With oral cancer treatment, we achieve that patients have fewer hospital visits. It is also more convenient for less mobile patients. Often it is difficult to control their loyalty to their treatment, medication intake, stools, nutritional intake and weight,… By home monitoring, it is possible to give patients a quick follow-up for their side effects, weight loss and diminished food intake.
We try to work multidisciplinary with a medical- and paramedical team. For the dieticians, it was important to see which patients were malnourished in the home situation. When patients are hospitalized they are screened for malnutrition by NRS 2002. Ambulatory patients are being referred by doctors, nurses and other paramedics. Even then, for us as dietitians, it is difficult to intercept every patient with nutritional problems. So we needed a tool for follow up at home for people who get oral chemotherapy. The AMOCT study helped to develop an application for home monitoring.
Selected patients got a smartphone to register medication intake, stools, nutritional intake, weight and other parameters at home. For example, they got a notification when they had to take their medication accompanied with the right dose. Afterwards, they had to confirm that they took the medication. Also, stools were being monitored by noting the consistency of their faeces.
Concerning nutrition, we did an anamnesis of the nutritional intake of patients who participated in the study and set an energy requirement. This energy requirement was spread throughout several meals. When necessary patients received a nutritional advice concerning malnutrition. Oral nutritional supplements like sip feeds were started when needed. At home, they had to answer a couple of questions concerning nutrition on their smartphones. The questions were about dinner. The application questioned whether the patient did have dinner and what this meal consisted off, F.E. vegetables, meat/fish and potatoes or other carbohydrate rich food. For each nutritional group the patient has to assign how much he/she ate by pictures of several portions. At last, the smartphone asks how many oral nutritional supplements the patient used and the patient has to enter his/her weight daily.
The smartphone gives a notification when there is 5% weight loss in 1 month, 5% weight loss in 3 months or 10% weight loss in 6 months.
In the future, we plan to use a new application only for nutrition. The application will be applied for all home enteral nutrition, not only for oncology patients.
In collaboration with Remedus. The current application, also for other home monitoring is called remecoach.