Jamie Oliva, PhD, ANP-BC, FNAP, BMTCN, of the University of Rochester Wilmot Cancer Institute, discusses a study evaluating the use of a mobile health application to track symptoms of chronic graft-versus-host disease (GVHD) in patients who received allogeneic hematopoietic stem cell transplantation (HSCT). Dr. Oliva and colleagues presented interim results from the study during the 49th Annual Oncology Nursing Society (ONS) Congress.
Dr. Oliva explained why it was important to evaluate the use of a mobile health application to track symptoms of chronic GHVD in recipients of allogeneic HSCT.
“It's been my clinical observation that sometimes patients wait until that routine visit to report symptoms or they perhaps might minimize the symptom because it's not really significant yet, or they've had a symptom like that before that was self-limited and they could treat it by themselves,” Dr. Oliva explained. “And then when they do come to clinic, we have to rely on retrospective symptom recall… So, it's challenging to know exactly when the symptom exactly started and how it's progressed over time.”
The mobile health application monitors and tracks symptoms based on an existing application that has been validated by the National Cancer Institute, she explained. Dr. Oliva and colleagues modified the application to include common GVHD symptoms. Patients received daily prompts to rate their experiences of those symptoms on a Likert scale.
Dr. Olvia explained that “the first step in our journey is really to test the feasibility and usability of this app,” noting that it was important to determine if patients would use the app and if it was found to be easily useable. The study included a convenience sample of patients who had undergone allogeneic HSCT.
“It does not matter if they've had graft-versus-host-disease or not,” Dr. Oliva said. “It's that risk that is the bigger issue and really makes them eligible to participate.”
The researchers enrolled volunteers and onboarded them to the app during a clinic visit. Patients tracked their symptoms for 30 days using the app. An interim analysis was then conducted to evaluate its feasibility and usability.
“Our interim results were that most patients use the app at least once a week, which was a defined study feasibility threshold,” Dr. Oliva said. “And we had an instrument that measured usability… the usability score was actually very high.”
She explained the implications of the interim feasibility and usability results and her observations since the 30-day symptom-tracking period concluded.
“It's promising that there's high feasibility and high usability and many of the patients continue to use the app… they were welcome to use the app after their participation was over and a high proportion of them did continue to use the app. So that speaks, in my opinion, to feasibility [and] usability, as well.”
Dr. Oliva also spoke about the future directions for the research and what she hopes will happen next with the mobile health application.
“When we complete this study [of] feasibility and usability, [we] anticipate those thresholds will be met and then we can have good evidence about feasibility [and] usability to move to an intervention study,” she said. “That is the goal of this particular study.”
With the rarity of chronic GVHD, Dr. Oliva said she hopes to eventually evaluate the application in a large population of patients with the condition.
“I'd like to expand it a little bit into a multi-center study, an intervention study, so that we have an adequate sample,” she said.
This larger sample may help Dr. Oliva and colleagues understand if the mobile health application is “workable” regarding symptom monitoring and reporting, she said. It can also help the team understand if the application affects the incidence and timing of chronic GVHD, the severity of it at diagnosis, progression, and relapse outcomes.