The Last Word
workforce, thus supplementing a shrinking oncologist workforce. Already used in cardiology and several other disease states, MHealth has reduced congestive heart failure hospital emergency department admissions by about two-thirds through point-of-care assessment that facilitates diagnosis and treatment by enabling remote physicians to advise on-site nurses, health workers, or caregivers. By sharing information on a patient’s status immediately, the software allows physicians to prioritize care, preventing deterioration of a patient’s condition and so head off disease progression. This track record suggests a myriad of possibilities that aggressive software development in this bioinformatics platform holds for PM in cancer, which is so dependent on informatics and personal counseling to achieve its treatment goals. Consider as a case in point 2 articles on prostate cancer risk factors that happened to appear in the same May 2013 issue of Cancer Epidemiology, Biomarkers & Prevention: “Sleep Disruption Among Older Men and Risk of Prostate Cancer” and “Obesity and Future Prostate Cancer Risk Among Men After an Initial Benign Biopsy of the Prostate.” The advantages of monitoring patients for exacerbation of either risk factor for prostate cancer speak volumes to the potential of MHealth to oncology PM. It also speaks to the issue staring oncology square in the face: finding the economies needed for the advance of PM informational sharing – whose complexity is suggested with all the subtlety of a sledgehammer in that first paragraph quoted at the beginning of this article. The cancer tumor/disease progression information updates that the oncologist, nurse, or pharmacist needs to receive is well suited to the MHealth bioinformatics platform. With apps developed relevant to the informational needs of practicing oncologists, MHealth can deliver on the promise of PM, which relies on an enriched patient population. The problem facing PM is trying to write this new chapter in the conquest of cancer using informational technology on the order of a clay tablet and stylus. It is time oncologists had technological weaponry equal to the complexity of the information they depend on in the PM arena. The breadth of functions that MHealth innovation can
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provide underscores the long list of tasks that oncology PM must satisfy. This bioinformatics platform can be outfitted with patient-oncologist contact and access capabilities appropriate to changes in a patient’s condition and signal oncologists, nurse navigators, pharmacists, hospitals, or any appropriate member of the treatment team/system to respond in a timely fashion. Alternately, an app could monitor adherence to treatment regimens or other ongoing trends affecting a patient’s condition. The patient in turn could reach out to the treatment team with questions or concerns. Either way, the flow of information is the essential PM linchpin for timing appropriate interventions – and this is the key to avoiding waste and achieving the pinpoint precision that PM requires. The benefits of MHealth to PM’s uptake are legion: timely responses, avoiding needless hospitalizations or ensuring quick hospitalization when needed, and the simple sharing of queries between patients and their providers to assuage fears and help keep patients and physicians clear on the goals of treatment. In short, a telemedicine platform has emerged with the potential to help PM deliver premier quality care while avoiding waste in resource allocation like never before. It is curious that information mobility could play so significant a part in bringing this about – but there it is: MHealth is a tactical element essential to bringing cost, quality, and access under control, and the data already exist, albeit in other disease states, to support this claim. A smartphone app that puts patient needs into clear and immediate focus, regardless of whether the patient or provider is at work or at the opera…now that’s a game changer. Dick Tracy, eat your heart out. The cancer apps for this tool appear certain to be written, and quickly. It will be interesting to see their order of progression. This will be an MHealth marvel worth watching. It appears we are ready to write that new chapter in the history of PM in cancer…with materials considerably more current than a clay tablet and stylus.
Robert E. Henry
PERSONALIZED MEDICINE
IN
ONCOLOGY
May 2013