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Objectives. Remote monitoring (RM) of health-related outcomes may optimize cancer care and prevention outside of clinic settings. CYCORE is a software-based system for collection and analyses of sensor and mobile data. We evaluated CYCORE’s feasibility in studies assessing: (1) physical functioning in colorectal cancer (CRC) patients; (2) swallowing exercise adherence in head and neck cancer (HNC) patients during radiation therapy; and (3) tobacco use in cancer survivors post-tobacco treatment (TTP). Methods. Participants completed RM: for CRC, blood pressure, activity, GPS; for HNC, video of swallowing exercises; for TTP, expired carbon monoxide. Patient-reported outcomes were assessed daily. Results. For CRC, HNC and TTP, respectively, 50, 37, and 50 participants achieved 96%, 84%, 96% completion rates. Also, 91-100% rated ease and self-efficacy as highly favorable, 72-100% gave equivalent ratings for overall satisfaction, 72-93% had low/no data privacy concerns. Conclusion. RM was highly feasible and acceptable for patients across diverse use cases.

We have established considerable expertise in studying the role of platelets in cancer biology. From this expertise, we were keen to recognize the numerous venous-, arterial-, microvascular-, and macrovascular thrombotic events and immunologic disorders are caused by severe, acute-respiratory-syndrome coronavirus 2 (SARS-CoV-2) infections. With this offering, we explore the evolutionary connections that place platelets at the center of hemostasis, immunity, and adaptive phylogeny. Coevolutionary changes have also occurred in vertebrate viruses and their vertebrate hosts that reflect their respective evolutionary interactions. As mammals adapted from aquatic to terrestrial life and the heavy blood loss associated with placentalization-based live birth, platelets evolved phylogenetically from thrombocytes toward higher megakaryocyte-blebbing-based production rates and the lack of nuclei. With no nuclei and robust RNA synthesis, this adaptation may have influenced viral replication to become less efficient after virus particles are engulfed. Human platelets express numerous receptors that bind viral particles, which developed from archetypal origins to initiate aggregation and exocytic-release of thrombo-, immuno-, angiogenic-, growth-, and repair-stimulatory granule contents. Whether by direct, evolutionary, selective pressure, or not, these responses may help to contain virus spread, attract immune cells for eradication, and stimulate angiogenesis, growth, and wound repair after viral damage. Because mammalian and marsupial platelets became smaller and more plate-like their biophysical properties improved in function, which facilitated distribution near vessel walls in fluid-shear fields. This adaptation increased the probability that platelets could then interact with and engulf shedding virus particles. Platelets also generate circulating microvesicles that increase membrane surface-area encounters and mark viral targets. In order to match virus-production rates, billions of platelets are generated and turned over per day to continually provide active defenses and adaptation to suppress the spectrum of evolving threats like SARS-CoV-2.

Both platelets and the liver play important roles in the processes of coagulation and innate immunity. Platelet responses at the site of an injury are rapid; their immediate activation and structural changes minimize the loss of blood. The majority of coagulation proteins are produced by the liver—a multifunctional organ that also plays a critical role in many processes: removal of toxins and metabolism of fats, proteins, carbohydrates, and drugs. Chronic inflammation, trauma, or other causes of irreversible damage to the liver can dysregulate these pathways leading to organ and systemic abnormalities. In some cases, platelet-to-lymphocyte ratios can also be a predictor of disease outcome. An example is cirrhosis, which increases the risk of bleeding and prothrombotic events followed by activation of platelets. Along with a triggered coagulation cascade, the platelets increase the risk of pro-thrombotic events and contribute to cancer progression and metastasis. This progression and the resulting tissue destruction is physiologically comparable to a persistent, chronic wound. Various cancers, including colorectal cancer, have been associated with increased thrombocytosis, platelet activation, platelet-storage granule release, and thrombosis; anti-platelet agents can reduce cancer risk and progression. However, in cancer patients with pre-existing liver disease who are undergoing chemotherapy, the risk of thrombotic events becomes challenging to manage due to their inherent risk for bleeding. Chemotherapy, also known to induce damage to the liver, further increases the frequency of thrombotic events. Depending on individual patient risks, these factors acting together can disrupt the fragile balance between pro- and anti-coagulant processes, heightening liver thrombogenesis, and possibly providing a niche for circulating tumor cells to adhere to—thus promoting both liver metastasis and cancer-cell survival following treatment (that is, with minimal residual disease in the liver).

6063Background: Assessment and intervention with mobile and sensor technology may improve early detection and mitigation of treatment-related symptoms, impact quality of life (QOL), reduce complications, and lower health care costs. The CYCORE (CYberinfrastructure for COmparative effectiveness Research) system utilizes sensor and mobile technology to remotely assess daily weight, blood pressure (BP)/pulse, and patient-reported outcomes in head and neck cancer (HNC) patients undergoing radiation treatment (RT). Clinicians reviewed data daily to identify early risk of dehydration and support early intervention to improve symptom management. We compared longitudinal symptom data in patients randomized to use CYCORE during RT versus those randomized to usual care. Methods: Methods: HNC patients (n = 357) completed the 28-item MD Anderson Symptom Inventory (MDASI) at RT initiation (baseline), completion of RT (6-7 weeks post-baseline), and 6-8 weeks post-RT completion. Symptom severity and interference were ra...

The potential of communication and health information technologies to transform research and improve clinical care in cancer has only begun to be realized (1,2). There is a need for innovative strategies and technologies that enable the aggregation and analysis of clinical and research data (including real-time health-related outcomes) and that foster the translation of knowledge gained into improvements in patient care (2–4). The use of health information technologies may alter how health-care providers and patients interact with personal health information by facilitating the collection, analysis, and dissemination of data to enhance clinical decision making (3). In turn, patients may report symptoms more readily and be reassured knowing that their providers are better informed about all aspects of their treatment and care. The American Society of Clinical Oncology has emphasized the need to use communication and information technology to better integrate clinical and translational research with patient care so that patients’ experiences can inform research and improve care (1). Accomplishing this goal requires a systems approach that enables greater and more rapid access to patient clinical information to better understand therapeutic responses, side effects, quality of life, and general health status (1). This approach may improve oncology care by synthesizing and distilling large amounts of data to identify earlier opportunities to manage treatment side effects and complications, as well as long-term survivorship issues (1,3). Systems that enable remote and real-time monitoring of patients’ symptoms and other health-related outcomes may offer cost-effective strategies to optimize cancer care outside of the clinic setting (5,6). Remote collection and transmission of patient health–related data to facilitate clinical decision making have been used in the management of chronic diseases other than cancer (7–12), and this has been shown to improve patient quality of life and symptom control, decrease emergency room visits and unplanned hospitalizations, and decrease overall health-care costs (12–15). Less is known about which patients and under which circumstances remote monitoring is most appropriate and effective, particularly in oncology (16,17). Studies evaluating remote real-time monitoring of cancer patients have reported positive outcomes (5); however, empiric evidence includes the collection of patient-reported outcomes largely using currently available telecommunications technologies (17,18). Systems that include biometric and self-reported feedback for cancer patients have been conceptualized; however, there is limited evidence regarding their feasibility or efficacy (19,20). This paper describes the results of an initial application of a novel system that incorporates data on environmental, psychological, treatment adherence, and lifestyle behaviors and the patient-reported outcomes into cancer treatment and research. The system, called CYCORE (CYberinfrastructure for COmparative effectiveness REsearch), is a software-based prototype of a user-friendly cyberinfrastructure that supports the acquisition, storage, visualization, analysis, and communication of data across the cancer continuum, using a suite of home-based and mobile sensors (19). Health-related data collected include symptoms, quality of life, performance status, and physiological parameters that can signal how patients are self-managing their treatment. The CYCORE prototype was rigorously tested in several diverse use cases that were grounded in challenging, real-world clinical problems in cancer prevention and treatment (19). One use case, which is the focus of this report, engaged head and neck cancer (HNC) patients in the use of home-based sensors for collecting and communicating blood pressure, pulse, weight, and patient-reported symptoms to their HNC radiation therapy (RT) clinicians. Clinicians reviewed these data outside of clinic visits for earlier identification of dehydration risk secondary to outpatient RT. HNCs are highly curable, yet primary RT is physically and emotionally challenging for patients (21). RT involves a 6- to 7-week course of 5 day/week treatments and causes serious locoregional side effects. In its severe form, mucositis, which occurs in up to 80% of irradiated HNC patients, makes it very difficult for patients to drink adequate levels of fluids (22). As a result, dehydration and its accompanying physiological changes can develop rapidly, often between weekly physician visits that are standard of care during RT. When unresolved, dehydration can lead to acute episodes requiring hospitalization and/or emergency care visits that are costly and potentially preventable. The number of patients affected is substantial, as up to 27% of HNC patients may be admitted to inpatient or emergency care units during RT (23–25) (personal communication, E. Shinn). Dehydration may represent one of the largest incremental health-care expenses in treating mucositis and related side effects for HNC (23). The development of systems to closely monitor hydration status has been suggested as a potentially valuable intervention that may reduce hospitalization and health-care costs, in addition to improving quality of life (26–28). Technology that supports remote monitoring of HNC patients during RT may enable greater access to clinical and patient-reported data that are currently unavailable, may provide greater insight into patients’ therapeutic response, and may help to identify opportunities for earlier and more effective intervention. In this context, CYCORE may serve as a new model of a communication architecture for improving clinical care and patient support outside of the clinic setting during critical periods of cancer treatment. This study evaluated the feasibility of using CYCORE to address early at-home identification of dehydration risk in HNC patients undergoing RT.

152 Background: Early identification and mitigation of cancer therapy-induced complications can improve quality of life and reduce complications and health care costs. We are evaluating the efficacy of a system, called CYCORE (CYberinfrastructure for Comparative effectiveness Research), to systematically and accurately collect daily weight, blood pressure, pulse and symptom data from head and neck cancer (HNC) survivors during their 6 to 7-week radiation treatment (RT) regimen using home-based biometric and other sensors integrated with a cyber-physical system. Aims include: 1) evaluate CYCORE’s efficacy in reducing hospitalization and emergency room visits related to dehydration; and, 2) evaluate related impact on costs related to treating dehydration. Methods: Remote, sensor-based monitoring via CYCORE identifies HNC survivors at increased risk for dehydration (i.e., reduced blood pressure and weight, increased pulse, and patient-reported outcomes (PROs) including decreased food and fluid intake). Upon initation of RT, HNC survivors are randomized to either: 1) standard care plus use of the CYCORE system, wherein biometric sensor data and PROs (e.g., pain, nausea, medications, food/fluid intake) are collected ; or, 2) standard care. Outcomes include hospital and emergency room admissions, and related costs. Results: To date, 113 survivors are enrolled (88.9% recruitment and 90.3% retention rates). Those randomized to CYCORE take daily home readings of weight, blood pressure and pulse via Bluetooth-enabled devices, and complete daily PRO assessments on a mobile application. Survivors’ data are available for viewing and clinical decision-making via a Web-based interface by their physicians and other providers. Previously, 59% of HNC survivors on RT showed physiologic signs of dehydration while using the CYCORE system. Worse ratings of nausea and vomiting predicted dehydration risk. Conclusions: CYCORE may serve as one model for integrating mobile and sensor technologies during critical periods of cancer care that occur outside of the clinic setting, and may improve management of treatment side effects, quality of life, and greater satisfaction with care. Clinical trial information: NCT02253238.

9585 Background: Remote monitoring of patients outside of the clinic setting during critical periods of care is an emerging paradigm in oncology. CYCORE (CYberinfrastructure for COmparative effecti...