title: Detection of lung cancer relapse using self-reported symptoms transmitted via an internet web-application: pilot study of the sentinel follow-up.
abstract: OBJECTIVE
  We aimed to investigate whether patient self-evaluated symptoms transmitted via Internet can be used between planned visits to provide an early indication of disease relapse in lung cancer.
  
  
  METHODS
  Between 2/2013 and 8/2013, 42 patients with lung cancer having access to Internet were prospectively recruited to weekly fill a form of 11 self-assessed symptoms called "sentinel follow-up". Data were sent to the oncologist in real-time between planned visits. An alert email was sent to oncologist when self-scored symptoms matched some predefined criteria. Follow-up visit and imaging were then organized after a phone call for confirming suspect symptoms. Weekly and monthly compliances, easiness with which patients used the web-application and the accuracy of the sentinel follow-up for relapse detection were assessed and compared to a routine visit and imaging follow-up.
  
  
  RESULTS
  Median follow-up duration was 18 weeks (8-32). Weekly and monthly average compliances were 79 and 94 %, respectively. Sixty percents of patients declared to be less anxious during the few days before planned visit and imaging with the sentinel follow-up than without. Sensitivity, specificity, positive, and negative predictive values provided by the sentinel (planned imaging) follow-up were 100 %(84 %), 89 %(96 %), 81 %(91 %), and 100 %(93 %), respectively and well correlated with relapse (pχ (2) < 0.001). On average, relapses were detectable 5 weeks earlier with sentinel than planned visit.
  
  
  CONCLUSIONS
  An individualized cancer follow-up that schedule visit and imaging according to the patient status based on weekly self-reported symptoms transmitted via Internet is feasible with high compliance. It may even provide earlier detection of lung cancer relapse and care.
authors.affiliation: Private Institut of Cancer, 9 rue Beauverger, Le Mans, France, f.denis@cjb72.org.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Denis
authors.forename: Louise
authors.initials: L
authors.lastname: Viger
authors.forename: Alexandre
authors.initials: A
authors.lastname: Charron
authors.forename: Eric
authors.initials: E
authors.lastname: Voog
authors.forename: Olivier
authors.initials: O
authors.lastname: Dupuis
authors.forename: Yoann
authors.initials: Y
authors.lastname: Pointreau
authors.forename: Christophe
authors.initials: C
authors.lastname: Letellier
mesh_terms: D059026:Diagnostic Self Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010349:Patient Compliance; D010865:Pilot Projects; D011446:Prospective Studies; D011795:Surveys and Questionnaires