Identifying the symptoms that cancer patients develop as a result of treatment remains a challenge today. Screening for these symptoms is another. In response, an innovative and promising program called e-IMPAQc is currently being developed in Montreal, at a time when Quebec is concerned about oncology services affected by COVID-19. The result of a collaborative effort, this project is led by Sylvie Lambert, senior researcher at the St. Gallen research center. A graduate of St. Mary’s University and associate professor at McGill, she recently won a major grant to evaluate its implementation in cancer centers. Sylvie Lambert reports on this project and its implications for healthcare.

The project proposed by Sylvie Lambert, in collaboration with McGill University researcher Peter Nugus, is one of two recipients of the Innove-Onco grant program, which is the result of a partnership between Oncopole, the Fonds de recherche du Québec – Santé (FRQS), the Innovation Bureau, the Programme québécois de cancérologie of the 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 innovations in oncology, this competition offers major financial support over two years to winners who have undergone rigorous evaluation. For Renaldo Battista, CEO of Oncopole, this funding is recognition of “the quality and [de] relevance of the projects, which will make a major contribution to improving oncology patient care”.

In this interview, Sylvie Lambert talks about her project and the impact of this study on healthcare organization and patient care.

Q: Based at the St. Gallen Research Center At St. Mary’s Hospital, you have developed a program called e-IMPAQc, which aims to detect symptoms in cancer patients undergoing treatment. How does it work?

Recognizing that cancer patients undergoing treatment suffer serious side effects, and that documenting these symptoms can improve the care process, we developed the e-IMPAQc program, a patient-centered approach using the Opal mobile application.

Thanks to e-IMPAQc, patients can fill in an online questionnaire at the time of their medical visit, which enables them to identify the symptoms they are experiencing. These symptoms can be physical or emotional – the most common being 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 that is transferred to the clinician-treater on the same day, as well as to the patient. This program enables clinicians to rapidly adapt patient care according to the severity of symptoms, while empowering patients to take charge of their own care.

Q: Your research project, funded by the Innove-Onco program, aims to identify the factors that promote and limit the integration of this program into the care system. How will you identify these factors?

Implementing this type of innovation necessarily requires a change in practice for clinicians and patients alike, and needs to be carefully studied. We have worked hard to develop this program, which is in line with the objectives of the Programme québécois de cancérologie to standardize symptom screening in patients. Thanks to the Innove-Onco grant, we will be able to evaluate its implementation in five adult cancer centers in Quebec: St. Michael’s, St. Joseph’s and St. Joseph’s. These include 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).

Through surveys and interviews with clinicians, managers and patients, we will be able to assess the frequency and mode of use of the application, as well as its impact on patient management. In addition, a clinical observation will be carried out by a research assistant directly on site. This identification of facilitating factors and barriers will enable us to target variations that may exist across centers, and ultimately to develop a guide for future centers wishing to join the program.

Q: The aim of your project is to improve patient care in oncology – and in particular the distress experienced by many patients. What impact will this project have on patient care?

The strength of this research project lies in the power of close collaboration between governments, funding partners, researchers, clinicians, psychologists and patients. Thanks to this innovation, we hope to improve communication, quality of life and potentially the survival of cancer patients. Once identified, symptoms can be better and earlier managed. Patients can also be referred to the clinic’s psychologists, nutritionists or social workers, depending on the symptoms they are experiencing.

Of course, healthcare professionals are very busy – especially with the current pandemic – and this innovation could take up some of their extra time. If a second wave occurs, the implementation of this technology could be limited. Nevertheless, we are very confident, given the motivation of all our partner sites.

Q: Why isn’t this identification common practice in healthcare, and why hasn’t it been done in the past?

It’s only recently that we’ve seen convincing evidence that this kind of program is making a real and significant difference to patient care. Despite this, questions remain about the frequency of screening, the timing of screening and the optimization of follow-up care. To change the daily lives of clinicians and patients with the implementation of a new practice, it is essential to first gather concrete evidence that it can be effective, and in this site in particular.

Some centers offer patient symptom identification questionnaires in paper format. One of the major advantages of this program is the use of the Opal mobile application, which both saves time and standardizes the analysis of results.

Once the effectiveness of the e-IMPAQc program in patient management has been demonstrated, large-scale deployment in Quebec – and even Canada – could be envisaged. This decision will of course be up to the Quebec government, but is of course part of our future objectives.

By Fatéma Dodat