07 August 2020

Identifying symptoms developed by cancer patients as a result of treatments remains a challenge at this time. Setting up screening of those symptoms is yet another. To address that need, an innovative and promising program called e-IMPAQc is currently being developed in Montreal, as Quebec worries about oncology services affected by COVID-19. The fruit of a collaborative effort, the project is being led by Sylvie Lambert, Principal Investigator at the St. Mary’s Research Centre and Associate Professor at McGill, who recently received a major grant to evaluate its implementation in cancer centres. Sylvie Lambert provides an update on the project and the effects on healthcare.

The project proposed by Sylvie Lambert, in collaboration with Peter Nugus, Investigator at McGill University, is one of the two recipients of the Innove-Onco grant program, the result of a partnership between Oncopole, the Fonds de recherche du Québec – Santé (FRQS), Bureau de l’innovation, Programme québécois de cancérologie du ministère de la Santé et des Services sociaux and the Institut national d’excellence en santé et services sociaux (INESSS). Aimed at optimizing the adoption of cancer innovations, the competition provides major financial support over two years to the winners, who have undergone a thorough evaluation. For Renaldo Battista, Executive Director of Oncopole, the funding is recognition of “the quality and [of] the relevance of the projects that will greatly contribute to improving patient care in oncology.”

In this interview, Sylvie Lambert provides an update on her project and the effects of the study on the organization of healthcare and on patient care.

Q: Based at the St. Mary’s Research Centre, you created a development program called e-IMPAQc intended to screen the symptoms developed by cancer patients undergoing treatment. How does the program work?

Recognizing that cancer patients undergoing treatment suffer from serious side effects and that documenting those symptoms can improve the care process, we developed the e-IMPAQc program, a patient-centred approach, which uses the Opal mobile app.

Thanks to e-IMPAQc, patients can fill out an online questionnaire during their medical visit, making it possible to identify the symptoms that they are experiencing. Those symptoms can be of a physical or emotional nature – the most common of which are nausea, fatigue, depression and pain – and can also be quantified.

One of the main innovations of the e-IMPAQc program is that it generates a report forwarded to the treating clinician the same day, but also to the patient. The program allows the treating clinician to quickly adapt the care given to the patient according to the severity of the symptoms and also results in an empowerment of the patient, who can then decide on his/her care.

Q: Your research project, funded by the Innove-Onco program, seeks to identify the factors fostering and limiting the integration of the program into the healthcare system. How will you go about identifying those factors?

Implementing this type of innovation requires a change in practice for clinicians and patients and needs to be examined very carefully. We have carried out a painstaking collaborative effort to develop the program, which fits into the objectives of the Programme québécois de cancérologie for standardizing the screening of patients’ symptoms. Thanks to the Innove-Onco grant, we will be able to evaluate its implementation in five adult cancer centres in Quebec: St. Mary’s Hospital Centre (SMHC), McGill University Health Centre (MUHC), Centre Hospitalier de l’Université de Montréal (CHUM), Hôpital de la Cité-de-la-Santé (Cité),  and Hôpital Maisonneuve-Rosemont (HMR).

Based on surveys and discussions with clinicians, managers and patients, we will be able to assess how often and the way in which the app is used, as well as the impact on patient care. Moreover, clinical observation will be carried out by a research assistant directly on-site. This identification of the facilitating factors and the obstacles will enable us to target the variations that may exist throughout the centres, and to ultimately develop a guide for future centres wishing to join the program.

Q: The objective of your project is to improve patient care in oncology – notably the distress felt by many patients. How will this project affect patient care?

The strength of this research project rests on the power of very close collaboration between governments, funding partners, investigators, clinicians, psychologists and patients. Thanks to this innovation, we hope to improve the communication, quality of life and potentially the survival of cancer patients. Once they are identified, symptoms can be better managed and at an early stage. Also, referrals to the clinic’s psychologists, nutritionists or social workers can be offered to patients based on the symptoms they are experiencing.

Of course, health professionals are very busy – particularly with the current pandemic – and this innovation could require more of their time. If a second wave were to occur, implementation of this technology could be limited. But we are very confident given the motivation of all our partner sites.

Q: Why isn’t that identification common practice in the healthcare system and why was it not done in the past?

It’s only recently that we have had compelling evidence that this type of program tangibly and significantly improves patient care. But certain questions remain involving screening frequency, when to carry it out and optimizing follow-up care. In order to change the daily routine of clinicians and patients by implementing a new practice, it is vital to first gather real proof that it can be effective, and particularly in this site.

Some centres offer questionnaires intended to identify patients’ symptoms, but in paper format. One of the major advantages of this program is the use of the Opal mobile app, which saves time and standardizes the analysis of results.

Q: The five adult cancer centres in Quebec selected to evaluate this technology are mainly located in Montreal and the surrounding area (Laval). Will the app then be extended to the rest of the territory?

Once the efficiency of the e-IMPAQc program has been shown with respect to patient care, large-scale deployment in Quebec – perhaps in Canada – may be considered. That decision will of course lie with the Quebec government, but certainly it is part of our future objectives.

By Fatéma Dodat