Review Outlines Unmet Need for Digital Health in Elderly Patients With MM

Patients with multiple myeloma (MM) who are elderly, at risk of relapse, or reside in rural communities often lack access to comprehensive, informative, and user-friendly digital health tools, suggesting that more needs to be done in this area to improve health-related quality of life (HRQoL), according to a review.

The literature review, published in JCO Clinical Cancer Informatics, comprised the multiple uses for digital health for the MM population, the barriers that prevent patients and health care providers (HCPs) from implementing it, and presented suggestions for guidelines and future clinical trials to improve adoptions rates.

“The growing demand for more personalized, patient-centric, and cost-effective care for patients with MM continues to drive the development of digital health solutions. These hold promise in improving patient education, patient and caregiver engagement, communication with HCPs, proactive symptom management, medication adherence, and HRQoL,” the authors wrote.

The median age at diagnosis of patients with MM is 69 years with the greatest incidence for adults between 65 and 74 years. Polypharmacy is common among elderly patients, potentially leading to adherence issues, drug-drug interactions, and increased risks of toxicities for this population, especially as oral antimyeloma therapies become more common. Additionally, MM is associated with the highest symptom burden and impacts to HRQoL among patients with hematologic malignancies.

Longitudinal patient-reported outcomes (PRO) monitoring can improve drug adherence, and management of MM has transitioned to a style that is similar to how chronic diseases are managed. Although data has demonstrated that digital health technologies can have a positive impact on patients in other areas of oncology, few studies have been conducted in patients with MM.

Most studies on digital health have focused on telemedicine, which is a great alternative to in-person visits for patients who live far from a clinic, have unreliable transportation, or mobility issues. During the COVID-19 pandemic, telehealth capabilities significantly increased. However, there has been substantial variability in telehealth adoption between states, suggesting that greater use of these tools is needed.

Tools for improving medication adherence, patient symptom monitoring, vital sign and activity monitoring, and fostering communication between patients and their providers have all shown to improve PROs, patient satisfaction, and HRQoL. However, a lack of access to, an inability to use, or a lack of acceptance of digital health technologies can jeopardize the effectiveness of these tools, especially because only 53% of US adults over 65 years old own a smartphone. MM mortality is also higher among patients who live in rural areas and those with later-stage disease, with some evidence suggesting that these populations of patients also are less likely to use digital technology.

Social media as a digital health tool has pros and cons. Social medica can empower patients with cancer by providing psychosocial support, informational support, enhanced relationships with physicians, and sources of education regarding cancer care and clinical trials. Conversely, social media can be rampant with misinformation, be an insufficient substitution for in-person support, may contain financial exploitation, contribute to information overload, and carry privacy concerns regarding personal information.

Studies focusing on social media in cancer populations mostly consist of White patients aged around 60 years who were treated at primarily academic medical centers. The authors suggested that future studies based in social media should be tailored to reach a representative group of patients with MM.

“Given the promise of these new technologies for improving outcomes in this important patient population, further studies are essential and the data that they provide will be much anticipated. We suggest that MM-specific guidelines should be developed to promote the integration of validated technologies into each phase of the patient journey. In the future, when digital technologies are widely deployed and all HCPs have access to evidence-based guidelines, patients with MM can hopefully experience better health and QoL,” the authors suggested.

Reference

Jagannath S, Mikhael J, Nadeem O, Raje N. Digital health for patients with multiple myeloma: An unmet need. JCO Clin Cancer Inform. 2021;5:1096-1105. doi:10.1200/CCI.20. 00145