Analysis of the applicability of the mHealth ALIBIRD platform and its impact on the follow-up of patients with lung cancer.
Authors: Sereno Maria , Iniesta-Chamorro Jose M. , Garrido Beatriz , Villarino Marta , Espinosa-Salinas Isabel , Falagan Sandra , Rubio Gustavo , Hernández de Córdoba Sánchez Irene , Morales Parga Maria , Moreno-Rubio Juan , Moreno Arribas M.V , Ramirez de Molina Ana , Gómez Enrique Javier , Casado Enrique 
Published: June 2023

e24050

Background: Lung cancer is associated with a wide symptom burden. Often, patient's symptoms are inadequately captured during routine visits. For this reason, there is an increasing interest in developing effective approaches for patient-reported symptom management at home. Emerging evidence suggests that this strategy should lead to reducing toxicity and emergency room visits and improving quality of life. In the context of the ALIBIRD2020-CM project, we developed the mHealth ALIBIRD platform (mHAP) to remotely monitoring cancer patients. Methods: The mHAP implemented consists of a mobile application for patients and a web tool for the clinical team. Through the mobile application, patients record symptoms, toxicities, and lifestyle variables such as diet, physical activity and sleep through Fitbit wearables. Based on patient-reported outcomes (PRO), patient-reported outcome measures (PROM), patient gut microbiome and nutrigenomics data, this platform provides personalised recommendations and advice. Clinicians can visualise patient data, resolve symptom alerts, and make clinical-therapeutic decisions. A single-branch interventional pilot study was carried out at Hospital Infanta Sofía and approved by the Ethics Committee (HULP PI-4735). The primary outcome was to assess the mHAP, usability. The secondary outcome was to assess the clinical impact of the tool. Results: Twenty patients with stage IV thoracic neoplasms under active treatment participated for 6 months with 10 face-to-face visits for oncological and nutritional control. Anthropometric parameters were measured at each nutritional control, and muscle ultrasound was performed on visits 1, 5, and 10. Our results demonstrate a high level of user satisfaction with mHAP. A total of 679 symptoms were captured by mHAP, 96 alerts were detected and resolved (only 3 patients were referred to ER) and an early detection of a progression was done. The two main categories of severe toxicities recorded through the PROCTCAE questionnaire were the sensation of pain (25%) and asthenia and quality of rest (23%). There was an increase in the trend of moderate physical activity and adherence to the Mediterranean diet (21.4%) from baseline. Nutrigenetic analyses have led to the detection of 5 lactose intolerant patients and 4 patients with intermediate tolerance to gluten. Preliminary results from gut microbiome analysis indicate that 75% of the patients have dysbiosis. At the last visit, the HADS questionnaire showed 7% of cases with anxiety problems and 14% with depression. Conclusions: The findings obtained so far relate the mHAP to a favourable clinical impact, high usability and satisfaction. mHAP promotes healthy lifestyle and patient´empowerment, and supports clinicians for personalized recommendations, therapeutic adjustments in medication and nutritional supplementation as well as referrals to other specialists.