Optimisation of outpatient therapy in paediatric oncology: digital medication planning and app-based therapy management for medical staff, patients and families

Contact person: Dr. med. Michael Neugebauer

The treatment of children with cancer poses particular challenges for the healthcare system. Unlike in adults, tumours are less common in children, but they are highly complex and individual. Every year, around 400,000 children and adolescents worldwide are diagnosed with cancer (Ward et al., 2019). According to the WHO, cancer is the second leading cause of death in wealthy countries (PHO/IAP, 2020). Treatment usually follows a curative approach and requires close monitoring tailored to the patient's age and physical development. In addition to inpatient treatment, the outpatient phase of chemotherapy plays a crucial role in the success of treatment – in particular, the correct administration of numerous medications at home (Hudson et al., 2021).

This sensitive phase in particular carries a considerable risk of medication errors, dosage deviations and poor adherence. Studies show that even minor deviations in medication intake can increase the risk of infections, relapses or even death (McGrady & Pai, 2019). Many clinics still use paper-based or self-created digital solutions (e.g. Excel or Word tables) to manage these individual therapies and to create and communicate complex medication plans. This manual process is time-consuming, prone to errors and hinders structured communication between the clinic, patients and their families.

Digital support systems such as Clinical Decision Support Systems (CDSS) have the potential to reduce medication errors and improve the quality of care (Pawloski et al., 2019; Armando et al., 2023). Nevertheless, there is a lack of specialised solutions for paediatric oncology. Although there are a large number of apps in the field of mobile health applications (mHealth), the specific requirements of paediatric oncology have hardly been taken into account to date (Skeens et al., 2024).

The dissertation aims to systematically improve outpatient oncological care through digital tools. The first step is to systematically record the current state of digitalisation in paediatric oncology in Germany, Austria and Switzerland. An online survey of paediatric oncology centres will reveal how outpatient therapies are currently organised, which software solutions are used and what challenges exist in everyday practice. This inventory will form the basis for the development of innovative, practice-oriented eHealth solutions.

Based on this, specialised software for digital support of oncological therapy management is being developed at the University Children's Hospital Zurich. This software is intended to support medical professionals in therapy management and, specifically, in the creation of complex, study-based medication plans. Algorithmic calculations, plausibility checks and automated dose controls can reduce errors and significantly speed up the planning process. In addition, the structured storage and standardised output of data (e.g. in PDF or FHIR formats) enables efficient transfer to other systems or individuals.

Finally, a mobile application is being developed. This app is designed to provide families with a digital overview of the entire treatment plan – including medication intake, laboratory values, appointments and status information. Automatic data exchange between the app and the hospital system creates a continuous flow of information, which increases both treatment adherence and patient safety. This not only improves the quality of the data, but also reduces the burden on families.

The aim of the dissertation is to empirically test whether these two applications can measurably improve the quality of outpatient oncological care for children. Both quantitative data (e.g. time spent, error rates, feedback from app use) and qualitative assessments by doctors, nursing staff and parents will be analysed.

The expected results will contribute to the further development of digital support systems in healthcare. They should show whether intelligent software solutions and mobile applications can not only increase efficiency in hospitals, but also strengthen the sense of security and self-efficacy of families with children suffering from cancer. In addition, the findings can serve as a model for other specialist areas with similarly complex therapy processes. The focus is on analysing how the integration of digital technologies influences the structures and processes of paediatric oncology and what implications this has for the further development of patient-centred, digitally networked medicine.

The dissertation project will be carried out as a cumulative work comprising three interrelated publications. It combines health economics, IT and medical perspectives, thus linking research and practice in a highly relevant field of application for digital healthcare.

Armando, L. G., Miglio, G., Cosmo, P. de & Cena, C. (2023). Clinical decision support systems to improve drug prescription and therapy optimisation in clinical practice: a scoping review. BMJ Health Care Inform, 30, e100683.

Hudson, M. M., et al. (2021). Long-term Follow-up Care for Childhood, Adolescent, and Young Adult Cancer Survivors. Pediatrics, 148, e2021053127.

IAP, PHO Chapter of Indian Academy of Pediatrics, InPOG & CKRCS Groups. (2020). WHO Global Initiative for childhood cancer – India responds. Pediatr. Hematol. Oncol. J., 5, 145–150.

McGrady, M. E. & Pai, A. L. H. (2019). A Systematic Review of Rates, Outcomes, and Predictors of Medication Non-Adherence Among Adolescents and Young Adults with Cancer. J. Adolesc. Young Adult Oncol., 8, 485–494.

Pawloski, P. A., Brooks, G. A., Nielsen, M. E. & Olson-Bullis, B. A. (2019). A Systematic Review of Clinical Decision Support Systems for Clinical Oncology Practice. J. Natl. Compr. Cancer Netw., 17, 331–338.

Skeens, M. A., Jackson, D. I., Sutherland-Foggio, M. S. & Sezgin, E. mHealth Apps in the Digital Marketplace for Pediatric Patients With Cancer: Systematic Search and Analysis. JMIR Pediatr. Parent. 7, e58101 (2024).

Ward, Z. J., Yeh, J. M., Bhakta, N., Frazier, A. L. & Atun, R. (2019). Estimating the total incidence of global childhood cancer: a simulation-based analysis. Lancet Oncol., 20, 483–493.