Gregory Megan E, Cao Weidan, Rahurkar Saurabh, Jonnalagadda Pallavi, Stock James C, Ghazi Sanam M, Reid Endia, Berk Abigail L, Hebert Courtney, Li Lang, Addison Daniel
Department of Health Outcomes and Biomedical Informatics, College of Medicine, Univeristy of Florida, Gainesville, FL, United States.
Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States.
JMIR Cancer. 2023 Dec 12;9:e46481. doi: 10.2196/46481.
Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown.
We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation.
We conducted semistructured interviews of >50% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis.
Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient's care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it.
Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed.
心脏毒性是几种癌症治疗方法的局限性，早期识别可改善治疗结果。症状跟踪移动健康（mHealth）应用程序是可行且有益的，但mHealth症状跟踪以指示心脏毒性早期迹象的关键要素尚不清楚。
我们探讨了为一家大型学术医疗中心设计并实施一款mHealth症状跟踪工具的相关考量因素，该工具用于在癌症治疗开始后早期识别癌症患者的心脏毒性。
我们对参与机构中管理癌症治疗相关心脏毒性的超过50%的医疗服务提供者（肿瘤学家、心脏肿瘤学家和放射肿瘤学家，n = 11）进行了半结构化访谈，并对6名患者进行了访谈、共同设计或两者兼而有之。使用主题分析法对数据进行编码和分析。
医疗服务提供者表示，目前没有能够早期识别心脏毒性的现有流程，并认为该应用程序可以减少诊断延迟并带来更好的患者治疗结果。医疗服务提供者建议跟踪的体征和症状包括胸痛或胸闷、呼吸急促、心跳加快或心悸、晕厥、头晕、水肿和过度疲劳。实施障碍包括确定谁将接收症状报告、确保患者护理团队的所有成员（如肿瘤学家、心脏病学家和初级保健医生）都了解症状报告并能够就护理计划进行协作，以及如何最好地将应用程序数据整合到电子健康记录中。患者（n = 6，100%）一致认为该应用程序有助于更好地捕捉症状和进行教育，并表示愿意使用它。
医疗服务提供者和患者一致认为，一款面向患者的、与癌症治疗相关的心脏毒性症状跟踪mHealth应用程序将是有益的。需要进行更多研究来评估mHealth作为启动有针对性的早期心脏保护治疗潜在策略的作用。
