A digital symptom monitoring system in which patients undergoing cancer treatment could report symptoms through weekly at-home surveys resulted in better symptom control and physical function, as well as improved communication with their medical team, according to results from a study by Basch et al. The study (Abstract 349527) was presented during a live broadcast session of the ASCO Plenary Series.
Study Methodology
Side effects from cancer and its treatment are common and, depending on their severity, can influence the continuance of treatment and negatively impact patients’ quality of life. In this cluster-randomized study, 52 United States–based community oncology practices were randomly assigned 1:1 to digital symptom monitoring with patient-reported outcome surveys or usual care control. Patients receiving systemic treatment for metastatic cancer were eligible.
A total of 1,191 patients were included in the study, 593 from practices using patient-reported outcome surveys and 598 patients at control practices. At the patient-reported outcome practices, participants were invited to complete a weekly survey via the Internet or an automated telephone system for up to 1 year.
The survey included questions about nine common systems, performance status, and falls. Severe or worsening symptoms triggered electronic alerts to care team nurses, and reports showing longitudinal symptom data over time were available to oncologists during in-person or telehealth visits. Patients completed 20,565 of 22,486 (91.5%) expected weekly surveys.
KEY POINTS
- For the patient-reported outcome arm vs controls, clinically meaningful benefits were experienced in physical function by 13.8% more patients; in symptom control, by 16.1% more patients; and in health-related quality of life by 13.4% more patients.
- Patients completed over 91% of expected surveys. Care team nurses responded to notifications about severe or worsening symptoms 59% of the time, usually by calling patients at home to counsel them on symptom management, add supportive medicines, or to set up new appointments.
- A digital symptom monitoring system improves patients’ symptom management and yields better clinical outcomes.
Key Results
The researchers found that enabling patients to report their symptoms and side effects directly to their medical team between visits led to improved communication with their medical team members, better symptom management, and improved quality of life.
For the patient-reported outcome arm vs controls, clinically meaningful benefits were experienced in physical function by 13.8% more patients (P = .009); in symptom control, including nausea/vomiting, pain, dyspnea, constipation, diarrhea, insomnia, appetite loss, and fatigue, by 16.1% more patients (P = .003); and in health-related quality of life (a combination of function and symptom scores) by 13.4% more patients (P = .006). Mean changes from baseline were superior with patient-reported outcome surveys vs controls for physical function (mean difference = 2.47, 95% confidence interval [CI] = 0.41–4.53; P = .02) and health-related quality of life (mean difference = 2.43, 95% CI = 0.90–3.96; P = .002).
“Digital symptom monitoring during cancer treatment confers clinical benefits,” concluded the study authors.
Clinical Significance and ASCO Expert Perspective
“This national trial provides evidence that a simple technology asking patients about their symptoms is feasible, significantly improves symptom management, and yields better clinical outcomes,” said lead author Ethan Bash, MD, MSc, Richard M. Goldberg Distinguished Professor of Medical Oncology and Chief, Division of Oncology at UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina, in a statement. “For this type of system to work, it is essential to have not only high patient participation, but a strong commitment from the health-care system [as well].”
“These results suggest a relatively simple approach to improving how we care for patients with advanced cancer receiving treatment and a range of future applications to further improve how oncologic care is delivered,” said ASCO expert Robert Dreicer, MD, MS, MACP, FASCO, in a statement.
This study was presented during a live broadcast session of the ASCO Plenary Series. The session recording is now available on the ASCO website. Log-in using your ASCO.org username and password to watch.
Disclosure: For full disclosures of the study authors, visit asco.org.
