A Randomized Trial of Weekly Symptom Telemonitoring in Advanced Lung Cancer

Abstract

Context Lung cancer patients experience multiple, simultaneous symptoms related to their disease and treatment that impair functioning and health-related quality of life (HRQL). Computer technology can reduce barriers to nonsystematic, infrequent symptom assessment and potentially contribute to improved patient care. Objectives To evaluate the efficacy of technology-based symptom monitoring and reporting in reducing symptom burden in patients with advanced lung cancer. Methods This was a prospective, multisite, randomized controlled trial (RCT). Two hundred fifty-three patients were enrolled at three sites and randomized to monitoring and reporting (MR) or monitoring alone (MA). Patients completed questionnaires at baseline, 3, 6, 9 and 12 weeks and symptom surveys via interactive voice response (IVR) weekly for 12 weeks. MR patients’ clinically significant symptom scores generated an e-mail alert to the site nurse for management. The primary endpoint was overall symptom burden; secondary endpoints included HRQL, treatment satisfaction, symptom management barriers, and self-efficacy. Results This RCT failed to demonstrate efficacy of symptom monitoring and reporting in reducing symptom burden compared with monitoring alone in lung cancer. HRQL declined over 12 weeks in both groups (P<0.006 to P<0.025); at week 12, treatment satisfaction was higher in MA than MR patients (P<0.012, P<0.027). Adherence to weekly calls was good (82%) and patient satisfaction was high. Conclusion Feasibility of using a technology-based system for systematic symptom monitoring in advanced lung cancer patients was demonstrated. Future research should focus on identifying patients most likely to benefit and other patient, provider and health system factors likely to contribute to the system’s success.

Capture, Transfer, and Feedback of Patient-Centered Outcomes Data in Palliative Care Populations: Does It Make a Difference? A Systematic Review

“…This was supplemented with extensive reference and citation searching, which allowed inclusion of articles published very recently. 41 The review team comprised a multiprofessional team of expert clinicians and researchers, and this aided the development of the review question, protocol, analysis, and synthesis of findings. Furthermore, our two-level review strategy allowed us to appraise the evidence from a general as well as specific perspective.…”

“…Five articles 38,39,41,42,47 reported on acceptability to patients. The main findings were that patients found the intervention ''helpful in discussing important issues/telling professionals how they were feeling'' (weighted mean 69%) and that patients ''would use PCOMs feedback as part of standard care'' (weighted mean 88%).…”

Automated home monitoring and management of patient‐reported symptoms during chemotherapy: results of the symptom care at home RCT

“…Many studies have shown the feasibility of electronic capture and monitoring of patient-reported outcomes (PROs) for symptoms related to cancer treatment [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Most studies have focused on PRO capture at clinic visits with fewer studies evaluating automated systems developed for between-visit home monitoring and realtime follow-up for intensification of care for poorly controlled symptoms.…”

Using telehealth to support end of life care in the community: a feasibility study

“…Authors have acknowledged the potential contribution that telehealth could play in palliative care for patients in rural and remote areas [15], the role that mobile technologies could play [16], and opportunities for specific population groups such as paediatrics [17] or lung cancer [18]. However, reviews and trials have also highlighted the need to build the evidence around palliative care telehealth in the community [12–14, 19, 20].…”