By Rebecca Wilson
The coronavirus pandemic is an unprecedented disruption to society and the healthcare community in particular. Any and all information that could help keep cancer patients as safe and connected as possible is welcomed.
"While there is a lot that we don't know about COVID-19, the medical community does know that individuals with cancer and those receiving anti-cancer therapies and treatments are more susceptible, and both patients and survivors are at an increased risk for contracting a more severe case of COVID-19," explained Sung Poblete, PhD, RN, CEO of Stand Up To Cancer, a non-profit with a mission to help fast-track new cancer therapies.
A new app, the COVID-19 Symptom Tracker, could help all parties involved, including patients, doctors and researchers. Innovators at Massachusetts General Hospital, health care science company ZOE, the Harvard T.H. Chan School of Public Health, and King's College London recently teamed up to create the free app to help identify at-risk patients as early as possible, which is a key component to slowing the viral spread. While the app isn't intended to be a diagnostic tool, it is an excellent way to track possible cases.
"The first goal of the app was to gather data on symptom burden in real time to track new hotspots so we can better distribute resources to the areas that are most likely to need them," explained Andrew Chan, MD, MPH, one of the app's lead researchers at Massachusetts General Hospital. "The second goal is to offer patients in the community who are also participating in other clinical studies and feel disconnected from their healthcare providers a way to report their symptoms."
Stay at Home, Stay in Touch
The latter of the two goals is why the app holds particular significance for patients with cancer, many of whom "typically crave information," according to Poblete. Now, with COVID-19 limiting healthcare visits, cancer patients may feel more isolated than ever.
"We wanted to find a way to make sure these patients' voices are heard, to check on how they are doing," Chan noted.
With the help of Stand Up To Cancer, the researchers included specific screening questions to give those patients their voice and to track crucial data.
"When Dr. Chan introduced us to the app, we saw an opportunity to add value by including questions specific to cancer patients," noted Poblete.
The app gathers demographic information such as age, sex, current medications and systemic complications, such as cancer. Patients who check "yes" to living with cancer are provided a few extra questions, such as what type of cancer they have, whether or not they are participating in a clinical trial and if they are on any chemotherapy or immunotherapy regimens.
"By including questions specific to cancer patients and survivors, we are hoping to improve outcomes for the cancer community and find the answers to so many questions when it comes to COVID-19 and these more at-risk populations," Poblete explained. "This data will help us learn how we can best support this high-risk community."
Chan added that the user-friendly app uses an intuitive process that balances the researchers' need for information with a respect for people's time. The app's format makes it a breeze for users, dubbed 'stay-at-home scientists' by the developers, to report how they are feeling—daily.
"We really need users to report even when they are feeling well, because the goal is to track change over time," Chan emphasized. "They may feel well one day, and then note new symptoms the next."
Poblete describes the common difficulty patients have remembering when symptoms first started, which can make a significant difference when trying to track a long-lasting and fast-moving virus like COVID-19.
"With the simple act of clicking on the app daily, entering if you've been tested for COVID-19, if you are feeling ok or unwell, and symptoms you might be having, we hope that the cancer community will be more cognizant of symptoms and reach out to their healthcare provider in a more timely manner."
Chan encourages oncologists to discuss the COVID-19 Symptom Tracker with patients and their families and to explain the importance of using the app as a health tracker.
One of the biggest issues with COVID-19 is that we just don't have enough data on the impact it has on cancer patients, Chan noted. Early studies suggest that patients with cancer have worse outcomes with COVID-19, but those are small studies primarily from other countries and focus on patients who developed the most severe infections, he added. While the information is helpful, it's also incomplete. Many patients experience mild, or even no, symptoms, "so we need more data on the spectrum of COVID infection," Chan explained.
This is where the app comes in. "This will lay the foundation for longer-term data," he explained. "It's going to be really important to understand the impact COVID-19 has on cancer care long-term, and this is where it starts."
"When we are able to gather data, we can make additional findings that may be important for patients and survivors," Poblete added. "If we don't gather data, we won't be able to assess the impact of comorbidity of cancer and COVID-19 with the same confidence."
Chan and his team are already seeing actionable data with the app, even as new users continue to sign on and report. While fever and new-onset dry cough are well-known early symptoms of COVID-19, early data pulled from the app revealed 59 percent of those who reported a positive COVID-19 test in their daily app also recorded a loss of smell or taste.
Chan and his team hope recruiting more users across the UK and the US can help them better understand symptoms, viral spread and overall infection rates.
"The more patients, their family members and greater community use the app, the more valuable the data," Chan emphasized. "As a physician I have embraced the call to help my patients. As a researcher, I also feel the need to support the public response by identifying new modalities to rapidly collect and analyze data that can have an immediate impact on patients."
Rebecca Wilson is a contributing writer.