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Technology developed at Western University and Lawson Health Research Institute can provide a new window into whether or not patients are responding to treatment for advanced ovarian cancer. A multi-centre clinical trial has demonstrated that CT Perfusion, which measures blood flow and blood volume to tumours associated with ovarian cancer, can provide an accurate prediction of how well a treatment is working, allowing physicians the opportunity to better plan treatment. Funding for the trial was provided by the US National Cancer Institute through the National Clinical Trials Network including NRG Oncology and ECOG-ACRIN.

“CT perfusion is homing into the change in blood flow to the tumour before and after treatment,” said Ting-Yim Lee, professor at Western University’s Schulich School of Medicine & Dentistry, scientist at Lawson Health Research Institute, and a Medical Physicist at St. Joseph’s Health Care London. “In this particular case we can see that blood flow tends to decrease in those who will survive longer without symptoms, whereas for those whose symptoms will recur within six months, we saw blood flow to the tumour increase after their treatment.”

 

 

The study was published in the journal, Clinical Cancer Research. Its authors point out that in 60 to 85 per cent of ovarian cancer patients, relapse will occur after initial treatment. By using CT perfusion to identify which patients are more likely to benefit from a specific therapy enables better patient selection and treatment planning, and also provides a biomarker for future clinical trials assessing new treatment options.  The authors also point out that although the trial is promising, further studies are required to corroborate the current findings.  

“Using this method we are able to see a change in the blood flow as early as four weeks after treatment. This means we don’t have to wait months to determine whether symptoms will recur, we are able to tell whether the treatment is effective much sooner,” said Lee.

Developed by Lee and his team at Western University’s Robarts Research Institute, CT perfusion uses X-ray dye in combination with existing CT scanners to measure blood flow. The technology is already used globally to assess blood flow to the brain after stroke. This clinical trial for use in ovarian cancer took place across 19 U.S. centres, and also demonstrated that the technology is easily implemented onto any existing CT scanner, and requires minimal training to be successful. 

A first-of-its-kind research study by Lawson Health Research Institute is moving into the community and evaluating the use of smart technologies in the home for people with severe mental illness.  

After prototyping this approach within a hospital setting through St. Joseph’s Health Care London, the research team will be outfitting eight affordable housing units at Canadian Mental Health Association Middlesex and London and Middlesex Community Housing with smart home technology. 

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In-hospital prototype for using smart technologies in the home 

The Smart Home Community Model 

“This solution is for people who are having difficulty managing their everyday life and need a high level of care to maintain community living,” says Dr. Cheryl Forchuk, Assistant Scientific Director at Lawson and project lead for the Smart Home Community Model. “Technology and applications are being embedded in the lived environment and then tested to ensure they are safe, secure and appropriate for use in health care.”

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Dr. Cheryl Forchuk announcing this phase of the project, from within one of the apartment buildings. 

Study participants will select from a wide range of tools that will best meet their individual needs. Devices such as smartphones and touch-screen monitors connect with applications to provide video-conferencing, questionnaires, and prompts and reminders based on the person’s care plan. 

As an example, participants have regular access to mood scales with questions about how they are feeling. These are used extensively in mental health care settings to help address issues and start conversations with clients. The care team receives notification of the answers, giving regular insight into how the person is doing and if they need additional follow-up. 

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Depending on their needs, participants have access to automated medication dispensers and smart health monitoring devices, such as weigh scales, blood pressure monitors, glucometers, and tracking monitors for heart rate, activity and sleep. 

This patient population often faces health challenges on multiple fronts, with higher rates of diabetes and cardiac issues. They can struggle keeping balance when it comes to activity, weight and sleep. Fluctuations in any of these can be early indicators that a crisis is looming. 

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“By integrating and testing these smart tools for health care, we are not simply looking at the technology but how it can be used as a tool for communication,” says Dr. Forchuk. “We see smart technology supporting more seamless communication between health care providers and the client – all from their own homes. This helps them better manage their care and overall wellbeing, flag issues earlier on and avoid trips to the clinic when appropriate.”

Paula's Perspective 

Paula Rawlinson is chair of the family council and sits on the patient council for St. Joseph’s Parkwood Institute Mental Health Care. She personally has lived experience with mental health and as also acted as a caregiver for a family member. 

“Both myself and my family member could have benefitted from these tools, very much so,” says Paula. “When I was really suffering, I isolated myself from people a lot. Even when I lived in a group home because I needed a higher level of care. Having some sort of helpful device right there, encouraging me to keep up with things and connecting me to someone I trusted, would have made a huge difference. Especially after the first discharge.”

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She adds that for someone who is really struggling, this could be a life-saving strategy that makes a vital difference. 

For her family member, Paula sees many uses for these tools and knows that they would actually use them. “I’ve been able to see the tools and they are even simpler than using email. It makes them accessible to a lot of people in the community who would make good use of them to improve their situation.” 

Results and Impact

Some of the tools as part of this project have previously been tested formally as part of a research study and shown positive results. 

The health team has access to the data to more easily stay in touch with the person. They can work together to track trends and pinpoint triggers, creating more personalized and effective strategies. With less focus on the daily aspects of care, providers reported that in-person meetings offered more meaningful and important discussions. 

“All of the data is also viewable by the client who continues to work with a health care provider,” explains Dr. Forchuk. Clients can reach out sooner and get support more quickly. Potential issues and crisis are addressed earlier on, and in previous studies they reduced psychiatric readmissions, emergency room visits and arrests. Clients reported more satisfaction with their care and feeling better overall. 

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“When we have more people successfully achieving community living and managing their care with fewer outpatient visits and other service utilization, we can open up capacity in the system and deliver quality care at a lower cost.” 

The team anticipates that participants will experience greater levels of independence and autonomy in maintaining housing and self-care for mental health and chronic illnesses. 

Paul points out that one of the key outcomes is to avoid re-admission. “One of the main, recurring struggles is loneliness. With tools to keep people in more regular contact with their care team and assistance with their everyday life, they can shift more to having a fun life. You can build up those crucial relationships with family and friends – and those people feel less burnout as caregivers. It adds a lot of support and resiliency.” 

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Dr. Forchuk adds that “our approach is to care for the whole person – mind, body and soul. It goes beyond managing the mental illness and is about supporting people in managing their life.” 

The team already has four people enrolled in the study. In addition to people living alone, they will have participants with roommates and families to test the strategy under various real-life situations. The initial study will take place over one year. 
 

This phase of project has received generous funding from the Canada Mortgage and Housing Corporation. The Canadian Institutes for Health Research contributed to the initial pilot phase.

 
 

A research team from Lawson Health Research Institute has announced promising results from a one-of-a-kind demonstration study that evaluated the use of smart technologies in the home for people with severe mental illness.   

“Our Smart Homes solution is for people who are having difficulty managing their everyday life and need a high level of care to maintain community living,” says Dr. Cheryl Forchuk, Assistant Scientific Director at Lawson and project lead for Smart Home Community Model Phase.

“We have strong initial evidence showing that technology and applications embedded in the lived environment are safe, secure and appropriate for use in health care.” 

After prototyping this approach within a hospital setting through St. Joseph’s Health Care London, the research team outfitted affordable housing units at Canadian Mental Health Association (CMHA) Elgin-Middlesex and London and Middlesex Community Housing (LMCH) with smart home technology.  

The team presented the full study results during a virtual event. 

There were 13 participants as part of this project phase who had different living situations such as individual apartments, group homes or family homes. Anxiety, mood and psychotic disorders were the most common mental health diagnoses, with many also suffering from chronic pain that make the activities of daily life difficult.  

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“More and more, smart technologies like phone applications or virtual care are being used for mental health care. A smart home solution like the one we have tested could be considered a higher dose of technology, offered to clients with higher needs. The right dose for one may not work for another – the technological solutions used should vary depending on the individual,” explains Dr. Forchuk.  

Each study participant selected from a wide range of tools that would best meet their individual needs, with all but one participant selecting more than one tool. Devices such as smartphones and touch-screen monitors connect with applications to provide video-conferencing, questionnaires, and prompts and reminders based on the person’s care plan. They also had access to automated medication dispensers and smart health monitoring devices for tracking heart rate, activity and sleep. 

“All of the data is viewable by both the client and health care provider, allowing for more seamless care and identification of issues earlier on,” adds Dr. Forchuk.  

The study found that visits to a health or social service provider and the emergency department decreased, as did home visits from a provider. Telephone appointments increased and communication between the client and provider were enhanced. Almost 80 per cent of the participants felt that the technologies improved their health care overall.  

Higher levels of community integration and a greater sense of independence were also reported, including a better ability to remain connected with friends and family during the pandemic. When medication dispensers were used, no medication doses were missed. Participants felt they were better able to track their own health and more motivated to lead healthier lives. 

“The compliment of smart technology in our Supportive Independent Living Program has proven to improve the quality of life of participants by reducing use of emergency services and fostering learning opportunities for independent living skills to create a good quality of life,” says Nedrita Shemshedini, Manager of Supportive Independent Living at CMHA Elgin-Middlesex. “In a large-scale rollout, this model could improve wellbeing and empower persons to better manage their care.”  

The research team hopes this work will help inform the integration of smart technology more fully into mental health care delivery. Laura Pearson, Executive Director at Ontario Peer Development Initiative, urges that “there is a need for key policies to be addressed and changed in order to support funding and access for technology at a system level for the purpose of mental health care.”  

The community model phase of the Smart Homes project was generously funded by the Canada Mortgage and Housing Corporation (CMHC).