Platform’s Feasibility and patients’ satisfaction
CureCancer was feasible, as it was highlighted from the increased participation of patients (> 80%) who offered us a wealth of patient-driven information. Importantly, patients highlighted the sense of safety, treatment adherence, reduced hospital visits and infection risk, saving time and money and their good communication with HCPs. Treatment adherence το oral anticancer agents and supportive care services can highly benefit with telemedicine particularly during the COVID-19 pandemic, while patient – doctor communication is an important factor in cancer care [10, 11, 13, 14]. Receiving newsletters and request for a mobile application were considered positive comments. Importantly, one patient highlighted that Medical Oncologists are responsible for the promotion and effective use of CureCancer.
Physicians were satisfied and commented on the improved communication with patients and colleagues, enhancing their clinical practice. Cross-sectoral video consultations to enhance continuity of cancer care received positive comments by oncologists, general practitioners and patients in another study .
Discussing the patient-reported profile, cancer status and socioeconomic details
As cancer diagnosis and therapy affect different physical, socioeconomic and occupational domains of life, the above information was thought necessary to assess the overall profile of cancer patients - users, in this preliminary phase of CureCancer function.
Age and level of education: Our patients were about one decade younger than the global median age of 66 years of cancer patients. A younger median age was also reported by other digital health solutions [16-19]. A median age of 63 years, aligned with the global median cancer rage, was reported in a web-based study, when, however, patients completed the survey, at the hospital, receiving assistance, when needed [6, 14]. Most participants, in the present study, were University and High School graduates, indicating an association between younger age and digital solutions. A higher education level was also related to higher acceptability of the digital solutions by other investigators [16-19]. Furthermore, in our study, the percentage of the University graduates was reduced at the completion of the study, compared to the one assessed 5 months after the initiation of the study (56% versus 61%), while the High School graduates were increased (30.75 % vs 23%) indicating a push to internet literacy due to the urgent need for digital solutions as a result of social distancing, related to the COVID-19 pandemic .
Cancer types, status and treatments, supportive care and care by non-oncology HCPs: Breast and lung cancers were most common cancer types, while the lack of prostate cancer reporting was interesting and could be related to the younger age of our cohort . CureCancer was feasible for patients under active treatment and/or advanced cancer. Almost half of our patients (44.7%) received supportive care. With appropriate supportive care, patients under active treatment successfully participated in another digital health solution . Although disease, users and treatment characteristics, reported in the present study, were relatively aligned with those in the literature, the level of agreement between disease and treatment characteristics, recorded in the Hospital files and those self-reported by our patients is not known and this could be the goal of a next study.
Importantly all patients visited non-oncology HCPs, while about half of them visited 2-9 HCPs, pointing to a multimorbidity status in our cohort. Multimorbidity and associated polypharmacy, with drug-drug interactions and other adverse events can increase cancer patient’s toxicity and healthcare burden and highlights the need for good communication between HCPs . This need for enhanced communication can be met with the use of CureCancer, according to the users’ experience and responses.
Working status, social profile and financial toxicity: Cancer diagnosis was related to changes at work, such as retirement, not contract renewal, or job change due to cancer therapy. The negative consequences of cancer therapy on employment, associated with financial problems and increased financial toxicity and reduced Health-Related Quality of Life were also reported by others [22, 23]. The living alone status and children at School can also add to patients’ burden and financial toxicity [1, 2, 24].
Patient communities: Although patient communities were reported as the main environment to connect with others and obtain trusted information, few patients, in the present study, participated in patients’ communities, possibly due to cultural differences .
Strengths and weaknesses
CureCancer had a positive impact on cancer supportive care fulfilling most of the qualities for a digital platform to re-form oncology care, particularly during periods of pandemics [3, 10]. The study is limited by its feasibility and satisfaction assessment nature.