Digital technology: Helping patients manage cancer, and enabling early diagnosis

  • Researchers find potential in using commercially-available digital technology to help doctors and patients manage their diseases
  • Wearable technology could be useful for evaluating whether patients are suitable for certain trials
  • Early-stage advances in blood screening technology could lead to earlier diagnosis of potentially lethal cancers

Advances in digital technology and diagnostics devices could help cancer patients manage their disease and allow for earlier diagnosis using a simple blood test, according to research unveiled at ASCO this year.

Wearable digital technology has been proving its worth in monitoring diseases such as diabetes over the last few years – but could it also be used in cancer?

According to new research unveiled at ASCO 2018, there is potential in using commercially-available digital technology to help doctors and patients manage their diseases. The study was conducted across several major US cancer centres and found that using fitness data gathered using a Microsoft Band could be a feasible way to reduce levels of unplanned hospitalisation.

Jorge Nieva, associate professor of clinical medicine at the University of Southern California, said the device is useful for patients who may find that the combination of the disease and a gruelling chemotherapy regimen effectively lays them low for weeks on end.

Nieva’s approach is to use the latest technology to find new ways to solve a problem that oncologists have known for decades – that the fitter and more active cancer patients are, the more likely to survive and benefit from chemotherapy treatment.

The research published at ASCO was from a multi-institutional single-arm observational clinical trial of 65 patients with solid tumours undergoing a chemotherapy regimen that was highly likely to make them vomit. The trial measured physical activity by analysing daytime hourly metabolic activity from 10am to 7pm over 60 days.

Patient-reported outcome (PRO) data was collected using smartphone apps, and details of unplanned health events were collected by reviewing medical records over the 60 days of wearing a Microsoft Band plus 90 days of clinical follow-up.

Patients complied with wearing the trackers on more than seven of nine total hours on 67.7% of study days. Only nine of the 41 patients registered over 60 hours of non-sedentary activity, and even in this group there were significantly fewer unplanned health events compared with 32 patients with lower exercise levels as measured by the wristbands.

Authors concluded that the technology is “feasible” to identify patients with a lower activity profile, which is predictive of unplanned health events such as hospital admissions. Nieva says that a repeat study of a similar size is still needed to confirm the findings.

He told pharmaphorum in an interview:

“We think that looking at how active patients are using this simple monitor can give you an idea [about] how much more help they need, and if they have a difficult turn.”

Similar technology could also be used to accurately evaluate whether patients are suitable for certain trials. Consciously or unconsciously, doctors can be over-optimistic in their assessment of a patient’s physical state and using standardised methods based on technology could help inform their decisions about who gets to take part in trials, Nieva said.

“Sometimes there can be bias to give patients better scores, you might want to get them on the hottest trial. It is important that everyone agrees, and we can use a simple consumer device to allow us to do that.”

Emojis help cancer patients generate quality of life data

Separate research published at ASCO also backed use of an Apple Watch-based system to collect PRO data to measure quality of life, using a patient-friendly emoji system to replace conventional paper forms.

In an oral abstract session, researchers from the Mayo Clinic used a system of emojis to gather information from a group of 296 patients with a range of cancers including lymphoma, myeloma, brain, pancreatic, breast and ovarian cancers.

The patients had to own an iPhone 5 or later and complete baseline and weekly outcomes surveys for 12 weeks that assessed fatigue, sleep, and physical and social function. Patients then were randomised into three groups to see if an emoji system could be used to assess these criteria. One group was given an Apple Watch, another was given an iPhone and a third was given a paper form to give feedback on these measures of wellbeing.

Authors found that logging more steps per day was associated with less fatigue and sleep disturbance, better global physical quality of life, physical function, and social function, while a greater number of minutes of exercise per day was associated with better global mental quality of life and sleep.

But they also found that feedback gathered using the emoji mood scale was strongly related to baseline PROs. They concluded that the system is feasible, that the Apple Watch data is significantly associated with the outcomes, and that emoji scales are a “promising” tool.

Could a blood test detect cancer?

But it’s not just wearable device technology that is developing fast – the assays and tests used to detect the disease save lives by catching the disease early, are improving and giving patients a much better chance of survival.

Also revealed at ASCO was new data from a study of blood screening technology funded by GRAIL, a Californian company which aims to screen for cancer using blood tests sensitive to mutant strands of DNA that circulate freely in the plasma. The technology works by screening out circulating DNA emitted by white blood cells, which creates ‘white noise’ that masks any genetic material in the blood stream emitted by cancer.

Early findings from a snapshot of 1,627 patients from a much larger 15,000 patient trial suggest that the approach could lead to a screening system based on a blood test. The preliminary results show the test detected 41% of early-stage lung cancer, and 89% of late-stage cancers. The rate of false positives was low, with less than 1% of patients in a cancer-free control arm showing a cancer-like signal in the blood test.

Geoffrey Oxnard, associate professor of medicine at Dana-Farber Cancer Institute, said the results show it is “possible to detect early-stage lung cancer from blood samples using genome sequencing”.

ASCO expert David Graham, from the Levine Cancer Institute in Charlotte, North Carolina, added:

“We’re one step closer to being able to detect early-stage lung cancer from a simple blood test. While there’s still a way to go before cell-free DNA from blood can be used for cancer detection on a broad scale, this research serves as a building block for the development of future tests.”

There is still a long way to go with this technology, which needs data from the larger study to get anywhere near the market. And there are competitors – for instance the UK’s Angle is developing a cancer blood test called Partsortix that uses circulating tumour cells as a basis to diagnose cancer.

But with this proof of concept the dream of early diagnosis of potentially lethal cancers is one step closer to becoming reality.

About the Author

Richard Staines is Senior Reporter at pharmaphorum. He has been a journalist since the 1990s and has written for websites, newspapers and magazines. He has always had an interest in health, and has been focusing on the pharma industry since 2010, interviewing industry leaders and covering stories on topics including regulation, mergers and acquisitions, and the latest clinical developments.

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