the progression-free survivals were not significantly different between the two arms. The rate of imaging was reduced by 49%/patient/year compared to the control arm. In the experimental arm, 74% of the first relapses were detected between scheduled visits while only 33% of first relapses in the control arm were detected between visits (p = 0.0007). The mean duration weekly spent by the oncologist to manage all the web-alerts was 15 min for 60 simultaneous users. These results were in line with previous work utilizing electronic health initiatives. Bakitas et al. observed a greater by 15% 1-year survival improvement in cancer patients using a tele-health (phone call) follow-up right after enrollment compared to those who started the tele-health program 3 months later [12]. This study was conducted in a population with various types of cancer (lung, breast, gastrointestinal, etc.) and varying stage. Survival was not their primary outcome. A second report by Basch et al. noted an increase from 6 to 14% in the survival in 766 patients receiving chemotherapy whose symptoms were monitored via tablet computer [13]. However, this study was monocentric, in a population with various types of cancer at any stage again with survival as a secondary outcome. Moreover, the web-application allowed for monitoring the supportive care efficacy by visualization of the symptom evolution through a novel graphic This may explain the significantly higher quality of life of patients in the experimental arm at 6 months. Better quality of life could favor better survival: early management of physical and depressive symptoms as well as iatrogenic events may delay patient degradation, while these symptoms may be not necessarily managed as quickly with routine follow-up. Moreover, lung cancer patients are often reticent about contacting their health care providers.

Fig. 10.3Kaplan–Meier estimates for the survival between the initiation and the end of the trial corresponding to the planned interim analysis in Moovcare™ randomized trial [11]

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