In an NRG Oncology/GOG study (GOG-0259) reported in the Journal of Clinical Oncology, Donovan et al found that both nurse-led (Nurse-WRITE) and self-directed (SD-WRITE) Web-based symptom self-management interventions (WRITE Symptoms) improved symptom control vs enhanced usual care alone in women with recurrent ovarian cancer.
Study Details
In the multicenter study, 497 women with three or more symptoms were randomly assigned 1:1:1 to receive Nurse-WRITE (n = 166), SD-WRITE (n = 166), or enhanced usual care alone (n = 165). SD-WRITE patients were assigned to an interactive computer module for 6 to 8 weeks. The module guided each patient through all elements of the WRITE Symptoms intervention to develop tailored Symptom Care Plans, followed by a 2-week strategy review and revision for each patient’s three targeted symptoms. Nurse-WRITE patients were assigned to a password-protected private message board. A nurse interventionist led each patient 1:1 through WRITE Symptoms via asynchronous postings on the message board; the nurse’s goal was to develop individualized Symptom Care Plans followed by a 2-week strategy review and revision for each patient’s three target symptoms over 8 weeks adhering to a standardized protocol. All patients received enhanced usual care, consisting of a monthly online symptom assessment with provider reports, online resources, and every-2-week emails.
The primary outcome measures were symptom burden and symptom controllability, assessed by the Symptom Representation Questionnaire, and global quality of life, assessed by the Functional Assessment of Cancer Therapy-General, version 4. Outcomes were evaluated at 8 and 12 weeks.
Photo credit: Getty
Key Findings
At baseline, 84% of patients were receiving chemotherapy and reported a mean of 14 concurrent symptoms, most commonly fatigue, constipation, and peripheral neuropathy. No differences among groups in target symptom burden, target symptom controllability, or quality of life scores were observed at baseline.
Target symptom burden scores improved significantly from baseline in all three groups at week 8 (all P < .001) and week 12 (all P < .001). No group by time interactions (P = .18) or group main effects (P = .24) were observed.
For target symptom controllability scores, a significant group by time interaction (P < .001) was observed in which both WRITE groups were superior to the enhanced usual care group. Scores significantly improved from baseline to week 8 and from baseline to week 12 (both P < .001) in the Nurse-Write group and from baseline to week 8 (P < .001) and from baseline to week 12 (P = .002) in the SD-WRITE group, whereas no significant changes over time were observed in the enhanced usual care group.
For quality of life scores, a significant time effect was observed (P < .001), with scores improving in all three groups from baseline to week 8 (all P < .001) and from baseline to week 12 (all P < .001). No significant group by time interactions (P = .83) or group main effects (P = .24) were observed.
The investigators concluded, “Both WRITE Intervention groups showed significantly greater improvements in symptom controllability from baseline to 8 [weeks] and baseline to 12 weeks compared with enhanced usual care. There were no significant differences between Nurse-WRITE and SD-WRITE. SD-WRITE has potential as a scalable intervention for a future implementation study.”
Heidi S. Donovan, PhD, RN, of the University of Pittsburgh School of Nursing, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by grants from the National Institutes of Health National Institute of Nursing Research and National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
