Feasibility Study of Monitoring by Web-application on Cytopenia Related to Chemotherapy
Feasibility Study of Monitoring by Web-application on Cytopenia Related to Chemotherapy
Patients should receive a chemotherapy regimen with an overall risk of febrile neutropenia ≥
 20%. The use of the web-application their will be proposed .

 They will be informed of the risk of neutropenia, fever and bleeding which may occur beyond
 the fifth day of each chemotherapy cycle (to eliminate fevers related to treatment).

 The temperature measurement is performed at home by an infrared forehead thermometer provided
 as part of the study, in a systematic manner once daily at the same time of day and in case
 of unexplained fatigue or chills.

 Before any fever reported to the physician via the web-application (alert), a questionnaire
 will be completed by the patient to the search for gravity criteria to assess his condition
 at home. The patient will be hospitalized immediately if it shows signs of severity in order
 to document the infection and provide intravenous antibiotics adapted to the clinical
 condition; in the absence of these signs, the patient will make a count to the nearest lab
 and will receive oral antibiotics if indicated. The subsequent strategy will be defined by
 the web-application algorithm to optimize the care of patients.

 The ability to use a web-application could allow early detection of complications of
 post-chemotherapy haematological toxicity and offer a taking over guided by a decision-making
 algorithm managed by the physician.

 The aim is to favour the taking over at home.
The hematological toxicity is frequent and sometimes severe complication of chemotherapy used
 in onco-hematology.

 The most frequent is the neutropenia. It is defined by Neutrophils rate lower than 1 Giga/L.
 The patient can then have a risk of fever or serious infection which requires a
 hospitalization, an empiric antibiotic therapy and sometimes a dose reduction of chemotherapy
 which can threaten the patient future. Hospital overall mortality by febrile neutropenia is
 estimated at 9.5%.

 The growth factor allowed to reduce the risk of neutropenia or to shorten the neutropenia. In
 general, they are suggested in primary prophylaxis for chemotherapy whose risk of febrile
 neutropenia is superior at 20%.

 However, only 20 to 30% of post-chemotherapy fever will be documented. A double and early
 empiric antibiotic therapy decreases significantly the risk of mortality.

 Thrombocytopenia is a less frequent complication than the neutropenia but there is a risk of
 spontaneous bleeding for the patient when the platelets rate is below 10 Giga/L.

 The patient is informed at the beginning of his taking care of the neutropenia risk, fever
 and hemorrhagic event which can happen at home between two chemotherapies. The patient is in
 the center of his taking care of and must report quickly all fever or bleeding happening
 after chemotherapy to evaluate the risk of immediate complication and to propose the
 appropriate therapeutic strategy. However too many patient with one or two hematological
 complication during the chemotherapy aren't take care of optimally nor in adapted delay.

 The use of a web-application could allow to febrile patient after chemotherapy to benefit of
 personalized care with a quicker communication of clinical symptoms and blood tests results
 to the oncologist via this tool.

 In practice, patients don't always contact their oncologist in case of fever. On the other
 hand, the delays for transmission of biological tests at the medical team don't always allow
 an optimal taking care of and in appropriate delays of hematological toxicity and febrile
 event of patient during chemotherapy.

 The possibility of using a web-application could allow to detect earlier the possible
 complication of post-chemotherapy hematological toxicity and to suggest a taking care of
 guided by a decisional algorithm managed by the oncologist. The aim is to privilege the care
 at home.

 The expected benefit for each patient is to have an earlier and adapted care in case of
 infection and/or bleeding. The use of this web-application could allow, in optimizing the
 care of chemotherapy-induced neutropenia, to limit the number of hospitalization and the
 prescription of intravenous antibiotic and to achieve optimally the therapeutic project.

 The usual monitoring (oral advice only) would have been proposed at all patient include in
 this study. It is unlikely that post-chemotherapy fever, neutropenia or thrombocytopenia will
 supported later than in the usual practice. Therefore it is expected that the use of the
 web-application will be for the benefit of patient by allowing to detect earlier
 post-chemotherapy complications and so to propose an optimal take care of for included
 patients.

 Patient must have a chemotherapy schema with a global risk of febrile neutropenia < 20% could
 use the web-application.

 Patients will be informing of the risks of neutropenia, fever and bleeding could happen
 beyond the 5th day after chemotherapy.

 Temperature will be taken at home by an infrared forehead thermometer provided in the study
 in a systematic once a day at the same time and in case of unusual fatigue or chills.

 When a fever is detected by the web-application, a questionnaire will be completed by the
 patient to find serious symptoms. The aim is to optimize the taking care of patient.
Inclusion Criteria:

 1. Patient with a histologically proven cancer regardless of the location (solid tumor or
 not) except brain tumor

 2. Patient should receive chemotherapy (any indication) associated with overall risk of
 neutropenia greater than or equal to 20%

 3. Age ≥ 18 years

 4. Performance Status ≤ 3

 5. Patient with Internet access and an email box

 6. Patient affiliated to a social security scheme

 7. Patient has given its written consent before any specific procedure for the study

 Exclusion Criteria:

 1. Symptomatic brain metastases

 2. Persons deprived of liberty, under guardianship or under curators

 3. dementia, mental impairment or psychiatric illness that may affect the patient's
 informed consent and / or protocol adherence and monitoring of the test

 4. Patient unable to submit the protocol followed for psychological, social, family or
 geographical reasons

 5. Pregnant or breastfeeding

 6. Patients at risk of severe neutropenia (Absolute Neutrophils Count <0.1 Giga / L
 within 7 days prior to inclusion, acute leukemia, auto or allograft)