Online symptom monitoring and tailored advice for patients with metastatic breast cancer on combination endocrine and targeted treatments
The CDK4/6 inhibitors (CDK4/6i: palbociclib, ribociclib and abemaciclib) and mTOR inhibitors (mTORi: everolimus) have increased treatment options for ER-positive metastatic breast cancer, leading to improved progression-free survival. Treatment is well tolerated and side-effects are manageable, but at the start patients require initial close monitoring. The new treatments add extra demands on stretched NHS services. There is a need for innovative cost-effective care models that improve patient support.
Using patient reported outcome measures (PROMs), online symptom monitoring offers a practical solution. This can be integrated in innovative services where asymptomatic patients can be managed remotely (online or via telephone clinics), reducing patient burden and health resources. In Leeds, over the past 6 years we have developed and evaluated the eRAPID system for chemotherapy and radiotherapy.
The aim is to establish and evaluate the use of an online symptom report system (eRAPID) for metastatic breast cancer patients starting first or second line targeted treatments (CDK4/6i/mTORi) alongside endocrine treatment. This should enhance the support/outcomes for patients by improving timely detection of side-effects, including those of recurrence, proactively manage side-effects, optimise treatment delivery and improve patient experiences.
Phase 1 is developmental and involves adapting the existing online symptom monitoring system called eRAPID (Electronic patient self-Reporting of Adverse events: Patient Information and aDvice) to include content specific to metastatic breast cancer, endocrine treatment and targeted treatments, specifically CDK4/6 inhibitors (CDK4/6i) and mTOR inhibitors (mTORi). This involves setting-up the clinical pathway to display patient self-reports in the electronic patient records (EPR) for use by medical staff. Usability testing will be performed on a small sample.
In Phase 2, a database of real-life patient-reported symptom data will be generated for clinical audit to guide future care and support services. Clinicians will be trained how to access the system and interpret reports leading to implementation and evaluation of the new remote monitoring pathway.
Professor Galina Velikova and Lorraine Warrington