Using Technology in Practice to Improve Patient Symptoms: the eCO experience

November 2018 Vol 9, NO 11
Nicole Houston, BSN, RN, CCRP
National Cancer Institute
Irene Ekwede, MSN, BSN, RN
National Cancer Institute
Stephanie Morrissey, RN, BSN
Dana-Farber Cancer Institute
Brittany Bowes, RN, BSN
Dana-Farber Cancer Institute
Eleni Rokakis, RN, BSN
Moffitt Cancer Center
Ruth Phillips, RN, BSN, MS, OCN
Blue Spark Technologies, Philadelphia, PA
Ellie Strock, ANP-BC, FAANP, CDE
Christin Whalen, RN, BSN, OCN
Dana-Farber Cancer Institute

Background: Cediranib-olaparib in combination has been shown to cause rapidly escalating hypertension and severe diarrhea in patients treated for ovarian cancer. Managing these side effects requires patients to be educated on the importance of reporting side effects, as well as close communication with the healthcare team. Digital technology offers a new way of enhancing communication channels and empowers patients to self-manage symptoms when appropriate.

Objectives: Electronic cediranib-olaparib (eCO) is a digital therapeutic built to support symptom monitoring for patients treated with cediranib-olaparib. eCO includes a mobile app for patients and a web portal for the healthcare team connected via the Cloud. Patients reported blood pressure twice daily using a Bluetooth-connected device, and reported diarrhea when it occurred. The app provided recommendations for self-management of symptoms. The primary goal of our study was to understand patients’ acceptance and use of a digital therapeutic to manage symptoms. We also needed to understand how using digital technology would impact the care process, and what practice changes would be required.

Methods: eCO was utilized in a feasibility, usability substudy within NCT02345265. Patient selection was based on the individual’s level of comfort with technology, willingness to participate, and level of compliance with previous therapies. During the pilot, User-Centered Design, Inc conducted a 10-minute phone interview with patients after 1 week of use. After 4 weeks of use, patients completed a usability/satisfaction questionnaire. Healthcare professionals completed a usability/satisfaction questionnaire at the completion of the pilot study.

Results: Sixteen patients enrolled from 4 participating sites (Dana-Farber Cancer Institute, Boston, MA; Moffitt Cancer Center, Tampa, FL; National Cancer Institute, Bethesda, MD; The Ohio State University Comprehensive Cancer Care Center, Columbus, OH). All completed the pilot study. The median age of participants was 58 years (range, 36-80 years). No application-related adverse events were reported. Patients found the application allowed for easy entry of blood pressure measurements and liked the history graph and summary that was available, which included timed entries of daily blood pressures. They found the list of study team contacts very helpful when needing to make a call. Patients using eCO entered data as expected 98.2% of the time.1 Nurses were able to check the web portal at all times to assess blood pressure readings and symptoms regardless of direct patient communication. Nurses found the app extremely helpful in assisting patients to manage diarrhea. eCO allowed nurses to act quickly and often prophylactically.

Conclusions: The introduction of a mobile application for patients with ovarian cancer improved the level of care provided and the level of confidence for including mobile applications in the care of future patients. eCO gave nurses confirmation that patients were doing well but also confirmed compliance in reporting blood pressures and other symptoms. Patients who needed attention were identified early, with appropriate interventions carried out to prevent escalation of symptoms. The eCO digital technology was relatively easy to implement and required minimal changes to practice. Looking to the future, the incorporation of digital technology should be a major component of patient care.
Note: The authors reported no financial disclosures and no conflicts.


  1. Liu JF, Lee J-M, Strock E, et al. Technology applications: use of digital health technology to enable drug development. Clin Cancer Inform. 2018.
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