Home self-testing of complete blood counts in patients with breast cancer during chemotherapy: A proof-of-concept cohort study in e-oncology
DOI:
https://doi.org/10.2340/1651-226X.2024.41050Keywords:
Home self-testing, complete blood count, point of care technology, breast cancer, self-monitoring, patient empowerment, patient educationAbstract
Background: Before administration of myelosuppressive chemotherapy, complete blood counts (CBC) collected at the hospital/nursing stations are evaluated to avoid severe bone marrow suppression. This maintains disease fixation which often reduces their quality of life. This mixed-method study examined at home self-testing of CBC, the test quality, and the effects on patients’ mental well-being.
Methods: Patients with breast cancer receiving chemotherapy were recruited and trained to perform capillary finger prick CBC testing at home using the HemoScreen Point-of-Care instrument and to upload the test results to the hospital’s IT system subsequently. A venous reference CBC sample was taken and tested at the hospital on the day of self-testing. Semi-structured interviews with open-ended components were performed to investigate the user experience and the impact of self-testing on the patients’ everyday lives.
Results: Thirty-nine patients completed the self-testing education using the HemoScreen instrument. Eight patients withdrew, while the remaining 31 patients performed 161 home tests (2–11 tests per patient) over a 4-month period. The test results compared well with the venous reference CBCs except for platelet counts (correlation coefficient 0.26). Qualitative interviews with nine of the 31 patients emphasized that the patients were comfortable using the self-testing instrument and becoming an active partner in their own treatment.
Interpretation: CBC self-testing at home produced clinically valid hemoglobin and white blood cell counts with the added benefit that the patients became active partners in their own treatment course, which was of great importance for the patients and increased their wellbeing.
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Liddy C, Poulin PA, Hunter Z, Smyth C, Keely E. Patient perspectives on wait times and the impact on their life: a waiting room survey in a chronic pain clinic. Scand J Pain. 2017;17:53–7.
https://doi.org/10.1016/j.sjpain.2017.07.015 DOI: https://doi.org/10.1016/j.sjpain.2017.07.015
Lambrinou E, Hansen TB, Beulens JW. Lifestyle factors, self-management and patient empowerment in diabetes care. Eur J Prev Cardiol. 2019;26:55–63.
https://doi.org/10.1177/2047487319885455 DOI: https://doi.org/10.1177/2047487319885455
Coppola A, Sasso L, Bagnasco A, Giustina A, Gazzaruso C. The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine. 2016;53:18–27.
https://doi.org/10.1007/s12020-015-0775-7 DOI: https://doi.org/10.1007/s12020-015-0775-7
Hermanns N, Ehrmann D, Finke-Groene K, Kulzer B. Trends in diabetes self-management education: where are we coming from and where are we going? A narrative re-view. Diabet Med. 2020;37:436–47.
https://doi.org/10.1111/dme.14256 DOI: https://doi.org/10.1111/dme.14256
Heneghan CJ, Garcia-Alamino JM, Spencer EA, Ward AM, Perera R, Bankhead C, et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Data-base Syst Rev. 2016;7:CD003839.
https://doi.org/10.1002/14651858.CD003839.pub3 DOI: https://doi.org/10.1002/14651858.CD003839.pub3
Solitano V, Alfarone L, D’Amico F, Peyrin-Biroulet L, Danese S. IBD goes home: from tele-medicine to self-administered advanced therapies. Expert Opin Biol Ther. 2022;22:17–29.
https://doi.org/10.1080/14712598.2021.1942833 DOI: https://doi.org/10.1080/14712598.2021.1942833
Schrijver J, Lenferink A, Brusse-Keizer M, Zwerink M, van der Valk PD, van der Palen J, et al. Self-management interventions for people with chronic obstructive pulmo-nary disease. Cochrane Database Syst Rev. 2022;1:CD002990.
https://doi.org/10.1002/14651858.CD002990.pub4 DOI: https://doi.org/10.1002/14651858.CD002990.pub4
Hodkinson A, Bower P, Grigoroglou C, Zghebi SS, Pinnock H, Kontopantelis E, et al. Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: systematic review and network meta-analysis. BMJ. 2020;370:m2521.
https://doi.org/10.1136/bmj.m2521 DOI: https://doi.org/10.1136/bmj.m2521
Department of Health. Equity and excellence: liberating the NHS Cm 7881. London: De-partment of Health; 2010.
Norskov KH, Fridthjof K, Kampmann P, Dunweber A, Andersen CL, Renaberg T, et al. A na-tional Danish proof of concept on feasibility and safety of home -based inten-sive chemotherapy in patients with acute myeloid leukemia. Leuk Res. 2022;112:106756.
https://doi.org/10.1016/j.leukres.2021.106756 DOI: https://doi.org/10.1016/j.leukres.2021.106756
Larønningen S, Ferlay J, Beydogan H, Bray F, Engholm G, Ervik M, et al. NORDCAN: cancer incidence, mortality, prevalence and survival in the nordic countries, Version 9.2. March 10th 2022. [cited 2023 Mar 10]. Available from: https://nordcan.iarc.fr/
DBCG. Systemisk behandling af brystkræft I – hvem skal anbefales adjuverende syste-misk behandling? July 7th 2022. [cited 2024 Jan 10]. Available from: https://www.dmcg.dk/Kliniske-retningslinjer/kliniske-retningslinjer-opdelt-paa-dmcg/brystcancer/systemisk-behandling-af-brystkraft---i--hvem-skal-anbefales-adjuverende-systemisk-behandling/
Boccia R, Glaspy J, Crawford J, Aapro M. Chemotherapy-induced neutropenia and febrile neutropenia in the US: a beast of burden that needs to be tamed? Oncologist. 2022;27:625–36.
https://doi.org/10.1093/oncolo/oyac074 DOI: https://doi.org/10.1093/oncolo/oyac074
Nordvig J, Aagaard T, Daugaard G, Brown P, Sengelov H, Lundgren J, et al. Febrile neutro-penia and long-term risk of infection among patients treated with chemo-therapy for malignant diseases. Open Forum Infect Dis. 2018;5:ofy255.
https://doi.org/10.1093/ofid/ofy255 DOI: https://doi.org/10.1093/ofid/ofy255
Chambers P, Wei L, Forster MD, Kipps E, Wong ICK, Jani Y. Evidence to guide the optimal timing for pre‐chemotherapy blood tests for early breast, colorectal cancer and diffuse large B‐cell lymphoma. Cancer Med. 2021;10:7996–8004.
https://doi.org/10.1002/cam4.4316 DOI: https://doi.org/10.1002/cam4.4316
Kristian Kur D, Thogersen D, Kjeldsen L, Friis-Hansen L. The HemoScreen hematology point-of-care device is suitable for rapid evaluation of acute leukemia pa-tients. Int J Lab Hematol. 2021;43:52–60.
https://doi.org/10.1111/ijlh.13330 DOI: https://doi.org/10.1111/ijlh.13330
Otto Mattsson T, Lindhart CL, Scholey J, Friis-Hansen L, Herrstedt J. Patient self-testing of white blood cell count and differentiation: a study of feasibility and meas-urement performance in a population of Danish cancer patients. Eur J Cancer Care (Engl). 2020;29:e13189.
https://doi.org/10.1111/ecc.13189 DOI: https://doi.org/10.1111/ecc.13189
Van de Velde D, De Zutter F, Satink T, Costa U, Janquart S, Senn D, et al. Delineating the concept of self-management in chronic conditions: a concept analysis. BMJ Open. 2019;9:e027775.
https://doi.org/10.1136/bmjopen-2018-027775 DOI: https://doi.org/10.1136/bmjopen-2018-027775
Knudsen KE, Willman C, Winn R. Optimizing the use of telemedicine in oncology care: postpandemic opportunities. Clin Cancer Res. 2021;27:933–6.
https://doi.org/10.1158/1078-0432.CCR-20-3758 DOI: https://doi.org/10.1158/1078-0432.CCR-20-3758
Atkins M, McGuire P, Balgobin B, Desouza N, Taylor D. Haematological point of care test-ing for clozapine monitoring. J Psychiatr Res. 2023;157:66–71.
https://doi.org/10.1016/j.jpsychires.2022.11.027 DOI: https://doi.org/10.1016/j.jpsychires.2022.11.027
Larsson A, Smekal D, Lipcsey M. Rapid testing of red blood cells, white blood cells and platelets in intensive care patients using the HemoScreen point-of-care ana-lyzer. Platelets. 2019;30:1013–6.
https://doi.org/10.1080/09537104.2018.1557619 DOI: https://doi.org/10.1080/09537104.2018.1557619
Ben-Yosef Y, Marom B, Hirshberg G, D’Souza C, Larsson A, Bransky A. The HemoScreen, a novel haematology analyser for the point of care. J Clin Pathol. 2016;69:720–5.
https://doi.org/10.1136/jclinpath-2015-203484 DOI: https://doi.org/10.1136/jclinpath-2015-203484
Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al. What is an adequate sample size? Operationalising data saturation for theory-based in-terview studies. Psychol Health. 2010;25:1229–45.
https://doi.org/10.1080/08870440903194015 DOI: https://doi.org/10.1080/08870440903194015
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa
Hansen M, O‘Brien K, Meckler G, Chang AM, Guise JM. Understanding the value of mixed methods research: the Children’s Safety Initiative-Emergency Medical Ser-vices. Emerg Med J. 2016;33:489–94.
https://doi.org/10.1136/emermed-2015-205277 DOI: https://doi.org/10.1136/emermed-2015-205277
Kur DK, Agersnap N, Hollander NH, Pedersen OBV, Friis-Hansen L. Evaluation of the He-moCue WBC DIFF in leukopenic patient samples. Int J Lab Hematol. 2020;42:256–62.
https://doi.org/10.1111/ijlh.13158 DOI: https://doi.org/10.1111/ijlh.13158
Bachar N, Benbassat D, Brailovsky D, Eshel Y, Gluck D, Levner D, et al. An artificial intelli-gence-assisted diagnostic platform for rapid near-patient hematology. Am J Hematol. 2021;96:1264–74.
https://doi.org/10.1002/ajh.26295 DOI: https://doi.org/10.1002/ajh.26295
Velikova M, Smeets RL, van Scheltinga JT, Lucas PJ, Spaanderman M. Smartphone-based analysis of biochemical tests for health monitoring support at home. Healthc Technol Lett. 2014;1:92–7.
https://doi.org/10.1049/htl.2014.0059 DOI: https://doi.org/10.1049/htl.2014.0059
Vinding KK, Elsberg H, Thorkilgaard T, Belard E, Pedersen N, Elkjaer M, et al. Fecal calpro-tectin measured by patients at home using smartphones – a new clinical tool in monitoring patients with inflammatory bowel disease. Inflamm Bowel Dis. 2016;22:336–44.
https://doi.org/10.1097/MIB.0000000000000619 DOI: https://doi.org/10.1097/MIB.0000000000000619
Larsson A, Carlsson L, Karlsson B, Lipcsey M. Rapid testing of red blood cell parameters in primary care patients using HemoScreen point of care instrument. BMC Fam Pract. 2019;20:77.
https://doi.org/10.1186/s12875-019-0971-2 DOI: https://doi.org/10.1186/s12875-019-0971-2
Maynard RD, Funk T, Harrill W, Jin J, Smith D, Smith G, et al. Analytical performance evalua-tion of three point-of-care CBC analyzers for management of Clozapine thera-py in ambulatory psychiatry clinics. J Appl Lab Med. 2023;8:1028–41.
https://doi.org/10.1093/jalm/jfad050 DOI: https://doi.org/10.1093/jalm/jfad050
Daae LN, Halvorsen S, Mathisen PM, Mironska K. A comparison between haematological parameters in ‘capillary’ and venous blood from healthy adults. Scand J Clin Lab Invest. 1988;48:723–6. DOI: https://doi.org/10.3109/00365518809085796
https://doi.org/10.1080/00365518809085796 DOI: https://doi.org/10.1080/00365518809085796
Fliervoet LAL, Tiel Groenestege WM, Huisman A. Comparison of capillary and venous blood sampling for routine coagulation assays. Clin Biochem. 2022;104:30–5.
https://doi.org/10.1016/j.clinbiochem.2022.01.010 DOI: https://doi.org/10.1016/j.clinbiochem.2022.01.010
Yeh PT, Rhee DK, Kennedy CE, Zera CA, Lucido B, Tuncalp O, et al. Self-monitoring of blood pressure among women with hypertensive disorders of pregnancy: a systematic review. BMC Pregnancy Childbirth. 2022;22:454.
https://doi.org/10.1186/s12884-022-04751-7 DOI: https://doi.org/10.1186/s12884-022-04751-7
Cases A, Dempster M, Davies M, Gamble G. The experience of individuals with renal failure participating in home haemodialysis: an interpretative phenomenological analysis. J Health Psychol. 2011;16:884–94.
https://doi.org/10.1177/1359105310393541 DOI: https://doi.org/10.1177/1359105310393541
Jorgensen CR, Eskildsen NB, Thomsen TG, Nielsen ID, Johnsen AT. The impact of using peer interviewers in a study of patient empowerment amongst people in can-cer follow-up. Health Expect. 2018;21:620–7.
https://doi.org/10.1111/hex.12655 DOI: https://doi.org/10.1111/hex.12655
Taylor D, Bury M. Chronic illness, expert patients and care transition. Sociol Health Illn. 2007;29:27–45.
https://doi.org/10.1111/j.1467-9566.2007.00516.x DOI: https://doi.org/10.1111/j.1467-9566.2007.00516.x
Sacristan JA, Aguaron A, Avendano-Sola C, Garrido P, Carrion J, Gutierrez A, et al. Patient involvement in clinical research: why, when, and how. Patient Prefer Adher-ence. 2016;10:631–40.
https://doi.org/10.2147/PPA.S104259 DOI: https://doi.org/10.2147/PPA.S104259
Langstrup H, Rahbek AE. Conceptualizing ‘role’ in patient-engaging e-health: a cross-disciplinary review of the literature. Commun Med. 2015;12:129–43.
https://doi.org/10.1558/cam.31817 DOI: https://doi.org/10.1558/cam.31817
Langstrup H. Chronic care infrastructures and the home. Sociol Health Illn. 2013;35:1008–22.
https://doi.org/10.1111/1467-9566.12013 DOI: https://doi.org/10.1111/1467-9566.12013
Oudshoorn N. How places matter: telecare technologies and the changing spatial di-mensions of healthcare. Soc Stud Sci. 2012;42:121–42.
https://doi.org/10.1177/0306312711431817 DOI: https://doi.org/10.1177/0306312711431817
Vercell A, Taylor S, Yorke J, Dowding D. Assessing the acceptability of home blood moni-toring for patients with cancer who are receiving systemic anticancer therapy from a patient, caregiver, and clinician perspective: focus group and interview study. JMIR Nurs. 2023;6:e39815.
https://doi.org/10.2196/39815 DOI: https://doi.org/10.2196/39815
Shneerson CL, Gale NK. Using mixed methods to identify and answer clinically relevant research questions. Qual Health Res. 2015;25: 845–56.
https://doi.org/10.1177/1049732315580107 DOI: https://doi.org/10.1177/1049732315580107
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Copyright (c) 2023 Lennart Friis-Hansen, Pippi Jonassen Bjørck, Ditte Hartvig, Susanne Andresen, Berit Hulehøj Nielsen, Christina Hansen, Anne Nistrup, Keld Hundewadt, Niels Henrik Holländer
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