Noona for Patient Engagement is an oncology-focused solution designed to support patients from diagnosis through post-treatment follow-up. Seamlessly integrated with ARIA CORE or other hospital information systems (HIS), Noona helps enhance patient care by automating the delivery of essential treatment information (i.e. upcoming appointments, education materials, and clinical reports) and extending the point of care from inside the hospital to where a patient is.
Queen’s Hospital Romford in Essex, UK, initially introduced Noona in 2021 to help streamline clinical workflows, improve early intervention with patients’ symptoms and side effects, and increase clinic capacity. Today, Noona has checked every box as its use continues to expand. It has brought the radiotherapy and chemotherapy clinics closer together, enabling a more coordinated approach to care and solving many of the communication challenges that arise when patients are served in separate clinics. Ultimately, this enables the clinical teams to focus more on patient care.
Implementing Noona across Radiation Oncology and Systemtic Anti-Cancer Treatment
Queen’s Hospital provides care for a diverse population of about 850,000 across northeast London, and is part of the North East London Cancer Alliance. In 2021, the radiation oncology (radonc) and medical oncology—known there as systemic anti-cancer treatment (SACT) — teams decided to start a phased-in approach to implementing Noona across both departments.
Previously, each clinic engaged separately with patients in either face-to-face appointments or telephone calls. Now, Noona allows subscribing patients at Queen’s to interact directly with their oncology care teams anytime and anywhere, informing them of any treatment-related symptoms, and enabling them to keep a personal diary of symptoms and appointments.
Proactively Helping Patients Having Problems Related to Treatment
“We're always looking at ways to improve capacity and how we might use new technology to proactively help patients who are having problems related to treatment,” said Nicola Akar, Lead Chemotherapy Nurse at Queen’s Hospital. “As a care team, we can proactively manage patients’ symptoms submitted via a symptom report or symptom questionnaire in Noona. Symptoms are color-coded, with red meaning the most urgent. Responses can be standardized, and each clinic can set up the automatic responses to reflect its symptom-specific emergency information.”
In the Radiotherapy clinic, patient signup for Noona initially begins when referrals are flagged in the ARIA oncology information system (OIS). Patients then receive an invitation to join Noona when informed about their first CT-simulation appointment. The radonc team created site-specific templates and custom questionnaires, including COVID screening.
“The questionnaires are a valuable tool in helping us improve and expedite our patient reviews,” explained Siobhan Graham, head of radiotherapy at Queen’s. “We saw this in action very early on in our Noona implementation, after we reduced the number of treatments for breast cancer patients from 15 to 5 based on clinical trial data. Anecdotally, we heard that the patients having 5 fractions were getting side effects a week or 2 after finishing treatment. This is in line with the expected side effects if they were having 15 fractions, However the patients were going to their GPs, who didn’t always recognize radiotherapy-related normal skin toxicity. Now we send a follow-up questionnaire to those patients at the right time, so we can give them the information and support they need when they need it.”
Simplified Symptom Management
When patients do have side effects, whether from radiation treatment or chemotherapy, Noona helps simplify symptom management by enabling patients to upload photos into the app for clinician review.
In one instance, Akar said, a 53-year-old ovarian cancer patient undergoing chemotherapy developed a grade 2-3 rash, which the team could monitor through the photos she sent in and not require additional hospital visits. The patient was prescribed antibiotics and an antihistamine and referred to a dermatologist. As a result, the only time she had to come into the hospital was to pick up her medication.
Both the Radiotherapy and Chemotherapy teams also are using the questionnaires to prioritize “red cases,” patients who are flagged as having symptoms that need urgent attention, so they can triage those cases quickly. They’re also looking at ways to track symptoms in particular tumor groups, which ultimately can help them determine proactive symptom management strategies.
“Noona makes it easy to spot when symptoms are starting for particular tumor groups,” Akar explained. “If we know a particular symptom is likely to start on day 5 or day 6, we can introduce a service that helps proactively manage those symptoms, rather than wait for it to happen.”
Expedited Review of Chemotherapy Patients’ Symptoms
As part of the chemotherapy group’s Noona implementation, patients are automatically sent a questionnaire when their appointment for the next cycle of treatment is made in ARIA OIS.
“The chemotherapy symptom questionnaire covers 18 of the most common side effects from chemotherapy, including those we’d typically ask about, such as nausea and infections,” Akar said. “On average, it used to take me 21 minutes to review blood and imaging results, speak to the patient or leave a voicemail, and prescribe therapies. With Noona, I can do it all within 7 minutes—that’s a third of what it used to take. And if a patient’s symptoms need more investigation, I can use digital messaging in Noona or set up dedicated time at the end of my clinic.”*
For Akar’s busy morning telephone clinic, using Noona means she can now complete 24 reviews in the time it used to take to do 12.* On the radiotherapy side, Graham confirmed that Noona has also led to significant improvements in patient care workflows, staff utilization, and symptom management.
“Noona is helping us understand how we can intervene at the right time and manage patient symptoms to avoid a trip to the emergency department or a hospital admission,” Graham said. “We’re also exploring how Noona could help our supportive care groups shorten the treatment pathways for metastatic patients having treatment on our Varian Ethos system.”
Improving Collaboration Among Treatment Teams
Perhaps one of the biggest benefits for both radonc and medonc groups has been the improved working relationships between them, which in turn has led to several new initiatives focusing on how to use Noona to improve collaboration across other teams, including prehab, GI consultants, and head & neck specialists.
“We were already using ARIA OIS in both groups and saw Noona as an opportunity to work together more closely and develop a holistic oncology pipeline,” Akar added. “Noona was built on the already paperless system in radiotherapy and it's helping me implement a similar system in the SACT department. Through collaboration with my radiotherapy colleagues, I’m enhancing my use of the ARIA OIS so we can streamline our workflows and begin to study patient-reported outcomes.”
For patients having both radiotherapy and chemotherapy, Noona is supporting collaboration so both teams can focus on providing timely, improved care and symptom management.
“Before Noona, when concurrent radiotherapy/chemotherapy patients called into the radiotherapy department with a chemotherapy side effect, staff would have to write down the symptom and try to find the right person to speak to,” Graham said. “Noona provides a space for the full narrative directly from the patient, which is easily accessible by anyone on the care teams.”
High Satisfaction Ratings from Patients
Keen to ensure that patients are also pleased with their experience of using Noona, the hospital conducted a satisfaction survey of 150 patients selected at random, with an equal balance of treatment modalities—chemotherapy, radiotherapy, and a combination of both, with a 43% response rate.
Results indicated that most patients found the system either very easy or easy to use and most preferred it to telephone calls. They noted that advice is easy to understand, response times usually less than 24 hours, and overall, the app received four- and five-star ratings.*
“One of the best markers for how patients feel about Noona is the comment, ‘I feel like I control my cancer journey now and not the other way around,’ which is how most patients feel about the system,” Akar says. “Clearly, if there’s one central point where patients can go to get the help and information they need, it’s a lot easier for them and helps us ensure they get the best possible care.”
*The statement by Varian’s customer described here is based on results achieved in the customer’s unique clinical setting. Because there is no “typical” clinical setting and many variables exist, there is no guarantee that other customers will achieve the same results.
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The information captured herein represents the genuine experience of the attributed individuals and may not necessarily represent the views of Varian or the above-referenced institution. Individuals were not compensated for their participation.