An easy-to-deploy, automated self-management intervention may prove to be of benefit in supporting competence and symptom management among cancer survivors, according to data presented during the 2022 ASCO Quality Care Symposium.1
Analysis of the randomized controlled trial found that 12 months after enrollment, veterans who engaged with the intervention were more confident in their ability to manage their symptoms, and it appeared there may be an association with the “dose” of intervention. Authors of the study also noted that self-reported use of services for most common symptoms was lower in the intervention arm.
Sarah T. Hawley, PhD, MPH
“Such an intervention could potentially promote more efficient use of services, such as primary and specialty care,” said lead study author Sarah T. Hawley, PhD, MPH, Professor of Internal Medicine and Professor of Health Management and Policy Health Behavior and Health Education at the University of Michigan School of Public Health, Ann Arbor.
As Dr. Hawley explained, there are more than 3.1 million survivors of prostate cancer in the United States. Long-term adverse symptoms following treatment of prostate cancer are prevalent. Although these symptoms can often be effectively self-managed, many survivors do not experience relief from them, leading to poor quality of life and even misuse of services. “Better tools are needed to support long-term survivors to self-manage symptoms and to appropriately seek primary and specialty care, which could translate to more efficient health utilization,” she said.
Between April 2015 and February 2017, Dr. Hawley and colleagues randomly assigned veteran survivors of prostate cancer (n = 556) to an automated tailored self-management support intervention vs a newsletter that included self-management strategies tailored to a specific symptom. The intervention lasted more than 3 months and delivered tailored information regarding symptoms for urinary, sexual, bowel, and general health, with patients allowed to choose focus areas. The intervention consisted of four separate phone calls, followed by four separate newsletters along with a symptom-specific audio testimonial. At 12 months, study participants were assessed regarding the use of services relative to their and their confidence in symptom self-management (on a scale of 5–15).
Of those randomly assigned to the study, 81.7% completed the 12-month survey assessment (n = 226 in the intervention group and n = 228 in the control group). At 12 months, said Dr. Hawley, the intervention group had a significantly higher level of confidence in symptom self-management compared with the control group.
Additionally, at the 12-month assessment, patients randomly assigned to the self-management intervention vs the control were less likely to have seen a provider or doctor regarding symptom management. “Based on these data, we hypothesized that if people are feeling more confident in their ability to manage symptoms, they’re less likely to seek care for those symptoms,” said Dr. Hawley. “That would be the ideal.”
Dr. Hawley underscored the high level of engagement from the veterans. “We recruited more than 500 prostate cancer survivors across four bases, and they remained engaged throughout the study, with more than 80% completing the 12-month assessment,” said Dr. Hawley, who noted that nearly 50% of patients chose to focus on more than one symptom. “More than 80% of participants also reported high satisfaction with the program and a desire to recommend it to others.”
“The intervention was easy to deliver outside of the EMR [electronic medical record] and had limited involvement by clinicians or staff,” she added. Despite good participation, Dr. Hawley noted that approximately half of the veteran prostate cancer survivors who were contacted opted not to participate. “Even for a simple intervention like this, not everyone has access to the requisite technology,” explained Dr. Hawley. “We also had difficulty accurately capturing procedures that may have been related to symptoms or the intervention use via the EMR.”
These limitations notwithstanding, Dr. Hawley and colleagues believe that interventions such as Building Your New Normal hold promise for helping long-term survivors effectively self-manage adverse symptoms.
DISCLOSURE: Dr. Hawley reported no conflicts of interest.
1. Hawley ST, Metreger T, Kim H, et al: 12-month secondary outcomes of a prostate cancer survivor symptom self-management intervention. 2022 ASCO Quality Care Symposium. Abstract 373. Presented September 30, 2022.
Manali I. Patel, MD, MPH, MS
In a presentation that followed the discussion of symptom self-management,1 Manali I. Patel, MD, MPH, MS, Assistant Professor of Medicine, Stanford University, Palo Alto, California, emphasized the need to improve symptom management in diverse populations.