Home Monitoring of late effects after breast cancer to enable early detection

Introduction: Late effects in breast cancer survivors significantly impact quality of life and societal well-being. Despite scheduled follow-up visits, there is a high prevalence of unmet patient needs regarding information, detection, and management of symptoms of late effects. Breast cancer patients face a plethora of such late effects. This study explores the potential of non-invasive home monitoring for tracking late effects.

Methods: A comprehensive literature review was conducted, utilizing PubMed, Google Scholar, and Scopus. The review encompassed various subsystems affected by late effects, including cardiac, respiratory, gastrointestinal, renal-urinary, nervous, psychological, reproductive, skin, breast area, and musculoskeletal systems. Factors considered in the overview comprised symptoms, monitoring options, and prevalence. An expert oncologist was interviewed to determine which late effects would benefit from early detection.

Results: Eleven subsystems were studied, with multiple late effects (Fig. 1). Monitoring possibilities include respiratory rate, mean arterial blood pressure, ECG data, renal function, and questionnaires. The specific late effects that were identified to benefit from early detection were cancer-related fatigue, insomnia, depression, fear of recurrence, neuropathy, reduced exercise tolerance, lymphedema, general anxiety disorder, and post-traumatic stress disorder. Examples of home monitoring include self-monitoring of e.g., chest pain and fluid retention and unobtrusive monitoring of palpitations and shortness of breath for cardiotoxicity. For depression, there are options for self-reporting as well as digital phenotyping using either a smartphone or smartwatch.

Conclusions: This study highlights multiple avenues for monitoring and early detection of late effects after breast cancer, which would lead to improved quality of life. The identified possibilities serve as a basis for prioritizing research on predicting and monitoring late effects to provide targeted interventions. Future research should explore the integration of digital biomarkers in cancer monitoring, providing innovative solutions for personalized and effective survivorship care, and subsequently enabling empowerment of patients.