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Rebecca Ingram Research in Focus Day UoW 27 th February 2008

Psychological Experience of Using a Mobile Phone to Self-Monitor Toxicity During Individualised Chemotherapy. Rebecca Ingram Research in Focus Day UoW 27 th February 2008. Self-Responsibility of Health. UK Government (DoH, 2006) Technology in Health Care

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Rebecca Ingram Research in Focus Day UoW 27 th February 2008

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  1. Psychological Experience of Using a Mobile Phone to Self-Monitor Toxicity During Individualised Chemotherapy Rebecca Ingram Research in Focus Day UoW 27th February 2008

  2. Self-Responsibility of Health • UK Government (DoH, 2006) Technology in Health Care • Explosion in Mobile Telecommunications • 50 million in UK

  3. Chemotherapy • Serious Adverse Effects (Dikken et al 1998) • Death Rates 0.8-2.2% Adjuvant Regimens • Prompt Intervention Save Lives

  4. Chemotherapy • Majority Outpatients • Manage Toxicity at Home Risk-Management: • Discussion pre-chemotherapy • Leaflets • Diaries • Internet

  5. Chemotherapy • History of Telephone follow-up BUT • Non-targeted • Time-consuming Also, • Patients reluctant to ‘bother’ nurses

  6. Mobile Phone Potential • Alert HCPs • Real-time • When necessary • Diabetes (Farmer et al, 2005) • Asthma (Ryan et al, 2005; Neville et al, 2002) • Feasibility Study (Weaver et al, 2007)

  7. Study Objectives • Develop system to manage side-effects • Individualise chemotherapy dose • Explore psychological consequences of using the technology

  8. The Technology

  9. Example Questions

  10. Example Questions

  11. Example Questions

  12. Example Questions

  13. Example Advice

  14. Example Red Alert Advice

  15. Confirmation of Understanding

  16. The Technology • All Data Stored • Patient can view history • Facilitate in-depth discussion at next apt Any Concerns – Call Hospital Anytime

  17. Alerts • Symptoms & Temp Entered 2x Daily • Generate Alert Acceptable Toxicity: • Self-care Advice Unacceptable Toxicity: • 30 mins Nurse to Contact • If not heard MUST contact Nurse

  18. The Patients Advanced Breast on: • Capecitabine • Capecitabine & Doxcetaxel Advanced Colorectal on: • Capecitabine • Capecitabine & Oxaliplatin

  19. Capecitabine (Xeloda) • Oral fluouropyrimidine carbamate • Converted to 5-FU in tumour tissue 3 steps • Rapidly Absorbed GI tract • Metabolised in Liver to 5’DFCR • 5-DFCR to 5’DFUR by Cytidine Deaminase in Liver and Tumour Tissue • 5-DFUR to 5-FU in Tumour Site due to higher concentrations of Thymidine Phosphorylase

  20. Capecitabine Common Toxicity • Febrile Neutropenia -CAPOX • Diarrhoea • Vomiting • Mucositis • Hand-Foot Syndrome • Peripheral Neuropathy – CAPOX/CAPDOX

  21. Cytotoxic Agent Dosage • Steep Dose-Response Curve = Narrow Therapeutic Ratios Dose • Phase 1 trials dose-limiting toxicity • Premise that cytotoxics must induce a degree of cell kill in rapidly proliferating cell compartments (e.g. bone marrow, intestinal crypts etc) to be certain that dose is within the therapeutic range.

  22. Individualised Dosage • Current Protocols all Dose Reductions – can compromise disease control & survival in curable malignancies But, • Dose Dense Schedules may increase survival rates So, • Dose Reduction and Increases • Driven by Toxicity Assessment 2x daily

  23. Psychological Consequences of Cancer • Depression, Anxiety & Somatisation >50% Patients (Zabora et al, 2001) • QoL, Physical & Psychological functioning • Disease Progression = > Distress • QoL issues Vital End-Point in Palliative Setting

  24. QoL End-Point • Real-time Monitoring of Toxicity • Enables Rapid Attendance to Side-effects • Less Physical Effects for Shorter Time Period BUT • QoL Issues Vital

  25. Psychological Consequences of Mobile Phone • Positive or Negative? • Explore and understand the psychological & practical experience • Heideggerian Phenomenological Approach

  26. Phenomenology • Study of conscious experience as experienced from the subjective or first person point of view. • Study of phenomena: literally, appearances as opposed to reality. • Concerned with the way individuals experience things and the meanings things have in individuals experiences.

  27. Heidegger Experiences, and the meaning of these experiences are embedded in, and cannot be seperated from a persons world Husserl De-contextualised experience ‘Epoche’ – bracketing presuppositions & beliefs Heidegger Vs Husserl

  28. Heidegger: Implications for Research • Interested in patients understanding of the experience and meaning of using the mobile phone within the context of the participants world • Clarification • Interpretations of Researcher

  29. Method Longitudinal Qualitative Semi-Structured Interviews Patients Staff Feasibility Patients Triangulation

  30. Reference List • Balas A E and Lakovidis I (1999) Distance technologies for patient monitoring. BMJ, 319; 1309 • Citron ML. Dose-density in adjuvant chemotherapy for breast cancer. Cancer Invest. 22(4):555-68 • Department of Health (2006) Supporting Self Care – A Practical Option: Diagnostic, Monitoring and Assistive Tools, Devices, Technologies and Equipment to Support Self-Care. Accessed 30th October 2007 at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4134006 • Farmer, A.J., Gibson, O.J., Dudley, C., Bryden, K., Hayton, P.M., Tarassenko, L. and Neil, A (2005) A Randomised Controlled Trial of the Effect of Real-Time Telemedicine Support on Glycaemia Control in Young Adults with Type 1 Diabetes (ISRCTN 46889446). Diabetes Care, 28, 11, 2697-2702 • Kimmel S REzai M, Kimmig R, Schmid P. 2007; Dose-dense chemotherapy for primary breast cancer. Curr Opin Obstet Gynecol 19(1): 75-81 • Lyman GH, Dale DC Friedberg J et al. Incidence and predictors of low chemotherapy dose-intensity in aggressive non-Hodgkin's lymphoma: a nationwide study 2004; JCO 22 (21): 4302-11 • Maglaveras N,m Koutkias V, Meletiadis S, Chouvarda I, Balas EA (2001) The Role of Wireless Technology in Home Care Delivery. Medinfo 2001 V Patel et al (Eds) Amsterdam: IOS Press • Mark, TL, Fortner B, Johnson G (2007) Tablet PC Helps Doctors and Patinet Focus on Chemotherapy Side Effects – Jurnal of Supportive Care in Cancer • Neville et al (2002) Mobile phone text messaging can help young people manage asthma. BMJ, 2002, 325, 600 • Ryan, D., Cobern, W., Wheeler, J., Price, D., and Tarrasenko, L. (2005) Mobile Phone Technology in the Management of Asthma. Journal of Telemedicine and Telecare, 11, (Suppl. 1), S1, 43-46 • Schwarz, R.E., Coit, D.G., Groeger, J.S (2000) Transcutaneously tunnelled central venous lines in cancer pateins: an analysis of device-related morbidity factors based on prospective data collection. Ann Sug Oncol, 7:441-449Balas, A., E and Lakovidis, I. (1999) Distance Technologies for Patient Monitoring. British Medical Journal, 319, 1309-1311 • Weaver A, Young AM, Rowntree J, Townsend N, Pearson S, Smith J, Gibson O, Cobern W, Larsen M. & Tarassenko L. Application of mobile phone technology for managing chemotherapy-associated side-effects Ann Oncol. 2007 18(11):1887-92. • Zabora, J., Brintzenhofeszoc, K., Curbow, B., Hooker, C., and Piantadosi, S. (2001) The Prevalence of Psychological Distress by Cancer Site. Psycho-Oncology, 10, 19-28

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