A mobile platform to allow patients to track, manage, and understand their care from home

Cancer care burden is growing, and one in two people now develop cancer. More than 2.5 million people in the UK were living with or after cancer in 2015 (see references). Global cancer deaths are projected to increase 45% by 2030.

Within cancer care, there is major unmet demand for personalised care and collection of patient-reported data, in order to:

• Improve patient self-management and quality of life (QoL), which are crucially important, as rising survival means many patients remain on long-term toxic treatments for 10 years or more
• Enable remote tracking and follow-up
• Streamline service delivery and reduce workforce burden

Situation

The NHS Long Term Plan sets out that all cancer patients should be able to access personalised care, including health and wellbeing assessment, information and support by 2021. This support must be available remotely to minimise patient inconvenience, personalise care, streamline services and reduce workforce burden.

Aspiration

Clinicians are spending precious time documenting toxicity themselves in clinic, which increases workforce burden, and patients are often being asked to attend clinic for treatment and then found to be too unwell and sent home again - wasting patient and service time. Better remote patient support, tracking, and communication can solve these issues.

Solution and impact

Vinehealth is a digital ecosystem combining behavioural science and AI (artificial intelligence) to deliver personalised support to improve cancer-related quality of life and clinical outcomes.

Vinehealth’s patient-facing mobile app delivers personalised Trust-specific support to patients, using evidence-based information to deliver medication reminders, clinical alerts, behavioural nudges, and psychological support.

This improves patient experience and self-management and enables patients to easily log and transfer PROMs data to clinicians. PROMs data collection allows clinicians to see, pre-empt and rapidly address clinical deteriorations. The Vinehealth platform can programme in any bespoke PROMs and questionnaires that may be wanted by a service, including holistic needs assessments (HNAs) and red flag questionnaires, as well as validated tools, such as European Organisation for Research and Treatment of Cancer (EoRTC) QLQ-C30, to be delivered to patients at the required frequency.

Patients can access summary reports of their data, equipping them to quickly and simply express their clinical history to clinicians. The Vinehealth ecosystem also includes a web dashboard (VinehealthPRO), accessible from primary and secondary care, from which individual or cohort level PROMs data can be viewed. It is also interoperable with electronic health records (EHRs) to drive clinical research and inform clinical decisions and service redesign. Communication of this rich data is particularly important to NHS teams in enabling stratified follow-up, remote tracking, and in enabling cancer care reviews with often limited resource.

Impact

Since its release in 2020, Vinehealth app has had approximately 5,000 voluntary patient downloads. Cohort analysis of patient usage data from more than 5,000 downloads of the Vinehealth app has demonstrated:

• feasibility of long-term use of the app across ages and other demographics
• platform usability and accessibility for the intended population
• evidence for positive impact on patient QoL and self-management. Study results have been published by the National Cancer Research Institute and UK Oncology Nursing Society.

Study results were presented in e-posters at the National Cancer Research Institute Cancer Conference and UK Oncology Nursing Society.

Royal Marsden NHS Trust undertook a mixed-methods longitudinal study evaluating the impact of Vinehealth on cancer patient engagement, self-management, QoL and PRO data collection during COVID-19. Patients receiving systemic anti-cancer therapy (SACT) were recruited across all tumour types. Outcomes included validated QoL instruments, app usage data, and semi-structured interviews.

Results show:

• 97% patient engagement
• 100% PROM (EQ5D) completion (primary outcome)
• 87% patients reported improved quality of life whilst using the app
• extensive positive qualitative feedback from independent patient and clinician semi-structured interviews

Functionality

The Vinehealth technology includes both a patient-facing mobile app and a web dashboard that can operate standalone or integrate with EHRs.

Data is cloud-based and all data processes are compliant with NHS requirements.

Capabilities

The platform allows patients to:

• easily report and monitor their symptoms, toxicity, medication adherence, and activity levels along clinically-validated scales
• access a library of evidence-based and Trust-specific advice and guidance, ensuring much better understanding and self-management around identified needs
• benefit from more effective communication with clinical teams through summary reports and remote gathering of PROMS data

The platform allows oncology clinicians and NHS Trusts to:

• see, pre-empt and rapidly address clinical deteriorations
• gather consistent PROMs data and validated toxicity data
• deliver evidence-based, Trust-specific information to patients
• remotely follow-up patients to streamline services and reduce workforce burden

Scope

The system is suitable for patients able to access care at home. Clinicians can remotely track patients through the clinician dashboard to support clinical decision making.

Key learning points

• The platform has been co-developed with patients and clinicians
• For patients, there has been a clear focus on accessibility and usability, for example for those who are sight impaired, have neuropathy, low health literacy, low digital literacy, or who want to more easily involved in loved ones and caregivers
• For clinicians, the focus has been on viewing information quickly and concisely to shorten consultation times and reduce the burden of toxicity scoring or completing HNAs for each patient. The clinician-facing aspect of the platform has been developed in consultation with more than 100 NHS oncology consultants, clinical nurse specialists (CNSs), pharmacists, dieticians and other allied health professionals.

Key figures/quotes

"I wish Vinehealth was around when I was diagnosed. It would have made it so easy to keep track of things, and make sure that my oncologist was getting accurate info instead of relying on my chemo-brain."
Dr Liz O'Riordan - Retired consultant breast surgeon with breast cancer

“Vinehealth extends the depth and breadth of information available to allow patients to make the best possible decision regarding their care with the clinical team. The platform also allows carefully curated information to be shared with the patient. Patients can definitely benefit from the advantages it offers.”
Professor Geoff Hall - consultant medical oncologist, CCIO Leeds Teaching Hospitals and professor of digital health and cancer medicine, University of Leeds

"The Vinehealth remote monitoring and support app is an important development in improving cancer patient outcomes and experience and is invaluable during the Covid pandemic."
Professor Muntzer Mughal - clinical lead - NCL Cancer Alliance, consultant general and upper GI surgeon, honorary clinical professor, division of surgery and interventional sciences, University College London

“An empowering and trusted platform which enables better patient-healthcare professional collaborative care”
Dr Pauline Leonard - consultant medical oncologist, co-chair of NCRI’s Living With and Beyond Cancer workstream

“Facilitates efficient and effective communication and strengthens relationships between patients and their medical team.”
Dr. Michael Kosmin - consultant clinical oncologist, National Hospital for Neurology and Neurosurgery and University College London Hospital

“This is a fantastic app and I use it everyday to monitor my wellbeing whilst going through breast cancer. I have tried several other apps and they didn't offer what I wanted. With Vinehealth you can record appointments and medication, any side effects you are experiencing each day, what types of exercise you are taking and hints and tips to manage your cancer”
Michaela Allison - patient

Find out more

Find out more on the Vinehealth website

References

Cancer prevalence data on CancerData

Economic impact of cancer in the UK revealed (2020)

Key contact

Dr Rayna Patel, co-founder and CEO of Vinehealth and NHS Doctor

rayna@vinehealth.ai