Kidney Cancer Journal 105
lar health monitors, the precision and benefits of real
time monitoring in the cases presented here appears to
give valuable clinical information.
Both patients in this case study presented were shown
to have a robust performance status of ECOG of 1. This
generally indicates patients who are fairly active with normal
activity and minimal symptoms. Both patients consistently
took less than 5000 steps/day, which is often
considered to be sedentary behavior.17 Home monitoring
of physical activity could provide a better assessment of
performance status. Furthermore, being able to detect real
time changes in activity patterns may provide a more objective
manner to quantify changes especially when it
comes to subjective clinical assessments such as fatigue,
functionality, and quality of life.
Finally, it is worth mentioning that two recent studies
in cancer patients also emphasize the importance of
prompt symptom detection in patients with cancer. A
phase III clinical trial (NCT02361099) in 121 patients
with metastatic lung cancer showed how a web application
based surveillance approach to capture symptoms
improved patient survival compared to standard of care
interval clinic based symptom monitoring (19 months
vs. 11.8 months).11 Just recently, another clinical trial
(NCT00578006) showed how using a web-based symptom
monitoring patient reported outcomes (PROs) tool,
which automatically alerted health care providers to severe
or worsening patient symptoms, improved survival
compared to usual care in outpatient cancer patients receiving
chemotherapy (31.2 vs 26.0 months).18
Conclusions
It is important to acknowledge that there are many hurdles
to consider in regards to expanding mHealth applications
in cancer care. These include the potential for
breach of privacy of patient health information, validation
of the accuracy of mHealth sensor technology,
health care cost and reimbursement, as well as the issue
of determining how to triage clinical responses to real
time monitoring of health information. Our current report
shows how mHealth can be used to remotely monitor
clinical parameters such as blood pressure, weight,
and physical activity, which are important for patients
with mRCC treated with VEGF inhibitors. In an era where
newer treatments for renal cancer including targeted
agents, immunotherapies, and combination approaches
continue to expand rapidly, we believe this feasibility
study is an important first step in a continuum of research
to eventually design larger interventional trials, which
will validate and better define how mHealth can help improve
clinical outcomes in this patient population.
Legend
BP - Blood pressure
FDA - Food and Drug Administration
mRCC - metastatic renal cell carcinoma
VEGF - vascular endothelial growth factor
TKI’s - tyrosine kinase inhibitors
mTOR - mammalian target of rapamycin
App - Application
BNP - B-type natriuretic peptide
Conflict of Interest
Richard A. Bloomfield Jr was Director of Mobile Technology
Strategy for Duke University Health System at the
time this clinical trial was designed and completed. He
currently works for Apple, Inc.
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