A randomized clinical trial of 766 patients, funded by the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO), shows that a simple, web-based, tool that enables patients to report their symptoms in real time, improves outcomes. 
The online intervention tool was designed to triggers specific alerts to clinicians.
Patients with metastatic cancer who used the tool to regularly report symptoms while receiving chemotherapy lived a median of 5 months longer than those who did not use the tool.
These findings presented during the Plenary Session of the 53rd annual meeting of the American Society of Clinical Oncology (ASCO) is among just four abstracts deemed to have the greatest potential to impact patient care.
More than 5,000 abstracts were included is part of the annual meeting.
Overall, patients with cancer may, as a result of their treatment, develop side effects including, nausea, pain, fatigue, diarrhea, constipation, or shortness of breath.
In some cases these symptoms may be due to the cancer itself, in other cases the symptoms may be due to the treatment. Because adverse events may have an impact on the treatment results ans the Quality of Life (QoL) of the patients, it is important to understand the reason. Generally, the best approach is to find out how a patients are feeling is to ask them directly.
But it may not always be possible to ask patients how they are feeling on a regular basis. And even during an appointment, the treating physician may not always have the opportunity to discuss the symptoms. Hence, a new study was designed to help see if an online reporting system to keep track of information about patients’ symptoms and quality of life would be beneficial.
The study enrolled 766 patients with advanced solid tumors (genitourinary, gynecologic, breast, and lung) who were receiving outpatient chemotherapy. The patients were randomly assigned to report their symptoms via tablet computers (intervention group) or to a group whose symptoms were monitored and documented by clinicians, as is usual care in clinical practice. In the usual care group, patients discussed symptoms during visits with oncologists. They were also encouraged to telephone the office between visits if any concerning symptoms arose.
On a weekly basis, patients in the intervention group reported on 12 common symptoms experienced during chemotherapy, including appetite loss, difficulty breathing, fatigue, hot flashes, nausea, and pain, and graded them on a 5-point scale.
The web-based tool, Symptom Tracking and Reporting or STAR, was developed for research purposes and is not commercially available. Patients could report the symptoms remotely from home or at the doctor’s office during oncology or chemotherapy visits, using tablet computers or computer kiosks. Doctors received symptom reports during visits, and nurses received email alerts when patients reported severe or worsening symptoms.
“Patients receiving chemotherapy often have severe symptoms, but doctors and nurses are unaware of these symptoms up to half of the time,” said lead study author Ethan M. Basch, MD, MSc, FASCO, Professor of Medicine at the Lineberger Comprehensive Cancer Center of the University of North Carolina, who was practicing at Memorial Sloan Kettering Cancer Center in New York when the study was conducted.
“We show that using a web-based symptom reporting system that alerts the care team about problems leads to actions that alleviate suffering and improve patient outcomes,” Basch added.
Better Quality of Life
An earlier report from the same study showed that use of the tool was associated with better Quality of Life (QoL), and fewer visits to the emergency room and less hospitalizations. Compared to patients who received the usual, standard, care, patients who used web-based symptom monitoring were also able to tolerate chemotherapy longer.
“The improvement in survival we saw may seem modest, but it is greater than the effect of many targeted cancer drugs for metastatic cancer,” Basch observed.
Patients receiving routine outpatient chemotherapy for metastatic solid tumors at Memorial Sloan Kettering Cancer Center were randomly assigned to self-report 12 common symptoms via tablet computers, or to usual care.
All patients (n=766) in the intervention group, including those with little prior experience using the Internet, were willing and able to regularly report their symptoms via the web throughout chemotherapy. The median age of the patients was 61 years of age (range 26-91), 86% was white, 58% was female. Twenty two percent of the patients had less than high school education.
The patients were diagnosed with a variety of cancers included genitourinary (32% of patients), gynecologic (23%), breast (19%), and lung cancer (26%).
As part of the program, nurses took immediate clinical actions more than three-quarters of the time when patients reported severe or worsening symptoms.
Survival results were assessed after a median follow up of 7 years. At this time 517 of 766 (67%) of the participating patients had died.
Compared to patients who received usual care, the study showed a median overall survival in the intervention arm that was 5 months longer than the control arm (31.2 vs. 26.0 months, p = 0.03). In the multivariable model, results remained statistically significant with a hazard ratio of 0.832 (p = 0.04; 95% CI; 0.696, 0.995).
“Online technologies have transformed communications in practically every aspect of our lives, and now we’re seeing they’re also allowing patients to take an active role in their care and get immediate access to their care provider,” said Harold J. Burstein, MD, PhD, FASCO, Associate Professor of Medicine, Harvard Medical School and an ASCO Expert not associated with the study.
“It’s impressive that something as simple as this not only improves quality of life, but in this case, helps patients live longer. I think we’ll soon see more cancer centers and practices adopting this model,” Burstein added.
These findings are being confirmed in a larger clinical trial, which uses an updated, more user-friendly online tool that works on both personal computers and mobile devices. The study is being conducted in community practices across the United States.
“Symptom management is a central part of what oncology care teams do,” noted Basch.
Basch concluded that this study supports broader use of online tools in routine practice to enable patients to communicate symptoms to the care team in real time.
Last editorial review: June 9, 2017
Featured Image: Faculty presentations during 2017 Conquer Cancer Foundation Grant Writing Workshop at the American Society of Clinical Oncology (ASCO) Annual Meeting. Courtesy: © 2017 Fotolia. Used with permission. Photo 1.0: Ethan M. Basch, MD, MSc, FASCO, The University of North Carolina at Chapel Hill. Courtesy: © 2017 ASCO/Scott Morgan.
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