According to the Journal of the American Medical Association, remote patient interactions across the country increased dramatically in the early months of the COVID-19 pandemic – jumping from 9% just before the pandemic hit in January 2020 to
58% in May 2020. Cancer care and survivorship was no exception.
"Many people didn't even know the word Zoom before the pandemic," says Ann Partridge, MD, MPH, founder and director of the Susan F. Smith Center's Program for Young Adults with Breast Cancer.
"And in the pandemic, all of our research related to young adults with breast cancer that had been taking place via mail transitioned to electronic surveying."
The key to making research progress in the early days of COVID was a willingness to pivot and adapt. "When the pandemic first started, we knew so little about how COVID-19 was transmitted, how to treat it, who would survive," says Dr. Wright. "It's hard
to imagine now because we've come so far, but at that time every human interaction seemed risky, particularly at hospitals and medical centers."
Patients, particularly those who were immunocompromised, needed an alternative to an office visit or a healthcare provider entering their home. "They worried that having someone into their home increased their risk of contracting COVID-19 – and it may
have," says Dr. Wright. "We found that patients and their caregivers were most interested in online interventions – particularly an intervention that used telehealth to help patients manage their symptoms when they were transitioning home from the
As the online research experiment proved successful, a new standard is now being set for the use of digital technology. At Dana-Farber, Dr. Wright, Dr. Partridge, and Huma Rana, MD, MPH, clinical director of
Cancer Genetics and Prevention, are helping pave the way.
Online Exercise Tools for Ovarian Cancer Survivors
Patients with gynecologic cancer diagnoses were able to enroll in Dr. Wright's Stepping Into Survivorship study, even while hospitals limited capacity, activities moved outdoors, and people moved their workouts from the gym to the home treadmill.
Dr. Wright knew that patients with ovarian cancer could become deconditioned to their disease while undergoing intense treatment, including surgery and chemotherapy. According to previous research, ovarian cancer survivors are three times more likely
to experience lower-body functional limitations with survivors of other cancers, and as a result half of ovarian cancer survivors become sedentary, and 25% become inactive. While evidence had shown that increasing physical activity could reduce the
risk of cancer recurrence and mortality, reduce symptoms, and improve physical functioning and mental health, Wright was able to test physical activity interventions specifically in sedentary or older ovarian cancer survivors.
Participants in Dr. Wright's study selected a partner and each member received a Fitbit, and set goals to increase their steps. Each week, teams received points based on progress toward their activity goals. The points had no monetary value, but many
participants found them motivating because of the powerful principle of loss aversion – the concept that losing things is more salient than gaining things. Focusing on team-based activity also provided increased social support for patients transitioning
away from treatment.
"Many women report that one of the toughest times is right after treatment ends," says Dr. Wright. "Everyone expects them to be better, but many women are still exhausted, scared about the disease recurring, and may feel alone in their experience."
Preliminary results of the study show, however, that their health still improved in the pandemic.
New Tools to Overcome PARP Inhibitor Fatigue
Dr. Wright and colleagues from outside of Dana-Farber, psychologists Hanneke Poort, PhD, and Joanna Arch, PhD, also made progress last year in a clinical trial for patients with ovarian cancer who reported fatigue while being treated with PARP inhibitors,
a class of drugs that have revolutionized treatment for patients with ovarian cancer. Her multi-site clinical trial called REVITALIZE provides support, knowledge, and skills to patients to reduce fatigue, psychological distress, and fear of cancer
recurrence. Before long, patients in the trial like Karen Maloney saw daily fatigue disappear.
"The one-on-one sessions were very helpful in giving me new perspectives on my fatigue and new ways to lessen its grip on me," Maloney says. "Learning new attitudes and skills to manage fatigue completely improved my quality of life."
Maloney is among nearly 70% of women who experience fatigue while taking PARP inhibitors. "And 10-20% of those will stop the drugs early because of side effects," says Dr Wright. "We're trying to help women continue on these life-saving medications by
tackling some of the worst side effects to make them more tolerable." Although the study is ongoing, several patients have noted to investigators that Acceptance and Commitment Therapy (ACT) strategies have reduced their fatigue and helped them to
realign their activities with what matters most to them.
By leveraging digital tools for exercise during the COVID outbreak, Dr. Wright is closer to potentially dramatically changing the treatment landscape for patients with an advanced form of the disease. With positive preliminary results, she and her colleagues
are performing a pilot randomized trial to see whether participants' fatigue is significantly reduced by the intervention.