Transforming management of advanced prostate cancer through digital health: increasing representation of ethnic minorities and developing a collaboration for research scale-up.

Healthcare systems face increasing demand for monitoring and treatment of long-term conditions, which account for 64% of NHS outpatient appointments. Remote monitoring avoiding hospital visits offers many advantages, including safety as for example, during the Covid-19 pandemic. Digital solutions benefitting patients, clinicians and the NHS are being sought.

Itecho Health has developed the innovative Ascelus platform, which enables patients to send information through a 'symptom checker' to their clinical team, which reviews this and the patient’s blood tests. Patients then receive encrypted clinical advice, results of blood and other monitoring sent directly to their smart phone or other device. Patients deemed at risk are called for face-to-face appointments.

Prostate cancer (PC) is the commonest male cancer worldwide. Incidence has increased by more than 40% since the early 1990s and is forecast to further increase year on year. In the UK, annual mortality from PC is around 10,000, mainly from men who have developed metastatic disease, which is incurable.

Nevertheless, with modern drugs, men with advanced disease may have several to many years of life. In particular, testosterone-lowering drugs, have led to improved patient quality of life and overall survival. These drugs include the tablet-based-treatments enzalutamide, abiraterone and apalutamide.

At this stage of the disease, PC behaves like a chronic disease, requiring stable medication and regular monitoring. In a current NIHR i4i Connect-funded project (completion expected in October 2022), Itecho Health has used its Ascelus platform and co-design principles working with patients with PC and Sheffield University/NHS staff, to reduce face-to-face appointments.

Men from black ethnic groups have twice the risk of developing PC as men from white groups, their PC is likely to be more aggressive and they are less likely to be involved in clinical trials. This project seeks to address this inequality, using the Sheffield team’s experience in extensive community work with black men with prostate cancer. The aims are to increase the representation and engagement of Black men, who have the highest risk of prostate cancer, in co-design of the Ascelus technology and to support the dissemination of results from the Connect study and onboarding of collaborators for a larger multi-centre study.

We will achieve this through 4 interlinked work packages as follows. WP1will develop engagement of men from high-risk ethnic groups in co-design and Ux testing; WP2 will link the results of WP1 into Ascelus platform development; WP3 will develop plans for dissemination, wider engagement of clinicians and NHS staff and on-boarding for a larger multi-centre study; WP4 will provide overall project management.

We have assembled a multidisciplinary team which is experienced in working together and which possesses the clinical, technological and management skills to deliver to time ont this project. The projected outcome will be a protocol and application for a larger national multisite study, incorporating the digital platform into management of patients with advanced PC in at least 6 large UK centres.

As a result of this project, this will include appropriate incorporation of measures to meet the special needs of men from Africa-Caribbean background who are at highest risk of developing aggressive PC.