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What if cancer patients could better self-manage their medications via text message reminders? How might that affect the treatment of their disease?

A study underway at Memorial Sloan Kettering Cancer Center in New York City may answer some of those questions. Researchers at the cancer center at testing the effectiveness of mobile technology intervention on breast cancer patients' self-management of the oral anticancer medication Ibrance (palbociclib).

A major concern for patients on oral anti-cancer therapy is their ability to self-manage the treatment regimen, a role that includes making sure the medications are taken on time, proper diagnostic testing, and attending scheduled doctor visits, the researchers wrote in an article in the 

Patients who do not effectively self-manage may experience inappropriate dosing,

 inadequate laboratory monitoring, failure to report side effects, and further cancer metastases, according lead author Ann M. Mazzella Ebstein and her colleagues. “Since patients with metastatic breast cancer require oral anticancer medication for extended periods, it becomes imperative that healthcare providers find interventions that facilitate access to supportive resources to help patients self-manage their anti-cancer therapy,” Ebstein and the others wrote.

The smartphone may be an untapped resource that can fundamentally improve a patient's ability to self-manage their oncologic treatment regimens while improving communication and satisfaction with healthcare providers, they added.

The study will test whether text messaging support will decrease the necessity for patient-initiated phone conversations and help manage the workload of nurses. “Mobile technology actively engages the patient as an equal partner in determining their health care and thus has the potential to change future care delivery models,” they wrote. 

Unidirectional text message reminders will be sent during the treatment cycle through a secure web application using the patient's smartphone. The researchers will collect self-reported survey responses at three time points: at consent, at the end of treatment cycles, and at the follow-up clinic visits.

Comparing a regular breast cancer patient group and an intervention group, the researchers will also compare demographics, quality of life, laboratory testing, and the nurse's workload in caring for the study patients.

“Given the importance of taking oral anti-cancer medications and the difficulties patients experience in achieving it, the effective use of mobile technology interventions can actively engage patients in their care and improve medication self-management of anticancer treatment regimens,” the researchers wrote.

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Automated texts may also lessen the workload on nurses.

Self-management Being Put to the Test in MSK Study of Patients Taking Ibrance 

Most of last year and during the first part of this year, many physicians and healthcare practices struggled financially because patients avoided in-person care. Patients were “medically distancing” inappropriately and not getting the medical care and routine screenings they needed because of COVID-19, according to 

, director of strategy advancement for Humana, told 

It was a different story for practices that were more deeply involved with value-based care.

“During the pandemic, value-based care providers were able to weather the storm much better,” said Cockerell. “We have seen patients behave differently in these kinds of arrangements. One of the things we stress in a value-based practice is to come into the doctor. “In addition to treating their health, we frequently screen for social determinants of health and refer them to organizations that can meet their needs.” 

Still, many physicians, social workers, nurses, pharmacists and other healthcare providers are not implementing value-based care programs. They need a better understanding of the intricacies of how they work, according to Cockerell.

Humana and the University of Houston are meeting that need with a seven-course “

” on Coursera, the online education program. Completing the flight of courses will help providers, academics, business and industry professionals and the public learn about the “fundamentals and real-world application of value-based care that has become integral to improving outcomes in health care,” Humana said in a 

“Taking this specialization will help practitioners understand how value-based payment works, how they can incorporate more social determinants of health in value-based programs, and how we treat the whole patient,” Cockerell said. “Keeping the patients at the center of care is really what our corporate strategy is about.”

Already, enrollment is in the “upper thousands” of people, and Cockerell expects many other students to enroll. The first of the seven courses is titled “Value-Based Care: Introduction to Value-Based Care and the U.S. Health System.”

The program is needed because it is “essential that those who work to improve bthe health of their communities speak the same language,” said 

, M.D., M.P.H, the founding director of Humana Integrated Health System Sciences Institute at the University of Houston, in the press release. Woodard; Susie Gronseth, a clinical associate professor at the University of Houston and Sara G. McNeil, an associate professor at the university, are the three instructors.

“The collaboration on this content assures that everyone, from the physician and nurse, to social workers, pharmacists and claims representatives, as well as consumers of health care understand what it takes to work together. These multisector partnerships help to ensure patients are receiving the best possible care and achieving the best outcomes at the lowest possible cost,” Woodard said in the press release.

Valued-based care helped some providers weather the pandemic. The seven-course "specialization" on Coursera will help providers, others understand how value-based care works.

Humana, University of Houston offer online courses on value-based care

The years leading up to menopause —  or menopause transition — is a time of increasing heart disease risk for women, according to a new Scientific Statement from the American Heart Association (AHA).

Monitoring women’s health and lifestyle while integrating early intervention strategies for good cardiovascular health are important, especially during midlife and menopause to help prevent heart disease, according to the statement, “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing for Early Prevention,” published in AHA’s journal, 

Hormone therapy during the menopause transition period may also help reduce heart disease risks, according to AHA.

“Over the past 20 years, our knowledge of how the menopause transition might contribute to cardiovascular disease has been dramatically evolving. We have accumulated data consistently pointing to the menopause transition as a time of change in cardiovascular health,” Samar R. El Khoudary, Ph.D., M.P.H., chair of the statement writing committee and associate professor of epidemiology at the University of Pittsburgh’s Graduate School of Public Health and the Clinical and Translational Science Institute, said in a 

Physiological changes during menopause, such as increased abdominal fat and visceral fat (body fat around the organs), are associated with a heightened risk of all-cause, cardiovascular disease and cancer mortality — even among those with normal body mass index levels, AHA said.

In addition, cholesterol levels, metabolic syndrome risk and vascular vulnerability appear to increase with menopause beyond the effects of normal aging.

For many women, the menopause transition begins when they are in their late 40s to mid-50s. Before this transition, women produce estrogen, which may also have cardio-protective effects. When women go through the natural menopause transition, their ovaries stop producing as much estrogen, AHA said. The changes can also occur through surgical menopause (a partial or full hysterectomy, which includes removal of one or both ovaries).

Since the increase in heart disease risk during menopause is associated with a decrease in estrogen production, healthcare professionals and scientists have studied if hormone therapy might help reduce cardiovascular risk.

“There is research indicating potential cardiovascular benefits of certain combinations of hormone therapy when initiated in early but not late menopause,” AHA said. “Further research is needed to evaluate the role of other hormone therapies, and how long these interventions impact cardio-metabolic health.”

In addition, some studies show the benefits of hormone therapy — including a decreased risk of type 2 diabetes and protection from bone loss — seem to outweigh the risks for most women in early menopause.

“Current recommendations from leading professional medical societies endorse the use of hormone therapy for women who have recently begun the menopause transition, with appropriate indications,” AHA said.

Healthcare professionals should also consider an aggressive, prevention-based approach for women during the menopause transition to decrease the probability of a future cardiovascular disease occurrence, such as heart attack or stroke, El Khoudary said.

Women have an increased risk of heart disease in the years leading up to menopause.

Menopause Transition Associated With Higher Cardiovascular Risks

Women face a 20% increased risk of developing heart failure or dying within five years after their first severe heart attack compared with men, according to a new study.

Other studies have looked at gender differences among people who have had heart attacks, but this study zeroed in on whether women and men have different rates heart failure. 

 and his colleagues at the University of Alberta, say their finding that women are more likely to develop heart failure after a heart attack mean  patients, and especially women, should be monitored for signs and symptoms of heart failure after a heart attack. If possible, they say, people should get care that prevents heart failure or keeps mild cases from getting worse.

Ezekowitz and his colleagues had a large database to work with: some 45,000 patients, hospitalized for a first heart attack between 2002 and 2016 in Alberta, Canada. Just over 30% of them were women. One cut of their analysis separated patients into those who had severe, life-threatening  ST-segment elevation myocardial infarction (STEMI) heart attacks and those who had less severe non-STEMI, or NSTEMI, heart attacks 

Women had a higher unadjusted rate of in-hospital mortality than did men in both patients with STEMI (women, 9.4%, vs men, 4.5%) and patients with NSTEMI (women, 4.7%, vs men, 2.9%) heart attacks. But after various statistical adjustments, the gender mortality difference "disappeared" for NSTEMI heart attacks but not for the more severe STEMI ones.  

After discharge, women more commonly developed heart failure after STEMI events (women, 22.5% vs men, 14.9%) as well as after NSTEMI heart attacks (women, 23.2% vs men, 15.7%).

Women were more likely to be an average of 10 years older than men at the time of their heart attack, at an average age of 72 years old versus 61 years old for men. They also had more complicated medical histories, including high blood pressure, diabetes, atrial fibrillation and chronic obstructive pulmonary disease—risk factors that may contribute to heart failure, according to a 

Notably, women were seen less frequently in the hospital by a cardiovascular specialist (72.8% vs 84% for men). In addition, fewer women were prescribed medications such as beta-blockers or cholesterol-lowering drugs.

Women also had slightly lower rates of revascularization procedures to restore blood flow, such as surgical angioplasty, the researchers found.

“Identifying when and how women may be at higher risk for heart failure after a heart attack can help providers develop more effective approaches for prevention,” Ezekowitz, a cardiologist and co-director of the Canadian VIGOUR Centre at the University of Alberta, said in the press release about the study. “Better adherence to reducing cholesterol, controlling high blood pressure, getting more exercise, eating a healthy diet and stopping smoking, combined with recognition of these problems earlier in life would save thousands of lives of women—and men.”

In addition to the elevated risk for heart failure among women, researchers found that 65.7% of men had NSTEMI heart attacks, while 34.3% of women experienced them.

More men (73.5%) also experienced the more severe STEMI heart attacks, while only 26.5% of women had them.

The next step is to further examine if all patients — particularly women — are receiving the best care and where interventions can address oversights, the study’s co-author, 

, Ph.D., co-director of the Canadian VIGOUR Centre, said in the press release.

“There are gaps across diagnosis, access, quality of care and follow-up for all patients, so we need to be vigilant, pay attention to our own biases and to those most vulnerable to ensure that we have done everything possible in providing the best treatment,” Kaul said.

Women are disproportionately affected by heart failure after heart attacks, according to a Canadian study. 

Christine Blank

Articles

Self-management Being Put to the Test in MSK Study of Patients Taking Ibrance

Humana, University of Houston offer online courses on value-based care

Menopause Transition Associated With Higher Cardiovascular Risks

Women Have Higher Rate of Heart Failure, Mortality After Heart Attacks Than Men