The Coronavirus pandemic has caused huge disruption to the clinical care sector, irrevocably changing the way care is being delivered and received. Technology has come to the fore, offering doctors and patients new ways to remain connected throughout periods of self-isolation and adjustments to treatment. However, with changes to the way patients are monitored and a backlog of undiagnosed cases, strategies must be employed to strengthen the efficacy of treatment and improve outcomes, especially in light of the threat of a potential second wave of COVID-19.
Going into lockdown to help prevent the spread of Coronavirus has ignited three main problems in cancer care - all with their own nuances. The first is that existing patients’ operations have - and continue to be - delayed because of the coronavirus, and other changes have been made to treatments such as swapping chemotherapy infusions in hospitals for oral chemotherapy tablets taken at home. This inevitably causes a number of anxieties for patients around whether their health may worsen, what implications this may have if it does and not knowing just when their treatment might change again.
Secondly, a fall in the number of people presenting their symptoms to their GPs has led to a delay in referrals and fewer people being diagnosed. This is likely to result in later-stage diagnosis further down the line and more complicated treatment which may be less effective than if they had been able to attend an appointment earlier.
We already know that delays in treatment have resulted in more than two million people awaiting cancer care in the UK. The third complexity lies in triage; with the backlog of new cases deciding whose treatment to prioritise will be difficult, particularly as there is no current method to determine who will be the most affected by a delay.
Scientists at the University of Michigan have begun to address this problem and have developed an app which goes beyond traditional tiering systems that determine who should receive the most urgent care. The software calculates the relative impact of delays in treatment on individuals, taking into account the likely length of the delay, the person’s age, their underlying health conditions and the availability of resources in their community. However, no such offering is yet available in the UK.
Why data is key to tackling these problems
There are already mainstream practices in use in clinical care such as telemedicine, where clinicians can video call patients to get an idea of how they are coping and what symptoms they are experiencing. However, there are limitations as this only provides a snapshot amidst weeks or months of treatment. A patient can look and feel brighter one day, but might have spent the last three very unwell.
A snapshot just isn’t enough for clinicians to have a true overview of a patient’s wellbeing. Enabling patients to use their mobile device to track their symptoms as they occur, log and monitor how they’re feeling throughout the day and automatically sharing this data with their doctor and family, will provide a more holistic picture of how they’re coping. Not only this but wearable technologies such as temperature patches can sync with smartphones, keeping tabs on anomalies or red flags. If there are spikes in temperature, which can indicate serious complications, these prompt alerts to the patient, their doctor and their families.
These advances could change cancer patients’ outcomes. Whilst someone might think a temperature they are experiencing is mild, it could actually be a fever caused by their cancer treatment which could quickly lead to sepsis; something that kills over 48,000 people a year in the UK alone. These fevers often spike during the night - which means they can go undetected or dismissed come the morning.
The data helps to reduce clinical risk as, in many cases, clinicians must rely solely on patient recall and video observations. It can also help to put less pressure on the patient to recall symptoms, allowing clinicians to monitor and track patient’s health in real-time and then intervene as necessary.
Supporting patients’ mental health through COVID-19
Delays and changes in treatment are undoubtedly causing anxiety for cancer patients at a time when they already feel uncertain, isolated and out of control. Breast Cancer Now, a charity providing research and care, polled 580 people affected by breast cancer and found that many had seen their chemotherapy changed or halted during the pandemic to improve their immune systems. As a result, Breast Cancer Now’s ‘Ask Our Nurses’ service saw a 60% increase in activity during March, with users worried about how ramifications of COVID-19 will affect them.
The charity’s chief executive, Baroness Delyth Morgan, said: 'It’s extremely concerning to hear of the huge emotional impact the outbreak is having on so many people living with secondary breast cancer. Many women are experiencing or fearing considerable changes to their care, and the level of anxiety, distress and fear that we’ve been hearing on our helpline is unparalleled in recent years.”
Smartphone apps also offer patients a tool to log, manage, report and track their day-to-day moods digitally alongside their symptoms, giving the patient more control, helping to reassure their caregivers and allowing their doctors to provide more efficient and effective advice and support.
Obstacles to widespread adoption of technology
Previously, one of the biggest barriers to the adoption of health technology has been a tendency for caution which is probably one of the reasons tech companies’ attempts at innovating in the sector have typically taken much longer to get right. Over the last three months however, we have seen a decade’s worth of behaviour changes for both clinicians and their patients.
At a time when clinicians are aware that people with health conditions may feel reluctant to reach out to them for help or guidance for fear of being a burden, technology can offer significant respite from worry. The ability to know in real-time when a patient is in need of urgent care could give clinicians the data to know when - and how - to alter treatment and, ultimately, to save lives.
This acute need is highlighted in a recent study from University College London which suggests that, because of a lag in diagnosis and factors like a 60% drop in chemotherapy appointments, up to 18,000 more people are likely to die of cancer within the next year.
The key to technology’s efficacy is that it must offer solutions for each nuance of the challenges patients and clinicians face. It needs to be reassuring and helpful to patients as well as being a meaningful tool for clinicians which removes some of the time burdens and allows them to work as efficiently as possible.
At a time when clinical care needs to be one step ahead of a potential second wave of Coronavirus and protect against these problems worsening even more, technology can - and must - play a part in helping as many people as possible who are living with cancer.
Paul Landau is founder of Careology, a cancer support app