Acceptability And Feasibility Of A Tablet Based Supportive Care Platform For Metastatic Breast Cancer Patients

Although metastatic breast cancer (MBC) survival is improving, symptoms associated with the disease process and treatments remain burdensome. Technology enabled supportive care platforms may reduce the challenges some MBC patients experience traveling to cancer centers. PURPOSE: This partial cross-over randomized controlled trial examined the acceptability, feasibility, patient satisfaction, cost, and initial efficacy of a tabled-based supportive care intervention (Nurse AMIE: Addressing Metastatic Individuals Everyday). METHODS: Seventeen female MBC patients (60 ± 11.6y) were randomized to immediate or delayed start for a three month intervention that included daily tablet-based guideline-concordant self-care for pain, distress, fatigue, and sleep, and weekly calls with a patient navigator. The primary outcome was patient acceptability. Secondary outcomes included feasibility, patient satisfaction, cost, and between group change in symptoms (pain, distress, fatigue, and sleep) across time. RM-ANOVAs examined differences in symptoms between immediate and delayed-start over time. Hedges’ d effect sizes [95%CI] quantified the magnitude of differences in change between groups across time for symptoms. RESULTS: We observed a patient acceptance rate of 68%, and feasibility rate of 48%. Patient satisfaction ranged from 83% for walking, to 49% for the psychological interventions. The cost of delivering Nurse AMIE for 3 months was $570.23. No significant group x time interactions were found for all symptoms (all p ≥ 0.16). There were small magnitude, nonsignificant improvements in fatigue (d = 0.24, [-0.70 to 1.17]), pain severity (d = -0.03, [-0.96 to 0.90]), and pain interference (d = -0.08, [-0.85 to 1.01]). Nonsignificant, but potentially clinically meaningful, moderate improvements were found for sleep (d = 0.65, [-0.30 to 1.61]) and distress (d = 0.74, [-0.31 to 1.79]). CONCLUSION: In a setting where the average travel distance to the cancer institute was nearly 50 miles, a tablet-based supportive care platform offering guideline-concordant self-care for pain, fatigue, sleep, and distress was acceptable and feasible for MBC patients. Patient satisfaction scores and initial evaluation of efficacy are promising, and the Nurse AMIE platform warrants further investigation.