Why don’t we actively follow up with how the patients are doing at home?
The Problem
As noted by Jama Network, 19% of the U.S. cancer population are from rural areas. Rural patients with cancer have been shown to have worse outcomes than those in metropolitan regions. Dr. Patton, CEO of Tennessee Oncology, explains, "people who live in a city can come into the clinic whenever they want to, but that's not true in rural areas. Rural demographics tend to have a higher percentage of economically challenged populations. Transportation is a challenge, having caregivers is a challenge at times."
Per a recent health policy report for the New England Journal of Medicine, "the age-adjusted rate of cancer deaths in rural areas from 2011 to 2015 was 180.4 per 100,000 individuals, compared with just 157.8 per 100,000 individuals in large metropolitan areas.“ Disparities in cancer outcomes for rural patients in the United States seem to be on the incline, but a new technological service may offer a promising solution: at home check ins.
Jani Ahonala, co-founder of smart cloud-based mobile software known as Noona, recognized the gap in patient care. She explains, "One thing we never understood is why don't we actively follow up with how the patients are doing at home? They spend most of their time at home but only spend a few hours a month at a hospital." The primary issue Ahonala has with this? "Providers don't have any tools to understand what patients are going through." In addition, patients are often stuck without knowledge to take action when they get sick. If they have mild symptoms or side effects, they're forced to go to the ER and sometimes must stop their cancer treatment.
"All they need," Ahonala added, "is someone saying 'yes you have a symptom, but you shouldn't worry about it. It's something you can treat over the counter." That's what Noona will do, providing medical follow up in real time.
Systematically monitoring cancer patients’ symptoms from the comfort of their homes will help care teams to predict complications and relapses in earlier phases while eliminating need for patient transportation, added travel costs, and needless hospital visits.
How Noona Works
Noona consists of 15 modules like "activity," "sleep," "and "mental health" that are "tailored for different cancer types to optimally measure the most relevant parameters in the patient's condition during and after the treatment period," as stated on the system's website. Outside of reporting for active symptoms, Noona’s software algorithms send specific questionnaires based on the patient’s diagnosis and treatment plan.
The customizable modules and questionnaires simplify a patient's need to extensively articulate the issues they face, making symptom reporting quick and easy. Noona can be integrated with wearables to measure a patient's vital signals like physical activity, body temperature, blood pressure, etc. The system determines the frequency at which it sends questionnaires to patients based on patient preferences, treatment cycles, stage of the disease and online user behavior.
As soon as patients experience symptoms, they log in to Noona on their iPad or computer and report what they’re experiencing via an intuitive interface.
Noona, then, assesses the data while also sending it to a nurse triage platform at the patient’s cancer clinic for further analysis based on specifically cited symptoms, patient-specific information, answered questionnaires and data collected from other patient reports.
From there, the system can gauge the severity of the issue and a tool will push out recommendations on how to manage it based on algorithms and feedback from the nurse triage. "It's not the same as googling something and not having reliable sources. This gives [patients] reliable and controlled educational materials," said Dr. Patton. If the symptoms are severe, the nurse working the system interface would notify a physician and recommend the patient come in for an appointment.
Noona grants patients remote access to lab results, notes from physicians, and other custom information. A built-in depression and distress screening tool can also track patient mental health. To address those sorts of patient issues, Noona has three psychologists, who can work with distressed patients and their families.
“This is a way to empower patients and to put them right in the center of their care," said Dr. Patton. “There’s direct communication and controlled education. We know it improves outcomes and satisfaction of patients.”
Benefits of Noona
The patient reported outcomes help shift quality care from reactive to proactive because severe symptoms and relapses can be identified right away rather than when a patient can make it into a hospital to consult with their doctor. This means complications and health threats may be recognized early on and treated before further complications arise. The preemptive action will subsequently mitigate hospitalizations and emergency visits, as aforementioned.
“If a patient already has a grade three toxicity, medical persons would have to intervene and potentially hospitalization but if you catch side effects at low grade, there are interventions we can take that would prevent adverse effects like a hospitalization,” Dr. Patton said. “It provides medical professionals with the timeliness of identifying symptoms early.”
According to a randomized trial in the Journal of Clinical Oncology, the use of patient-reported outcome (PRO) solutions like Noona can result in 20% fewer ER visits, 30 to 50% fewer clinic calls, 10% fewer hospitalizations and a 20 to 25% improved survival rate.
The study found that PRO solutions may help patients live longer due to early recognition of severe symptoms and relapses, toxicity management, dose optimization and reduced treatment durations. Systematic remote monitoring of cancer patients’ symptoms, wellbeing and quality of life will help the care teams to predict complications and relapses in much earlier phase than before.
Present and Future
Ahonala believes the main problem traditional researchers face today is patient frustration with questionnaires on which they never receive medical feedback. Patients think, "if you don't review my data, then why should I bother?" posited Ahonala.
Noona provides a response that allows the patient to feel heard and has a 90% compliance rate among users.
For now, the platform remains in a growing phase. Tennessee Oncology provides cancer treatment to more than half of cancer patients in Tennessee. Noona currently exists in 33 clinics across the state and has 389 nurses and assistants responding to around 2,000 patients within the system.
In October of 2018, Noona was acquired by oncology software maker, Varian.
Dr. Patton believes technology like Noona will soon be an integral aspect of cancer care for all patients, whether they’re in metropolitan or rural areas.
