Symptom Monitoring Intervention for Hospitalized Patients With Advanced Cancer

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In a single-institution study reported in JAMA Oncology, Nipp et al found that a symptom monitoring intervention for patients hospitalized with advanced cancer did not increase proportions of days with improved symptoms, nor reduce length of hospital stay or unplanned readmission rates.

Study Details

In the trial, 321 evaluable patients admitted to the inpatient oncology service of Massachusetts General Hospital were randomly assigned between February 2018 and October 2019 to a symptom monitoring intervention (n = 160) or usual care (n = 161). All patients reported symptoms on the Edmonton Symptom Assessment System (ESAS) and the Patient Health Questionnaire-4 (PHQ-4) daily using tablet computers. Patients in the intervention group had symptom reports displayed during daily oncology rounds, with alerts for moderate, severe, or worsening symptoms; those in the usual-care group did not have symptom reports displayed during rounds.

Linear regression adjusted for baseline symptoms was used to determine differences in the mean proportion of days that patient symptoms improved, with the difference expressed as the unstandardized coefficient (B). The primary outcome measure was proportion of days with improved symptoms; secondary measures were length of hospital stay and 30-day rates of unplanned readmission.

Key Findings

Proportions of days with improved symptoms for the intervention group vs usual-care group were 47% vs 54% for fatigue, 39% vs 48% for pain, 46% vs 43% for poor well-being, 32% vs 33% for lack of appetite, 36% vs 33% for drowsiness, 25% vs 25% for shortness of breath, 20% vs 25% for constipation, 27% vs 23% for nausea, and 16% vs 17% for diarrhea.

Overall, no significant differences were observed between the intervention group and the usual-care group for proportions of days with improved symptoms on ESAS-physical (B = −0.02, 95% confidence interval [CI] = –0.10 to 0.05, P = .56), ESAS-total (B = −0.05, 95% CI = –0.12 to 0.02, P = .17), PHQ-4-depression (B = −0.02, 95% CI = –0.08 to 0.04, P = .55), or PHQ-4–anxiety (B = −0.04, 95% CI = –0.10 to 0.03, P = .29).

No significant differences were observed between the intervention group vs the usual-care group for length of hospital stay (7.59 vs 7.47 days, B = 0.13, 95% CI = –1.04 to 1.29, P = .83) or 30-day readmission rates (26.5% vs 33.8%, hazard ratio = 0.73, 95% CI = 0.48–1.09, P = .12).

The investigators concluded, “This randomized clinical trial found that for hospitalized patients with advanced cancer, the assessed symptom monitoring intervention did not have a significant effect on patients’ symptom burden or health-care use. These findings do not support the routine integration of this type of symptom monitoring intervention for hospitalized patients with advanced cancer.”

Ryan D. Nipp, MD, MPH, of Massachusetts General Hospital & Harvard Medical School, is the corresponding author for the JAMA Oncology article.

Disclosure: This study was supported by an Alliance NCI Community Oncology Research Program (NCORP) grant and the Alliance NCORP Research Base. For full disclosures of the study authors, visit

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