A smartphone app that includes artificial intelligence elements may be able to reduce the effects of cancer-related pain, according to recent research presented at the 2018 American Society of Clinical Oncology (ASCO) Palliative and Supportive Care in Oncology Symposium.
The app, named ePAL, was designed and studied as part of a collaboration between Partners HealthCare Pivot Labs, the Massachusetts General Hospital Division of Palliative Care, and the Massachusetts General Hospital Cancer Center.
“There is a significant shortage of palliative care providers, which will only worsen in the future as our population ages,” lead study author Mihir M. Kamdar, M.D., associate director of the Division of Palliative Care and an interventional pain physician at Massachusetts General Hospital in Boston, said in a statement. “This is one of the reasons why technology solutions to help manage palliative care challenges, such as cancer pain, are so important.”
“The vast majority of people with cancer experience pain at some point, and we need better tools to track and report it,” said Joshua Adam Jones, MD, MA, Chair, 2018 Palliative and Supportive Care in Oncology Symposium News Planning Team. “My hope is that these findings will pave the way for more widespread use of apps among patients who are experiencing pain, so that they can get the support they need.”
Key stakeholders, including Partners HealthCare Pivot Labs, the Massachusetts General Hospital Division of Palliative Care and the Massachusetts General Hospital Cancer Center, collaborated to create the ePAL app, which sent daily alerts to users’ phones with pain management tips. The app also prompted them to rate their pain on a scale of zero to 10 (10 being the worst pain imaginable) three times each week. In turn, the app was able to distinguish between urgent and non-urgent pain and provide individuals with real-time education. If users reported severe pain or indicated a need for medical attention, the app automatically connected them with their clinicians.
Fifty-six patients with metastatic solid tumors were asked to use the app over an eight-week period, while 56 of their counterparts were assigned to usual care without app usage. All 112 participants filled out questionnaires at the beginning, middle and end of the eight-week period.
At the start of the study, the two groups had similar pain levels, with an average pain score of 4. However, by the end of the eight weeks, the group that used the app experienced a 20 percent decrease in pain scores – from 4 to 2.99.
In addition, the app lessened the number of pain-related inpatient hospital admissions compared to those who were not using ePAL, which led to a 69 percent reduction, per patient, in the risk for having a pain-related admission during the study for those who used the app.
“It’s significant that patients who used the app had significantly fewer hospital admissions without an associated increase in outpatient clinical burden,” said senior investigator Kamal Jethwani, M.D., senior director of Pivot Labs at Partners HealthCare. “These findings suggest that integrating innovations like mobile technology and artificial intelligence could have a real impact on patient well-being, resource utilization and cost of care.”
However, when it came to anxiety patients using the app saw a steeper increase than those who did not. Anxiety was ranked on a scale of zero to 21, and those using ePAL experienced an increase from 6.67 to 7.68 compared to a decrease from 5.9 to 5.03 for those who did not use the app. The researchers explained that some people may become anxious just by being asked about pain and that it should be noted that app users who reported pain more than twice a week did not experience an increase in anxiety.
Moving forward, the researchers hope that these findings can pave the way for more artificial intelligence-telehealth platforms that can continue to be studied in other settings.
“We’re especially interested to see if this type of novel technology can be helpful in areas where access to palliative care is limited,” said Kamdar. “Our hope is to use innovation and technology to extend the reach of palliative care to those who need it most.”