Abstract

BackgroundNausea and vomiting are common and distressing side effects for children receiving chemotherapy. Limited evidence is available to guide antiemetic recommendations; therefore, prospective and reliable evaluation of antiemetic efficacy is needed. Smartphone apps can be used to effortlessly and precisely collect patient-reported outcomes in real time.ObjectiveOur objective was to develop a smartphone app to monitor nausea and vomiting episodes in pediatric cancer patients aged 0 to 18 years and to test its usability and adherence to its use.MethodsWe used a user-centered design process and the evolutionary prototype model to develop and evaluate the app. Multidisciplinary group discussions and several rounds of patient feedback and modification were conducted. We translated the validated Pediatric Nausea Assessment Tool to assess nausea severity in children aged 4 to 18 years. The child’s own term for nausea was interactively incorporated in the nausea severity question, with response options expressed as 4 illustrative faces. Parent-reported outcomes were used for children aged 0 to 3 years. Reminders were sent using push notifications in order to ensure high response rates. Children aged 0 to 18 years who were undergoing chemotherapy were recruited from the Department of Pediatric Oncology at Copenhagen University Hospital Rigshospitalet to evaluate the app.ResultsThe app’s most important function was to record nausea severity in children. After assistance from a researcher, children aged 4 to 18 years were able to report their symptoms in the app, and parents were able to report symptoms for their children aged 0 to 3 years. Children (n=20, aged 2.0-17.5 years) and their parents evaluated the app prospectively during a collective total of 60 chemotherapy cycles. They expressed that the app was user-friendly, intuitive, and that the time spent on data entry was fair. The response rates were on average 92%, 93%, and 80% for the day before, the first day of, and the next 3 days after chemotherapy, respectively. Researchers and clinicians were able to obtain an overview of the patient’s chemotherapy dates and responses through a secure and encrypted web-based administrative portal. Data could be downloaded for further analysis.ConclusionsThe user-friendly app could be used to facilitate future pediatric antiemetic trials and to refine antiemetic treatment during chemotherapy.

Highlights

  • Chemotherapy-induced nausea and vomiting are among the most common and burdensome side effects that are experienced by children who are undergoing cancer treatment [1,2]

  • The prevention of chemotherapy-induced nausea and vomiting has been improved over the years with novel antiemetic drug combinations [3,4,5,6], but approximately 50% of pediatric cancer patients still suffer from chemotherapy-induced nausea and vomiting [7,8,9]

  • Clinicians and children express and interpret nausea differently, which makes it a challenge to score the symptoms with high validity and reliability; antiemetic efficacy in pediatric trials is often solely based on vomiting, while nausea is rarely included as a clinical outcome [7,8,10]

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Summary

Introduction

BackgroundChemotherapy-induced nausea and vomiting are among the most common and burdensome side effects that are experienced by children who are undergoing cancer treatment [1,2]. Clinicians and children express and interpret nausea differently, which makes it a challenge to score the symptoms with high validity and reliability; antiemetic efficacy in pediatric trials is often solely based on vomiting (an objective outcome), while nausea (a subjective outcome) is rarely included as a clinical outcome [7,8,10]. Objective: Our objective was to develop a smartphone app to monitor nausea and vomiting episodes in pediatric cancer patients aged 0 to 18 years and to test its usability and adherence to its use. Children (n=20, aged 2.0-17.5 years) and their parents evaluated the app prospectively during a collective total of 60 chemotherapy cycles. They expressed that the app was user-friendly, intuitive, and that the time spent on data entry was fair. Conclusions: The user-friendly app could be used to facilitate future pediatric antiemetic trials and to refine antiemetic treatment during chemotherapy

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