Utilizing Digital Health to Collect Electronic Patient-Reported Outcomes in Prostate Cancer: Single-Arm Pilot Trial

Background: Measuring patient-reported outcomes (PROs) requires an individual’s perspective on their symptoms, functional status, and quality of life. Digital health enables remote electronic PRO (ePRO) assessments as a clinical decision support tool to facilitate meaningful provider interactions and personalized treatment. Objective: This study explored the feasibility and acceptability of collecting ePROs using validated health-related quality of life (HRQoL) questionnaires for prostate cancer. Methods: Using Apple ResearchKit software, the Strength Through Insight app was created with content from validated HRQoL tools 26-item Expanded Prostate Cancer Index Composite (EPIC) or EPIC for Clinical Practice and 8-item Functional Assessment of Cancer Therapy Advanced Prostate Symptom Index. In a single-arm pilot study with patients receiving prostate cancer treatment at Thomas Jefferson University Hospital and affiliates, participants were recruited, and instructed to download Strength Through Insight and complete ePROs once a week over 12 weeks. A mixed methods approach, including qualitative pre- and poststudy interviews, was used to evaluate the feasibility and acceptability of Strength Through Insight for the collection and care management of cancer treatment. Results: Thirty patients consented to the study; 1 patient failed to complete any of the questionnaires and was left out of the analysis of the intervention. Moreover, 86% (25/29) reached satisfactory questionnaire completion (defined as completion of 60% of weekly questions over 12 weeks). The lower bound of the exact one-sided 95% CI was 71%, exceeding the 70% feasibility threshold. Most participants self-identified with having a high digital literacy level (defined as the ability to use, understand, evaluate, and analyze information from multiple formats from a variety of digital sources), and only a few participants identified with having a low digital literacy level (defined as only having the ability to gather information on the Web). Interviews were thematically analyzed to reveal the following: (1) value of emotional support and wellness in cancer treatment, (2) rise of social patient advocacy in online patient communities and networks, (3) patient concerns over privacy, and (4) desire for personalized engagement tools. Conclusions: Strength Through Insight was demonstrated as a feasible and acceptable method of data collection for ePROs. A high compliance rate confirmed the app as a reliable tool for patients with localized and advanced prostate cancer. Nearly all participants reported that using the smartphone app is easier than or equivalent to the traditional paper-and-pen approach, providing evidence of acceptability and support for the use of remote PRO monitoring. This study expands on current research involving the value of digital health, as a social and behavioral science, augmented with technology, can begin to contribute to population health management, as it shapes psychographic segmentation by demographic, socioeconomic, health condition, or behavioral factors to group patients by their distinct personalities and motivations, which influence their choices

Radiation Oncology at Thomas Jefferson University: A Specialty Emerges as a Department Evolves

Jefferson Radiation Oncology has maintained over fifty years of excellence led by only four chairmen. Dr Kramer after receiving his medical training inLondonled the department into the modern megavoltage era while creating the first independent academic radiation oncology department in the country. He was well-respected nationally as a leader and advocate for the specialty and he mastered the execution of progressive ideas that have raised the standard for the profession. The creation of the Radiation Therapy Oncology Group (RTOG) was critical in developing trials to expand the management and treatment of malignancy. The Patterns of Care Study (PCS) educated the masses on providing optimal care to patients by comparing strategies for the management and treatment of carcinoma through surveys across theUnited States. Dr Mansfield expanded his mentor’s vision and together they developed the Bodine Centre for Cancer Treatment, a new state-of-the-art building for cancer treatment. He helped to dispel common misconceptions, thus raising the social consciousness for managing and treating the underserved community. Dr Curran grew the RTOG to new levels in trial development, funding, and respect both domestically and internationally. He helped develop new technology in the department and markedly expanded the Jefferson Cancer Network. Finally, Dr Dicker set a new course for the department with biologically-driven radiation therapy keepingJeffersonat the forefront of new technology for the diagnosis and treatment of malignancy

Financial Toxicity: A Side Effect of Radiation Therapy for Cancer?

The field of oncology is ever-changing, as new treatment options become available and treatment plans are unceasingly optimized. While the US remains at the forefront of medical innovation and treatment options for serious and complex conditions such as cancer, costs for cancer care are extremely high and continue to increase. Modern healthcare does not come without a price, and medical expenses can have a profound economic impact on American households. Nearly half of bankruptcy filings are in some way a result of medical expenses. While recent healthcare initiatives have increased access to care, many remain underinsured while facing increasing copayments and deductibles. For many, the out of pocket (OOP) cost for treatment represents a significant portion of their income. Such a large and often unanticipated financial burden not only contributes to non-adherence to medications, but also reduced spending on essentials such as food and clothing. Cancer patients, because of the complexity of care and high cost of treatment are especially sensitive, with an estimated 20-50% of oncology patients facing difficulty in paying medical bills. The American Society for Clinical Oncology (ASCO) has recognized the runaway cost of cancer care and has developed a Cost of Care task force to address patient financial well-being. While ASCO is at the forefront of the much needed movement, their impact has been limited. Surprisingly, many physicians are unaware that the task force even exists. The cost of care and financial burden for radiation oncology patients is largely unknown. The use of radiation therapy for treatment, either as stand-alone therapy or part of a multimodal approach, is efficacious for many different types of cancer. In fact, radiation therapy is an important treatment modality for many of the most common cancer types, including prostate, breast, and lung. To date, there are no studies addressing OOP cost or other forms of financial burden and its sequelae on patients who received radiation therapy as a part of their cancertreatment. Likewise, there are no financial toxicity tools validated for use in radiation oncology. Given the large role radiation therapy plays in modern cancer treatment, it is important for the field to develop and utilize financial toxicity tools. We hypothesize that radiation oncologists do not routinely screen for financial toxicity, and that a significant percentage of patients encounter financial burden as a result of radiation treatment. Here, we aim to identify demographic trends in patients facing financial burden, as well as gauge physician understanding of treatment costs and their willingness to adopt use of financial toxicity tools. Strategically developed physician surveys and post-treatment patient surveys will be used, utilizing a prospective, non-interventional observational study approach. This is an ongoing study as of April 2016, which we are optimistic will reveal much needed information on the financial toxicity of radiation therapy. Preliminary data will be presented, showing some intriguing trends in both the physician and patient surveys

Pilomatrix Carcinoma of the Thoracic Spine: Case Report and Review of the Literature.

CONTEXT: Pilomatrixoma is a common head and neck neoplasm in children. Its malignant counterpart, pilomatrix carcinoma, is rare and found more often in men. METHOD: Case report of a 21-year-old man with pilomatrixoma of the thoracic spine that underwent malignant degeneration to pilomatrix carcinoma. FINDINGS: The appearance of a painless mobile axillary mass was followed by severe back pain 1 year later. Imaging revealed a compression fracture at the T5 level. The patient underwent resection of the axillary mass and spinal reconstruction of the fracture; the pathology was consistent with synchronous benign pilomatrixomas. Three months later he presented with a recurrence of the spinal lesion and underwent further surgical resection; the pathology was consistent with pilomatrix carcinoma. He received adjuvant radiotherapy and at his 1-year follow-up examination had no sign of recurrence. CONCLUSION/CLINICAL RELEVANCE: Pilomatrix carcinoma involving the spine is a rare occurrence. It has a high incidence of local recurrence, and wide excision may be necessary to reduce this risk. Radiotherapy may be a helpful adjuvant therapy. Clinicians should be aware of this entity because of its potential for distant metastasis