Patient Symptom Surveys Linked to Reduced ER Visits, Improved Survival and Quality of Life
Systematic collection of cancer patients’ symptoms using computer surveys was linked to less frequent emergency room admissions, longer average chemotherapy adherence, greater quality-of-life improvements, and improved survival, according to a new randomized, controlled trial spearheaded by a UNC Lineberger Comprehensive Cancer Center researcher.
The first-in-kind study, led by Ethan Basch, MD, MSc, a UNC Lineberger member, Director of the UNC Lineberger Cancer Outcomes Research Program, and an Associate Professor in the UNC School of Medicine Division of Hematology and Oncology, published by Basch et al in the Journal of Clinical Oncology, compared outcomes for cancer patients at the Memorial Sloan Kettering Cancer Center who reported their symptoms using a Web-based survey system with outcomes for patients who relied on usual care for symptom detection. The study evaluated outcomes for 766 patients at Memorial with metastatic cancers who were receiving outpatient chemotherapy. Dr. Basch led the study at Memorial before his move to UNC in 2012.
Survey System
For patients using the Web system, automatic e-mail alerts were sent to nurses and doctors for severe or worsening symptoms. Prior research has shown that doctors miss up to half of patients’ symptoms during cancer treatment. Researchers say survey systems like this one can effectively inform clinicians about issues of concern.
“If we had developed a new drug that yielded these kinds of benefits, we would be very excited,” Dr. Basch said. “This randomized trial found that integrating systematic collection of patient symptoms via the Web into cancer treatment improves multiple key clinical outcomes.”
Study Findings
A larger number of patients using the survey system experienced quality-of-life improvements, with improvements in 34% patients compared to 18% of patients receiving usual care. The survey group also had fewer emergency room visits, with 34% visiting the ER compared to 41% receiving usual care.
Survey patients remained on chemotherapy longer at an average of 8.2 months compared to 6.3 months. They also saw survival benefits: 75% of patients using the surveys were alive after 1 year, compared to 69% of those receiving usual care.
“While this study wasn’t designed to evaluate the mechanism of why we saw these improvements, we can hypothesize that by flagging symptoms that clinicians would otherwise miss, we enable earlier symptom management that avoids downstream events like pain crisis, dehydration, or intractable nausea,” said Dr. Basch. “I would suspect that the main mechanism of action is improved awareness by clinicians of patient symptoms, which enables earlier interventions to avert downstream, untoward events.”
Dr. Basch noted that the computer survey system improved symptom management activities. The study found that nurses directly acted upon the system results more than three-quarters of the time, with changes in medication resulting from 12% of e-mail alerts, and referrals to the emergency room occurring due to 8% of alerts.
“Direct patient reporting gives patients a voice—their unfiltered experience is captured and conveyed to their health-care providers, and their perspective is not being modified by a clinician or anybody else,” Dr. Basch said.
The study was supported by the National Cancer Institute and the Steps for Breath Fund of Memorial Sloan Kettering Cancer Center.
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®.
