Over the past 25 years, the oncology field has seen a dramatic shift in the delivery of cancer care with the development of new therapeutics, it is desirable to shift care from inpatients and clinics to the home and widespread deployment of electronic health records.
PROBLEM
One area of innovation is the development of oral anticancer drugs, including cytotoxic chemotherapy, that patients can self-administer at home. It is estimated that about 25% of new antineoplastic agents under development are intended for oral administration. NCCN task force report: Oral chemotherapy.
The use of these drugs allows patients to have more autonomy in their care, said Dr. Parul Agarwal, assistant professor of clinical medicine at the University of Pennsylvania Health System who is part of the “Penny” organization and allow them to spend more time at home. “, especially taking on a leadership role in gastrointestinal cancers.
“However, there are some issues to consider when doing oral chemotherapy at home,” she notes. “Dosing schedules can be complex and there are concerns about compromised efficacy if patients take less than prescribed doses and an increased risk of potentially life-threatening toxicity if more than the prescribed dose is taken.
“Recognizing these challenges, a number of mitigation strategies have been evaluated, including intensive, provider- and pharmacist-run outpatient monitoring programs,” she continued. “In addition, measuring adherence to medication, and identifying and managing appropriate toxicity for patients with oral chemotherapy is challenging.”
Capecitabine is a particularly complex oral chemotherapy that serves as the therapeutic backbone for many gastrointestinal malignancies. It is manufactured in two pill sizes and is prescribed twice daily, dosed according to body surface area and a cyclical regimen, leading to the date of treatment and the date of cessation of treatment.
“Our Penny pilot using an augmented intelligence chatbot is a novel strategy for improving medication adherence and toxicity management associated with oral chemotherapeutic agents with the primary goal of improving patient outcomes and a secondary goal of improving health care utilization metrics.”
Dr. Parul Agarwal, University of Pennsylvania Health System
“In addition, capecitabine, often given with other intravenous chemotherapy, other oral chemotherapy regimens, or concurrently with radiation therapy can lead to more severe complications when used,” Agarwal explains. “. “Typically, monitoring these agents to ensure safe management is multi-vendor and resource-intensive, and documenting frequent failures and avoidable complications.
“Our Penny pilot using an augmented intelligence chatbot is a novel strategy for improving medication adherence and toxicity management associated with oral chemotherapeutic agents with the primary goal of improving patient outcomes, and the secondary goal is to improve healthcare utilization metrics,” she added.
PROPOSE
To improve medication adherence, and monitor and manage toxicity with the ultimate goal of providing high-quality patient care, Penny, the algorithm-driven, augmented intelligent chatbot has been proposed.
Penny uses text-based, two-way, conversational interactions to guide patients through potentially complex protocols and minimize potential mistakes they can make while undergoing chemotherapy sessions. treat.
MEET CHALLENGES ONLY
Patients with gastrointestinal cancer receiving oral chemotherapy only capecitabine, or capecitabine in combination with other anticancer drugs or radiation therapy, can participate. The Penny chatbot works two-way and messages can be initiated by the chatbot or the patient.
To address compliance and medication-related issues, the chatbot sent twice-daily dosing reminders to patients about capecitabine dosage and when to take it. In the first phase of the pilot, participants received a text message asking them to answer “LOSE” after each dose of capecitabine. This was later modified into a weekly survey to assess medication adherence.
To address the toxicity associated with oral antineoplastic agents, the chatbot also initiated a weekly survey to find patient-reported symptoms. These symptoms are handled using a combination of survey algorithms and natural language processing, a form of AI.
Participants can also initiate messaging with the chatbot at any time during the process to report a symptom. All interactions between participants and chatbots are monitored in real time by the research team.
RESULT
Agarwal explains: “The main outcome of this study was to evaluate the feasibility of using augmented intelligent chatbots from a patient safety perspective. “Nearly 4,000 drug-related text messages were exchanged and about 93% were correctly interpreted by Penny.
“A medication adherence rate of approximately 70% was measured in participants who responded ‘JOIN’, although actual medication adherence rates could be much higher,” she continued. “Over 500 symptom-related text messages were exchanged and about 98% were correctly interpreted by Penny.”
Through an iterative process, patient participation in the symptom assessment increased from 25% to approximately 70%, and the majority of misinterpreted messages were handled by the team. real-time, she added.
More than 50% of participants completed qualitative interviews. These interviews She demonstrated superior patient interaction with clear feedback that Penny provided an extra layer of support, giving them more confidence in taking their medication and interacting with their care team, she said. he said.
TIPS FOR OTHER PEOPLE
“The iterative way in which this intervention was performed led to some improvements in Penny’s natural language processing functionality and resulted in higher levels of patient interaction as the pilot progressed, this is crucial for healthcare innovations in this area,” said Agarwal.
“This process requires a high level of involvement from all stakeholders – the healthcare team, the research team and the Memora Team, with whom we have collaborated for a technology platform,” she said. continue. “Penny has identified inconsistencies in the delivery of care with capecitabine scheduling, dosage, and monitoring among gastrointestinal cancer providers, leading to initiatives aimed at reduce unnecessary changes in care.”
A patient journey dashboard has been created to clearly outline schedules and dosages with the aim of facilitating the delivery of high quality care.
“In the future, this dashboard will be integrated into the EHR to become a standard tool for clinical teams to use to monitor their patients and adjust dosage as needed,” said. Agarwal.
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