Passive Data to Improve Outcomes in Advanced Cancer

项目摘要 患有晚期癌症的患者经历了通常治疗不足的痛苦和衰弱症状。 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， 随时获得实时支持，并使用急诊室来管理控制不佳的症状， 冒着漫长的等待时间接受治疗，而在门诊治疗可能更舒适。 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， 医疗保健使用和疾病相关的结果，远程症状监测很少用于肿瘤学。 该项目的长期目标是改善晚期癌症患者的症状负担， 功能和生存，同时通过使用智能手机检测急性临床 癌症患者的病情恶化，而不需要他们的积极参与。智能手机是理想的可扩展 长期远程监测技术，因为它们可以客观地测量身体活动（例如，每天 活动，在家里花费的时间），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到的信息 在这个项目中，我们将确定一组临床上重要的患者症状和结果， 使用现有的妇科疾病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）。我们将开发并验证一种方法， 癌症患者行为中有临床意义的异常（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 在一个新的20名妇科癌症患者及其癌症护理提供者的队列中进行及时的临床干预 (Aim 3）。 本项目响应PA-18-163“使用技术改善患者结局”。结果 这项研究将为未来随机对照试验的设计和实施提供信息，以测试 远程实时行为异常检测在改善癌症患者的症状负担（主要 结果）和身体功能，医疗保健使用和生存（次要结果）。如果成功，这个工具 具有改善不同患者人群、疾病状况和环境的结果的潜力。

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.