title: Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European Project.
abstract: Telehealth solutions can improve the safety of ambulatory chemotherapy, contributing to the maintenance of patients at their home, hence improving their well-being, all the while reducing health care costs. There is, however, need for a practicable multilevel monitoring solution, encompassing relevant outputs involved in the pathophysiology of chemotherapy-induced toxicity. Domomedicine embraces the delivery of complex care and medical procedures at the patient's home based on modern technologies, and thus it offers an integrated approach for increasing the safety of cancer patients on chemotherapy.
  
  
  
  The objective was to evaluate patient compliance and clinical relevance of a novel integrated multiparametric telemonitoring domomedicine platform in cancer patients receiving multidrug chemotherapy at home.
  
  
  
  Self-measured body weight, self-rated symptoms using the 19-item MD Anderson Symptom Inventory (MDASI), and circadian rest-activity rhythm recording with a wrist accelerometer (actigraph) were transmitted daily by patients to a server via the Internet, using a dedicated platform installed at home. Daily body weight changes, individual MDASI scores, and relative percentage of activity in-bed versus out-of-bed (I<O) were computed. Chemotherapy was administered according to the patient medical condition. Compliance was evaluated according to the proportions of (1) patient-days with all data available (full) and (2) patient-days with at least one parameter available (minimal). Acceptability was assessed using the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire. Linear discriminant analysis was used to identify the combination of parameters associated with subsequent unplanned hospitalization.
  
  
  
  A total of 31 patients (males: 55% [17/31]; World Health Organization Performance Status=0: 29% (9/31); age range: 35-91 years) participated for a median of 58 days (38-313). They received a total of 102 chemotherapy courses (64.7% as outpatients). Overall full compliance was 59.7% (522/874), with at least one data available for 830/874 patient-days (95.0%), during the 30-day per-protocol span. Missing data rates were similar for each parameter. Patients were altogether satisfied with the use of the platform. Ten toxicity-related hospitalizations occurred in 6 patients. The combination of weighted circadian function (actigraphy parameter I<O), body weight change, and MDASI scores predicted for ensuing emergency hospitalization within 3 days, with an accuracy of 94%.
  
  
  
  Multidimensional daily telemonitoring of body weight, circadian rest-activity rhythm, and patient-reported symptoms was feasible, satisfactory, and clinically relevant in patients on chemotherapy. This domomedicine platform constitutes a unique tool for the further development of safe home-based chemotherapy administration.
authors.affiliation: Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.|Department of Oncology, Queen Elizabeth Hospital, Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom.|French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.
authors.forename: Pasquale F
authors.identifier: 0000-0002-0653-8261
authors.initials: PF
authors.lastname: Innominato
authors.affiliation: Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.|French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.
authors.forename: Sandra
authors.identifier: 0000-0003-3886-6494
authors.initials: S
authors.lastname: Komarzynski
authors.affiliation: Laboratory of Signals and Systems (L2S), Unit 8506, Gif-sur-Yvette, France.
authors.forename: Ali
authors.identifier: 0000-0003-0678-7759
authors.initials: A
authors.lastname: Mohammad-Djafari
authors.affiliation: French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.
authors.forename: Alexandre
authors.identifier: 0000-0002-7087-3603
authors.initials: A
authors.lastname: Arbaud
authors.affiliation: French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.|Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.
authors.forename: Ayhan
authors.identifier: 0000-0001-8683-6818
authors.initials: A
authors.lastname: Ulusakarya
authors.affiliation: French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.|Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.|Ramsay Générale de Santé, Mousseau Clinics, Evry, France.
authors.forename: Mohamed
authors.identifier: 0000-0001-9096-6922
authors.initials: M
authors.lastname: Bouchahda
authors.affiliation: Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.
authors.forename: Mazen
authors.identifier: 0000-0002-7337-3401
authors.initials: M
authors.lastname: Haydar
authors.affiliation: Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.
authors.forename: Rachel
authors.identifier: 0000-0002-6646-2481
authors.initials: R
authors.lastname: Bossevot-Desmaris
authors.affiliation: Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.
authors.forename: Virginie
authors.identifier: 0000-0002-5976-3825
authors.initials: V
authors.lastname: Plessis
authors.affiliation: Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.
authors.forename: Magali
authors.identifier: 0000-0002-2623-9445
authors.initials: M
authors.lastname: Mocquery
authors.affiliation: Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.
authors.forename: Davina
authors.identifier: 0000-0002-8166-3927
authors.initials: D
authors.lastname: Bouchoucha
authors.affiliation: St Georges Hospital, National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Mehran
authors.identifier: 0000-0002-1095-3046
authors.initials: M
authors.lastname: Afshar
authors.affiliation: French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.
authors.forename: Jacques
authors.identifier: 0000-0002-1110-7706
authors.initials: J
authors.lastname: Beau
authors.affiliation: French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.|AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France.
authors.forename: Abdoulaye
authors.identifier: 0000-0003-2074-2557
authors.initials: A
authors.lastname: Karaboué
authors.affiliation: Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.|Faculty of Medicine, Paris South University, Le Kremlin-Bicêtre, France.
authors.forename: Jean-François
authors.identifier: 0000-0002-8745-8414
authors.initials: JF
authors.lastname: Morère
authors.affiliation: Chorleywood Health Centre, Chorleywood, United Kingdom.
authors.forename: Joanna
authors.identifier: 0000-0003-0612-0399
authors.initials: J
authors.lastname: Fursse
authors.affiliation: Telefónica Research and Development, Barcelona, Spain.
authors.forename: Jordi
authors.identifier: 0000-0003-0771-691X
authors.initials: J
authors.lastname: Rovira Simon
authors.affiliation: Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.|Department of Oncology, Queen Elizabeth Hospital, Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom.|French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.|Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.
authors.forename: Francis
authors.identifier: 0000-0003-1364-7463
authors.initials: F
authors.lastname: Levi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D019454:Chronotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000188:drug therapy*; D010349:Patient Compliance; D011795:Surveys and Questionnaires; D017216:Telemedicine; D055815:Young Adult
keywords: MDASI; actigraphy; chronotherapy; domomedicine; telemonitoring