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Technology and Medication Outcomes for Older Adults with

Cancer

Ronald Maggiore, M.D.

Assistant Professor of Medicine

Division of Hematology/OncologyUniversity of Rochester

SIOG Annual Meeting 2017

Conflicts of Interest

• None to Disclose.

Learning Objectives

• Become More Familiar with Factors Affecting Older

Adults’ Uptake of Health Technology-Based

Interventions in Clinical Care

• Examine Newer Health Technologies as Clinical

Reminder Tools for Older Adults

• Review Study Data Relating to Health Technology-

Based Interventions for Adults with Cancer

• Symptom/Side-Effect Reporting

• Oral Anti-Cancer Medication Adherence

Utilizing Technology to Improve Medication Adherence

Unique Issues of Older Adults• Motor Skills

• Cognitive Function

• Hearing

• Vision

• Other Sensory/Perception Barriers

• Global Health Status (Mental & Physical)

• Health-Related Education

• Computer or Other Technology Experience

• Caregiver Presence/Involvement

• Reminder Systems for Oral Meds

• Complexity of Other Medication Regimens/Pill Burden

NHATS

Levine DM et al. JAMA 2016 (Letter)

NHATS

Levine DM et al. JAMA 2016 (Letter)

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Intervention Studies to to Improve Cancer Symptom/Toxicity Reporting among Patients/Caregivers

• Advanced Symptom Management System (ASyMS)

• Symptom Tracking and Reporting (STAR)

ASyMS

Kearney et al. Support Care Cancer 2009

• Study Overview:• Took approximately 5 years to develop

• Manage chemotherapy-toxicity symptoms at home

• Cluster Randomized Trial across 7 UK Cancer Centers

• Must be starting a “new” chemotherapy regimen for a

solid tumor diagnosis

• Six Common Chemotherapy-Related Symptoms Tracked

• Clinicians notified of symptoms as either “amber” or “red”

alerts via linked paging system

• Patient Characteristics:• Mean Age: 56 years +/- 10 years

• Cancer Type: >50% were breast cancers; ~25% lung

cancers

• Followed for at least 4 cycles

ASyMS: Impact on Capecitabine Side-Effects

Kearney et al. Support Care Cancer 2009

STAR

Basch E et al. JAMA 2017; JCO 2016

• Study Overview:• Single-site Longitudinal Study at Memorial-Sloan Kettering Cancer

Center, patients undergoing any “new” chemo for advanced solid

tumors

• 3 Year Follow-up

• 12 Common Symptoms (using PRO-CTCAE)

• Web-Based tool; if severity threshold triggered, email goes to RN

assigned to patient

• Symptom History Compiled for each Oncologist Visit; primary

outcome=HR-QOL at 6 months (EQ-5D QOL index)

• Patient Characteristics:• N=766

• 58% Female

• Median Age = 61 years (range, 26-91)

• 30% Computer-Inexperienced

STAR: STAR: Overall Survival Results

Basch E et al. JAMA 2017; JCO 2016

1)

Tools to Improve Medication Adherence

Burhenn et al. CJON 2015

Literature Review of Studies to Improve Oral Anti-Cancer Medication Adherence

Multicomponent Interventions (MCIs) Appear to work the best:

• Patient/Caregiver Education

• Technologic Mediators: Electronic Reminders, Tool-Kits, Mobile

Phone Apps

• Nursing/Pharmacist-Led Reminders and Interventions

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MCIs Endorsed by SIOG Recommendations

Burhenn et al. CJON 2015

Literature Review of Studies to Improve Oral Anti-Cancer Medication Adherence

Multicomponent Interventions (MCIs) Appear to work the best:

Patient/Caregiver Education

Technologic Mediators: Electronic Reminders, Tool-Kits, Mobile Phone Apps

Nursing/Pharmacist-Led Reminders and Interventions

MCI Studies to Improve Adherence to Oral Anti-Cancer Medications

Arthurs G et al. JBI Database System Rev

Implement Rep 2015

• Marked heterogeneity in attempts for pooled analyses

2 studies included

1) Schneider SM et al. J Adv Pract Oncol 2014Mean age 60 +/- 13 years; N=45

Any new oral agent, adherence up to 4 months

Looked at self-report and cancer center pharmacy fills

NP would call patient weekly for first month, then every other week, questions tailored by

intake form

2) Simons S et al. Support Care Cancer 2013N=48 patients with breast or colorectal cancer about to receive capecitabine

Half received intensive pharmacist-led educational consultation initially and during

each cycle of chemo (median = 2.2 phone consults/cycle),

Also utilized medication event monitoring system (MEMS) pill bottles

GlowCap® & AdhereTech®: “Smart” Pill Bottles

www.nanthealth.com/vitality;

www.Avella.com, www.adheretech.com

GlowCapTM: Imatinib Adherence for Patients with GIST

www.Avella.com

AdhereTechTM: Lenalidomide Adherence for Patients with MM

www.Avella.com

MOATT

Ongoing study involving 2 cancer centers in Montreal, Canada

Patients Age ≥65 years to Received Adjuvant Endocrine Therapy

Primary outcome will be treatment discontinuation rates

1 site will allocated to the eHealth tool intervention; the other to usual care

The eHealth Tool will notify treatment teams of clinical events that may

adversely impact adherence to therapy, including pharmacy-based events

Multiple factors controlled for in the statistical analysis, including comorbidity

and polypharmacy

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Study Design: Factors to Weigh In

• What is the Target Patient Population?

• What is the Study Trying to Accomplish?

• What is the Intervention?

What is the Technology (e.g., device, software/platform) to Be

Incorporated?

• What Do Patients and Caregivers Have to Say (e.g., focus groups,

surveys)?

• What Do Nurses, Pharmacists and Allied Health Professionals Have

to Say?

OPTIMUM Trial

Meguerditchian A et al. JMIR Res Protoc

2016

• Ongoing study involving 2 cancer centers in Montreal,

Canada

• Patients Age ≥65 years to Receive Adjuvant Endocrine

Therapy

• Primary outcome will be treatment discontinuation rates

• 1 site will allocated to the eHealth tool intervention; the

other to usual care

• Multiple factors controlled for in the statistical analysis,

including comorbidity and polypharmacy

Future Directions?TouchStream Intervention: Tablet

Slide Courtesy of Dr. Melissa Loh

TouchStream Intervention: Web-Portal

Slide Courtesy of Dr. Melissa Loh

Acknowledgments

• Dr. Melissa Loh, Geriatrics/Hematology-Oncology

Fellow, Univ of Rochester

• Dr. Allison Magnuson, Assistant Professor, Univ of

Rochester

• The rest of the Geri Onc team at Univ of Rochester

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