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The Surprising Degree By Which MoovCare, A Web App, Helps Cancer Patients Live Longer

This article is more than 7 years old.

I’m not generally keen on health apps. So when I planned my last day at the cancer meeting in Chicago, I considered skipping out on the first paper at the early press session with a techy-dull title: “Improved Overall Survival in Lung Cancer Patients Using a Web Application-Mediated Follow-up (Moovcare) Compare to Standard Modalities: Results of Phase III Randomized Trial.”

I was astonished by the results. The app’s benefits were so clear that the study had to be stopped early, said Dr. Fabrice Denis, an oncologist based at the Institut Inter-regional de Cancérologie in Le Mans, France who presented the late-breaking report at the ASCO conference.

In the SENTINEL study, people with high-risk lung cancer were assigned to access MoovCare, a symptom-reporting web tool, or routine follow-up. In this analysis of 121 evaluable patients receiving care at five medical centers, split between two trial arms, median follow-up was 9 months.

The intervention prolonged life. Overall survival was 19 months in the group assigned to use MoovCare, and 12 months in the group receiving standard follow-up for lung cancer after surgery. This difference was highly significant from a statistical perspective (p=0.0014) and from a clinical perspective.

Benefits of MoovCare included fewer deaths, less use of routine imaging tests and prompter access to treatment when symptoms occurred. It appears to be a win/win/win.

“If we had a drug that caused this level of survival benefit, wouldn’t we want to go out and use it?” said Dr. Patricia Ganz, an oncologist and professor at UCLA’s Jonsson Comprehensive Cancer Center. She’s an expert in survivorship and health policy, not involved in the MoovCare project, who discussed the findings.

Note, these were not young people using the app; the median age of the patients enrolled was 65 years. Eligibility for the trial required Internet access and prior experience using email. All had lung cancer for which monitoring was required. Most had advanced, stage III or IV disease. At the time of enrollment, they needed have stable disease, but could be receiving chemotherapy or a pill, such as a targeted therapy.

Patients assigned to use MoovCare were asked to provide weekly self-assessment of 12 symptoms. They or a caregiver submitted those updates using a smartphone or computer. The technology is being developed by Sivan Innovation, a company based in Jerusalem.

Based on the patients’ assessments–what are essentially patient-reported outcomes–a MoovCare algorithm determines the need for possible intervention. The system generates an alert, such as an email, to doctors in case of a concerning change in the patient’s condition. The physician would be prompted, then, to arrange for an examination and appointment, and might change the cancer treatment, which in this Phase III trial could include supportive care.

The responsiveness of the MoovCare protocol led patients to receive care when their symptoms changed, in a “personalized” and non-routine fashion, i.e. when they needed it. By contrast, patients assigned to standard follow-up visited their doctors, as is routine, and underwent CT scans every 3-6 months based on the doctor’s or researcher’s clinical discretion. Patients assigned to the app had approximately 50% fewer imaging studies than those assigned to standard follow-up.

In discussing these results, Dr. Patricia Ganz referred to the ABIM’s Choosing Wisely campaign. Her point was that that the app reduced patients’ exposure to imaging procedures, such as CT scans, without compromising their well-being. The app has the potential to lower the costs of care, while improving quality and length of life.

While listening to Dr. Denis’s presentation, I wondered: How can an app make such a difference? It seems dreamy, but there’s nothing magical about the app. Perhaps the algorithm is better than a physician’s judgment, for prompting an exam or change in care.

I asked if the app could function as a surrogate for patient engagement. Perhaps it’s just one way by which patients might benefit by more frequent reporting of symptoms and contact with their doctors.

Denis suggested said that yes, it’s about communication. Phone calls might work, he considered. If patients were evaluated weekly, without an app, that might provide a similarly positive effect, he and others on the panel suggested. But then doctors’ offices would have to hire staff to deal with those communications, he and others considered.

“We know when patients report their symptoms, the data rarely generates action,” Ganz added. “Here it seems to be doing that.”

Toward the end, I asked Denis if the MoovCare app might help patients with other diseases and cancer types. “Yes, of course,” he responded.

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