Web-Based Self-Care Support and Communication Coaching Program Reduces Symptom Distress in Cancer Patients
In the ESRA-CII trial reported in the Journal of Clinical Oncology by Berry et al, patient use of a Web-based self-care program featuring tailored education and communication coaching resulted in significantly reduced symptom distress compared with symptom/quality-of-life tracking alone in patients with a variety of cancers receiving standard education. Benefit was particularly evident in patients aged at least 50 years.
Study Details
In the study, 752 ambulatory adult patients with cancer treated at Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium and the Dana-Farber Cancer Institute were randomly assigned to symptom/quality-of-life screening at four time points (control; n = 378) or Web-based screening, targeted education, communication coaching, and the opportunity to track/graph symptoms/quality of life over time (intervention; n = 374).
Patients completed symptom/quality-of-life assessments at baseline, approximately 3 to 6 weeks after starting treatment (when symptoms were likely to be prevalent), 2 weeks later (to assess response to previously identified issues), and at 2 to 4 weeks after treatment ended or at the next staging visit in those continuing treatment indefinitely. Clinicians received a summary of the patient-reported data at each time point in both groups. The primary outcome measure was change in Symptom Distress Scale-15 (SDS-15) score between baseline and last assessment.
Intervention
The intervention program offered tailored education, communication coaching, and symptom/quality-of-life tracking and was accessible from home. Patients used the program to self-assess symptoms/quality of life both when prompted at each study time point and as they wished between visits. After each self-report, the program delivered messages regarding issues reported at a predetermined threshold, such as why and how often this issue typically occurs, what can be done, and how the patient should talk to the clinical team about the issue.
Patients were coached to verbalize specifics tailored for each issue to providers, including how often and when the issue occurred, intensity, alleviating or aggravating factors, and requesting help. Additional features alerted patients to call providers immediately when levels of symptom distress, depression, or pain were severe or when any suicidal ideation occurred between clinic visits. Patients could visualize graphed responses over time for 24 symptom/quality-of-life items and annotate the results using a journal feature. Patients could access the self-care strategies and coaching for any issue at any time.
Control group patients completed the same symptom/quality-of-life assessments but only at each study time point. Research staff verbally notified providers of severe levels of depression or pain at the time of the clinic visit. Both groups were provided the same patient education typically available in each clinic.
The control and treatment groups were generally balanced for age (median, 59 and 56 years; 76% and 66% ≥ 50 years), sex (54% and 50% male), ethnicity (7% and 9% minority), working status (59% and 60% working), clinical service (56% medical oncology in both, 31% and 33% radiation oncology), cancer diagnosis (eg, breast in 26% and 30%, prostate in 16% and 17%, colorectal in 8% and 9%), and stage (I in 19% and 16%, II in 23% and 27%, III in 17% and 21%, IV in 36% and 32%).
Improved Symptom Distress
Mean (standard deviation) SDS-15 scores were 24.1 (6.8) in the control group and 24.3 (6.7) in the intervention group at baseline and 25.4 (7.9) vs 24.2 (6.7) at end of study. The mean SDS-15 score change was +1.27 (6.7) in the control group (higher distress) vs −0.04 (5.8) in the intervention group (lower distress), yielding an estimated reduction of 1.21 (95% confidence interval = 0.23–2.20, P = .02) in the intervention group with adjustment for baseline SDS-15 score.
On multivariate analysis adjusting for age, clinical service, working status, and baseline SDS-15 score, the reduction in the intervention group remained significant (P = .04). Baseline SDS-15 score (P < .001) and clinical service (P = .01) were also predictive of SDS-15 score change.
Improvement Evident in Older Patients
A borderline significant interaction (P = .06) between age and study group was observed on multivariate analysis. Subsequent multivariate analysis by age < 50 vs ≥ 50 years showed that reduction in SDS-15 score was significant in patients aged ≥ 50 years (−1.93, P = .002), whereas change was not significant in those aged < 50 years (+0.87, P = .4).
Clinical service was significantly associated with SDS-15 score change only among older participants (+1.85, P = .005 for medical oncology vs radiation oncology), working status was significant only in younger patients (+2.26, P = .04, for not working vs other), and baseline SDS-15 score was significant in both younger (−0.27, P < .001) and older patients (−0.42, P < .001).
The investigators concluded, “Web-based self-care support and communication coaching added to [symptom/quality-of-life] screening reduced symptom distress in a multicenter sample of participants with various diagnoses during and after active cancer treatment. Participants age ≥ 50 years, in particular, may have benefited from the intervention.”
Donna L. Berry, PhD, RN, of Dana-Farber Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the National Institute of Nursing Research, National Institutes of Health.
The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
