As the director of behavioral medicine at Camden, N.J.-based MD Anderson Cancer Center at Cooper, Cori McMahon is familiar with the physical symptoms of cancer treatment, but perhaps even more intimately familiar with the emotional symptoms, such as feelings of depression and anxiety. A new pilot study of breast cancer patients at MD Anderson Cancer Center at Cooper is leveraging wearable technology to address some of these facets of the patient experience, with the ultimate goal of improving patients’ quality of life during treatment.
“We’re hoping to improve the sense of control that patients feel during treatment. What often happens when you are diagnosed with cancer is that you feel as if you have lost control of a great deal, if not most, of your life,” McMahon says, referring to the nine-month pilot study that involves 30 breast cancer patients. McMahon, who, along with her team, provides psychology support to the oncology patients at Cooper, is aware of the impact of integrating behavioral health into cancer care. “Through this project, I’m hoping that it moves the patient from being a passive recipient of their medical care to being an active participant in their medical care,” she says.
The pilot project uses the Apple Watch
For the project, MD Anderson Cancer Center at Cooper is teaming up with Wayne, Pa.-based Polaris Health Directions, a behavioral health technology vendor, to capture behavioral health data of 30 breast cancer patients as they use customized Apple Watches and Polaris’ emPower app to record their experiences during specific times in their treatment cycle. The project also leverages Polestar, Polaris’ behavioral health outcomes management platform. While the app, which runs on the Apple Watch and users’ smartphones, is the key to the patient engagement aspect of the project, the Polestar platform will collect that data and provide it to the clinical and behavioral health teams. The goal is to use that data to provide better care and improve patient outcomes.
According to McMahon, built-in sensors in the Apple Watch will track passive data such as heart rate and patient activity levels, and the emPower app will collect patient-initiated data via “daily check-ins.”
“Patients will answer a quick question that asks them to rate their mood and rate their pain level as well as their fatigue level every day,” she says. McMahon notes that the app will collect data about patients’ feelings of depression and anxiety with bi-weekly “check-ins” that focus specifically on those behavioral health issues. “Unfortunately, in the area of cancer care, those symptoms are not uncommon,” she says.
One critical aim of the project is to help patients improve their health literacy, McMahon says. “That means patients are able to understand how their body and their minds are reacting to treatment.”
At the same time, McMahon and her team are hoping the project will improve communication between breast cancer patients and the medical teams as well as the efficiency and clarity of that communication, and that is where the real-time data capturing capabilities of wearable technology like the Apple Watch comes into play.
“What happens when patients are seeing me as a psychologist and also seeing their medical doctors once a week is that they have to recall the symptoms they experienced during the week. They might say to me, ‘I felt significant anxiety last week on my way into chemotherapy and radiation.’ And, we can talk about it and try to address it, but if we can capture this data, have patients really able to look at those symptoms in more real-time, and then collect that data in real-time, we may be able to intervene more quickly. Both because patients will see what’s happening and then communicate with us and also because we’ll see it happening through the data,” McMahon says.
“Another type of data we want to collect during the project is the communication data and we want to see if patients are interested in participating in virtual Apple Watch-enabled support groups with other project participants,” she says. “We know that support groups are a good thing for patients to come to, but unfortunately, when patients are in active treatment, they feel terrible and they are going to a number of appointments a week, so it’s not always feasible for patients to physically get to a support group meeting. We’re interested to see if a virtual support group is useful.”
MD Anderson Cancer Center at Cooper opened its doors two years ago through a partnership between the University of Texas MD Anderson Cancer Center and Cooper University Health Care. The two organizations wanted to create a comprehensive cancer center as well as co-branded satellites in New Jersey. As a vendor, Polaris has had a relationship with Cooper University Health Care for the past 10 years, and now MD Anderson at Cooper, with developing behavioral health solutions for its continuum care processes. That relationship with the MD Anderson at Cooper healthcare teams prompted Polaris to suggest a project exploring wearable technology in the area of behavioral health and oncology patients, says John McLaughlin, senior vice president, sales and business development at Polaris Health Directions.
“I joked with them that if they bought me an Apple Watch, then I was in,” McMahon says. As a leading treatment center, MD Anderson at Cooper was an ideal partner and setting for the project as the project teams had the ability to impact patients during their active treatment phases.
For the project, Polaris’ tech teams specifically tailored the emPOWER app for oncology patients in collaboration with the clinical and behavioral health teams at MD Anderson at Cooper. The app also leverages Apple’s iOS HealthKit to access relevant physical health metrics. According to McMahon, the data collected through the emPower app and through the HealthKit goes to a cloud-based server and the Polestar platform managed by Polaris.
“Once all that data collected comes into the Polestar platform, we have the ability, through our analytics technology, to take that data and parse it and make sense of it on behalf of MD Anderson at Cooper. And we then provide that data back to them so they can use those insights to provide better care to patients,” McLaughlin says.
For the breast cancer patients involved in the pilot study, the data will be accessible through a weekly dashboard as well as daily summaries of their physical and behavioral health.
“This gets back to health literacy because if the patients can see what they are going through and how they are rating their mood and pain levels, they can then learn patterns in terms of how their minds and bodies are responding to treatment. And, they can then communicate that with the medical team and my team,” McMahon says.
All this real-time, patient-generated data can translate into better, faster care. For example, there are automatic messages built into the app that are triggered by certain patient responses. If a breast cancer patient involved in the pilot study rates her mood as low for two days in a row or rates her pain level as high for several days, she will get specific automatic messages via the app on the Apple Watch, McMahon says.
“We’re able to push an automatic message through the app, such as ‘We see you are feeling down, would you like to speak with someone?’ or ‘We see you’re experiencing pain, would you like to speak to the oncology nurse navigator?’
Throughout the project, the clinical and behavioral health teams, in collaboration with Polaris, will be consistently honing and upgrading the app based on patients’ feedback. “We hope to expand this to other cancer disease sites and ultimately to other chronic health conditions, perhaps diabetes management, for example,” McMahon says.
Mark Anthony, Polaris CEO, says Polaris’ vision is to unite technology with leading edge behavioral health research to transform patient outcomes, in this case, “the lives of women who are currently undergoing breast cancer treatment.”
“MD Anderson at Cooper has long been aligned with this vision. We knew they were the perfect partners for this pilot and look forward to making a positive impact on patient quality of life together,” he says.
