The HOPE Trial: Helping Ovarian cancer Patients Excel
The goal of palliative chemotherapy is to reduce symptoms
and extend survival. Yet, oncologists’ methods of monitoring patients’ symptoms
are underdeveloped. Studies show that clinicians consistently miss more than
half of cancer patients’ symptoms, even in clinical trials that mandate
collection of treatment toxicities. Similarly, oncologists’ estimates of
patients’ performance statuses are highly subjective, yet key determinants of
patients’ eligibility for clinical trials, chemotherapy, and hospice.
Oncologists’ performance status estimates are only moderately correlated with
one another and are even less reliable when compared with patients’ estimates.
Smartphones offer an accessible, low-cost method for
conducting assessments of patients' symptoms and activity levels. The goal of
this proposal is to adapt, refine, and pilot-test an existing smartphone
research platform named “HOPE: Helping Ovarian cancer Patients Excel” to assess
patients’ toxicities and activity levels in a population of seriously-ill
patients with gynecologic cancers receiving palliative chemotherapy. This study
is innovative because it will harness a validated app, paired with both a
phone-based and wearable Fitbit accelerometer, to collect patients’ toxicities
and activity levels between clinic visits, categorize patients’ symptoms as
low- or high-risk, and provide patients with tailored advice to help manage
their symptoms in real time in the real world. The app will also generate a
graphical display of data obtained between visits for patients and physicians
to discuss during subsequent visits.
We will conduct a pilot randomized controlled trial of the
adapted and refined smartphone app plus a wearable accelerometer vs. usual care
in 60 patients with metastatic gynecologic cancers to assess the feasibility and
acceptability of the intervention. If we meet our feasibility and acceptability
targets, we will plan a full-scale randomized trial of the HOPE intervention to
formally test whether it improves symptoms, activity levels, and clinical
outcomes in cancer patients with serious illnesses.
Alexi A. Wright, MD, MPH is
Assistant Professor of Internal Medicine at Harvard Medical School and a
practicing medical gynecologic oncologist at Dana-Farber Cancer Institute. Dr.
Wright is a health services researcher whose work focuses on improving outcomes
in women with gynecologic cancers and ensuring that cancer patients’
end-of-life care is both patient-centered and congruent with their informed
values. She is currently examining how patients, caregivers, and physicians
make decisions about palliative chemotherapy and the outcomes of these
decisions. She is also testing interventions to improve cancer patients’
decision-making, quality of life, and outcomes while receiving palliative
chemotherapy. Dr. Wright has received funding from the National Palliative Care
Research Center, the American Society of Clinical Oncology, the American Cancer
Society, and the National Cancer Institute.