Kerri Winters, Ph.D., Research Professor, School of Nursing PhD Program
Knight Cancer Institute Cancer Center Support Grant
Title: "Development and feasibility of a remote sensing system to capture symptoms and functional consequences of peripheral neuropathies in cancer patients"
Collaborators: Tamara Hayes, Ph.D.; Jeffrey Kaye, M.D.; Fay Horak, Ph.D.; Shiuh-Wen Luoh, M.D.; Joe Gray, Ph.D.; Paul Spellman, Ph.D.
Abstract: Our proposed study is significant because most of the 12 million cancer survivors alive today will report more problems with day-to-day functioning and more falls than persons who have not had cancer and we have data from our other studies suggesting that neuropathy that develops from neurotoxic chemotherapy may be a reason why cancer survivors experience these problems. Neuropathies develop from nerve damage and result in numbness and tingling in the hands and feet (i.e., periphery) and are often also very painful. Neuropathies are an understudied side effect of cancer chemotherapy, but are projected to affect up to 74% of patients receiving chemotherapy and the resulting pain and numbness can last for many years or never disappear at all. The incidence of chemotherapy-induced peripheral neuropathy is rising because more neurotoxic chemotherapy regimens have been developed and are used to treat a wider variety of cancers, because patients are living longer, and because multiple chemotherapy drugs are often administered to a patient. Neuropathies are known to cause problems with a person’s ability to sense touch or pain and we know from studies of persons with neuropathy from non-cancer causes that they have difficulties with grabbing or holding objects, balance, walking and falling. Unfortunately, we know little about the prevalence of neuropathies in cancer patients, when and in whom neuropathies develop and how they impact a patient’s physical functioning. Oncologists have little time to conduct frequent comprehensive neurologic exams or functional assessments on patients. This inadequate monitoring means that pain medications for painful neuropathies are not started on time, early changes in chemotherapy doses to reduce neuropathies are missed, and that the consequences of neuropathies, such as fall risk, go unrecognized. There is an urgent need for tools that are sensitive enough to frequently monitor for changes in neuropathy as patients go through treatment and that detect related decreases in physical functioning as early as possible. If a clinician or patient could easily administer a simple test for neuropathy and for physical function through a remote system such as a smartphone or video gaming system, such a system could transform clinical practice and patient care. Self-monitoring devices of balance and movement exist, but have never been used to study symptoms and functioning in cancer survivors. Likewise, smartphone technology could be used to develop simple, easily self-administered tests of symptoms and function but have not been used yet for these purposes. We propose a developmental and descriptive project to pilot-test a remote sensing system to detect signs of chemotherapy related neuropathy and poor physical functioning in cancer survivors treated with neurotoxic chemotherapy. As part of this system, we are developing a novel smartphone app that administers simple tests for peripheral neuropathy by manipulating the phone’s vibratory features to mimic clinical exams. In addition, new approaches to in-home assessment of physical function using a Wii platform and activity watches are proposed. In this study we will measure neuropathy using a questionnaire, a smartphone app and clinical tests and will measure physical functioning using a Wii balance board, activity watches, and laboratory measures of walking and balance in 60 persons who have been treated with neurotoxic chemotherapy for cancer within the past 5 years. Of the 60 persons, half of those must report symptoms of neuropathy and half must not. Participants will come to the laboratory to have clinical tests of neuropathy and laboratory tests of physical functioning done and will then collect data on themselves for 7 days using the smartphone app, Wii balance board and activity watches. We will determine whether or not the at-home tests are as valid as laboratory measures of neuropathy and function and we will determine how acceptable the at-home data collection system is to patients. The findings from this study and future studies that develop from this project could have a significant impact on clinicians who monitor the well being of cancer patients following treatment, patients who could more easily and quickly report changes in their symptoms and functioning to their health care team, researchers who measure symptoms and physical functioning as an outcome of treatment or predictor of quality of life, rehabilitation therapists who could determine the effectiveness of their interventions and geneticists who can identify which patients are most likely to develop neuropathies from chemotherapy so that alternate treatments or physical therapy can be tailored for them.