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A Research Roadmap: Connected Health as an Enabler of Cancer Patient Support

2019-10-29, Signorelli, Gabriel, Lehocki, Fedor, Mora Fernandez, Matilde, O'Neill, Gillian, O'Connor, Dominic, Brennan, Louise, Monteiro-Guerra, Francisco, et al.

The evidence that quality of life is a positive variable for the survival of cancer patients has prompted the interest of the health and pharmaceutical industry in considering that variable as a final clinical outcome. Sustained improvements in cancer care in recent years have resulted in increased numbers of people living with and beyond cancer, with increased attention being placed on improving quality of life for those individuals. Connected Health provides the foundations for the transformation of cancer care into a patient-centric model, focused on providing fully connected, personalized support and therapy for the unique needs of each patient. Connected Health creates an opportunity to overcome barriers to health care support among patients diagnosed with chronic conditions. This paper provides an overview of important areas for the foundations of the creation of a new Connected Health paradigm in cancer care. Here we discuss the capabilities of mobile and wearable technologies; we also discuss pervasive and persuasive strategies and device systems to provide multidisciplinary and inclusive approaches for cancer patients for mental well-being, physical activity promotion, and rehabilitation. Several examples already show that there is enthusiasm in strengthening the possibilities offered by Connected Health in persuasive and pervasive technology in cancer care. Developments harnessing the Internet of Things, personalization, patient-centered design, and artificial intelligence help to monitor and assess the health status of cancer patients. Furthermore, this paper analyses the data infrastructure ecosystem for Connected Health and its semantic interoperability with the Connected Health economy ecosystem and its associated barriers. Interoperability is essential when developing Connected Health solutions that integrate with health systems and electronic health records. Given the exponential business growth of the Connected Health economy, there is an urgent need to develop mHealth (mobile health) exponentially, making it both an attractive and challenging market. In conclusion, there is a need for user-centered and multidisciplinary standards of practice to the design, development, evaluation, and implementation of Connected Health interventions in cancer care to ensure their acceptability, practicality, feasibility, effectiveness, affordability, safety, and equity.

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Functional, physiological and subjective responses to concurrent neuromuscular electrical stimulation (NMES) exercise in adult cancer survivors: a controlled prospective study

2020-08-19, O'Connor, Dominic, Lennon, Olive, Mora Fernandez, Matilde, Signorelli, Gabriel, Caulfield, Brian

The primary aim of this study was to investigate the functional, physiological and subjective responses to NMES exercise in cancer patients. Participants with a cancer diagnosis, currently undergoing treatment, and an had an Eastern Cooperative Oncology Group (ECOG) performance status (ECOG) of 1 and 2 were recommended to participate by their oncologist. Following a 2-week, no-NMES control period, each participant was asked to undertake a concurrent NMES exercise intervention over a 4-week period. Functional muscle strength [30 s sit-to-stand (30STS)], mobility [timed up and go (TUG)], exercise capacity [6-min walk test (6MWT)] and health related quality of life (HR-QoL) were assessed at baseline 1 (BL1), 2-week post control (BL2) and post 4-week NMES exercise intervention (POST). Physiological and subjective responses to LF-NMES were assessed during a 10-stage incremental session, recorded at BL2 and POST. Fourteen participants [mean age: 62 years (10)] completed the intervention. No adverse events were reported. 30STS (+ 2.4 reps, p =.007), and 6MWT (+ 44.3 m, p =.028) significantly improved after the intervention. No changes in TUG or HR-QoL were observed at POST. Concurrent NMES exercise may be an effective exercise intervention for augmenting physical function in participants with cancer and moderate and poor functional status. Implications for cancer survivors: By allowing participants to achieve therapeutic levels of exercise, concurrent NMES may be an effective supportive intervention in cancer rehabilitation.

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Personalised and progressive neuromuscular electrical stimulation (NMES) in patients with cancera clinical case series

2019-10-01, O'Connor, Dominic, Mora Fernandez, Matilde, Signorelli, Gabriel, Caulfield, Brian, Valero, Pedro

Purpose Neuromuscular electrical stimulation (NMES) may be a pragmatic short-term alternative to voluntary exercise to augment cancer rehabilitation. However, previous attempts to use NMES as an exercise modality in this cohort have been unsuccessful, largely due to the use of NMES protocols that were developed for other rehabilitation contexts. We assessed the effects of a personalised and progressive NMES exercise intervention, designed with early stage cancer rehabilitation in mind, on exercise capacity, lower body functional strength and quality of life in (QoL) in patients who are currently undergoing or have recently completed treatment for cancer. Methods Ten adult patients were recruited. A personalised and progressive NMES exercise intervention was implemented in each case over a 4 – 8-week period. The 30 seconds sit to stand test (STS), 6-minute walk test (6MWT), and EORTC QLQ C-30 were performed pre-and post-intervention. Patients completed semi structured interviews post intervention to explore their experiences and views on the intervention, and its impact on their daily lives. Results Six of the 10 recruited patients completed the intervention and completed pre-and post assessments. Four of 6 patients improved STS, 5 of 6 patients improved 6MWT and 4 of 6 patients improved Global QoL. Perceived benefits included improved muscle strength and more confidence when walking. Conclusion A personalised and progressive NMES exercise intervention appears safe and may improve functional capacity and QoL in adults who are undergoing or have recently completed treatment for cancer. Replication of these results in a controlled prospective study is warranted prior to clinical implementation.