Passive Data to Improve Outcomes in Advanced Cancer

项目总结 晚期癌症患者会出现令人痛苦和虚弱的症状，这些症状往往得不到充分治疗。 此外，患者和护理人员经常被期望在家中管理复杂的副作用，而不是 随时获得实时支持，并使用急诊科管理控制不佳的症状， 冒着漫长的等待时间接受可能在门诊环境下提供更舒适的治疗。 虽然及时发现和处理症状可以改善患者的生活质量，功能状态， 在医疗保健使用和疾病相关结果方面，远程症状监测很少在肿瘤学中使用。 该项目的长期目标是改善晚期癌症患者的症状负担、身体状况 功能和存活率，同时通过使用智能手机检测急性临床来减少繁重的急诊就诊 癌症患者的病情恶化，而不需要他们的积极参与。智能手机是可扩展的理想选择 用于长期、远程监控的技术，因为它们可以客观地测量身体活动(例如每天 活动、在家中度过的时间)、行为(例如，睡眠)以及使用被动数据的社会和认知功能 从手机传感器和日志中收集的。 在这个项目中，我们将确定一组临床上有意义的患者症状和结果。 通过使用现有的妇科患者队列连续收集被动智能手机数据 正在接受姑息化疗的癌症患者(目标1)。我们将开发和验证一种方法来识别 癌症患者行为异常的临床意义(目标2)。最后，我们将确定可行性 以及使用我们基于智能手机的实时行为异常检测系统作为触发器的可接受性 对20名妇科癌症患者和他们的癌症护理人员进行及时的临床干预 (目标3)。 该项目是对PA-18-163“使用技术来提高患者预后”的响应。结果来自 这项研究将为未来随机对照试验的设计和实施提供参考，以测试其有效性 远程实时行为异常检测在改善癌症患者症状负担中的作用 结果)和身体功能、卫生保健使用和存活率(次要结果)。如果成功，则此工具 有可能在不同的患者群体、疾病状况和环境中改善结果。

PROJECT SUMMARY Patients with advanced cancers experience distressing and debilitating symptoms that are often undertreated. Moreover, patients and caregivers are frequently expected to manage complex side effects at home, without ready access to real-time support, and use the emergency department to manage poorly-controlled symptoms, braving long wait times for treatment that might be more comfortably delivered in the outpatient setting. Although timely detection and management of symptoms can improve patients' quality of life, functional status, health care use, and disease-related outcomes, remote symptom monitoring is rarely used within oncology. The long-term term goal of this project is to improve advanced cancer patients' symptom burden, physical functioning, and survival, while reducing burdensome ED visits by using smartphones to detect acute clinical deteriorations in cancer patients without requiring their active involvement. Smartphones are an ideal scalable technology for long-term, remote monitoring because they can objectively measure physical activity (e.g. daily activity, time spent in house), behavior (e.g., sleep), and social and cognitive functioning using passive data collected from phone sensors and logs. In this project, we will identify a set of clinically significant patient symptoms and outcomes that are associated with continuously collected passive smartphone data using an existing cohort of patients with gynecologic cancers who are receiving palliative chemotherapy (Aim 1). We will develop and validate a method to identify clinically meaningful anomalies in cancer patients' behaviors (Aim 2). Finally, we will determine the feasibility and acceptability of using our smartphone-based real-time behavioral anomaly detection system as a trigger for timely clinical intervention in a new cohort of 20 gynecologic cancer patients and their cancer care providers (Aim 3). This project is responsive to PA-18-163 “Use of Technology to Enhance Patient Outcomes.” Results from this research will inform the design and conduct of a future randomized controlled trial to test the effectiveness of remote real-time behavioral anomaly detection in improving cancer patients' symptom burden (primary outcome) and physical functioning, health care use, and survival (secondary outcomes). If successful, this tool has the potential to improve outcomes in diverse patient populations, disease conditions, and environments.