Vazquez-Zamora

Instituto Mexicano del Seguro Social, Mexico

Abstract Title:Addressing the unmet needs of women with breast cancer in Mexico a non-randomised pilot study of the digital ePRO intervention

Biography:

Dr. Vazquez-Zamora graduated in 2006 as a surgeon and midwife from Benemerita Universidad Autonoma de Puebla, studied Internal Medicine at the same University and later graduated as a doctor specializing in Radiation Oncology from National Autonomous University of Mexico. Completed fellowship in radiosurgery at University Hospital from Geneva, Switzerland. Since 2013 is in charge of head and neck cancer and central nervous system tumours, gynecological cancer and the radiocurgery clinic.

Research Interest:

Abstract: Introduction: The incidence of breast cancer has increased in Mexico in the past 60 years, and the cancer treatment typically involves a combination of local and systemic treatments whose side effects can negatively impact a patient’s physical and emotional health and quality of life, potentially interrupting cancer treatment and decreasing the patient’s chances of survival. Patient-reported outcome measures (PROs) have been developed to guide patient-centred care by aligning health services with patients’ values. Electronic PRO (ePRO) interventions have been proposed to facilitate patient-centred cancer care. Objectives: The Mexican Institute of Social Security (IMSS) provides healthcare to over 70 million people. In 2022, IMSS treated 71 000 women for breast cancer. Nearly all women treated for breast cancer at IMSS reported at least one unmet supportive care need, including health systems and information needs as well as psychological, physical, sexuality and patient care needs. To address the supportive care needs of women with breast cancer at IMSS, we designed an intervention combining a responsive web application registry to capture symptoms and supportive care needs with proactive follow-up by nurses guided by predefined clinical algorithms. Methods: We conducted a multimethod non-randomised pilot study from August 2023 to February 2024 within the oncology services of three IMSS hospitals. We used a pre-test/ post-test design for quantitative assessment of the intervention’s effect on patients’ supportive care needs and quality of life. Women between 20 and 75 years diagnosed with stage I–III breast cancer who: have started neoadjuvant or adjuvant treatment with chemotherapy or radiotherapy within the past 2 weeks; have access to the ePRO application internet via mobile phone, computer, or tablet. On this platform were entered weekly symptoms report asked about the presence and severity of 20 symptoms commonly experienced by women with breast cancer during neoadjuvant and adjuvant chemo and radiotherapy. In addition, the ePRO application also inquired about characteristics that help define the severity of these symptoms as mild, moderate, or severe. Nurses received immediate automatic alerts by email and followed-up with patients by telephone within 5–20 min to provide information or non-pharmacological guidance. Results: 50 women agreed to participate; the mean age was 53.4 years with 60% completing secondary schooling. 44% had clinical stage III, 40% had clinical stage II and the mean time since diagnosis was 39.5 weeks. Half received CT, and another half received RT. Local recurrence in the breast was observed in only 6% of patients. There were 203 website visits per IP address per month. Overall adherence to weekly symptom reporting was 76.3%, half of the participants had an adherence rate of 70% or higher. The median time nurses took to respond to moderate or severe alerts during business hours was 13 min, with an IQR of 8–20.5 min. All participants completed the 4-week assessment, the median number of supportive care needs decreased significantly from baseline to 4-week assessment: 11 versus 3, difference −8. Conclusion: The present study identified multiple benefits of the ePRO intervention perceived by women and health professionals and encouraging preliminary results related to high retention rate, decrease in the supportive care needs, and breast symptoms and increase in global quality of life, justifying further RCT. The study also revealed several barriers to successful ePRO implementation at individual, intervention and institutional levels and suggested improvements to the randomized controlled trial protocol methods.