Automated monitoring of symptoms during ambulatory chemotherapy and oncology providers’ use of the information: a randomized controlled clinical trial

Abstract

Purpose Monitoring patient-reported symptoms is necessary to adjust and improve supportive care during chemotherapy. Continuing advances in computerized approaches to symptom monitoring can enhance communication about unrelieved symptoms between patients and oncology providers and may facilitate intensified symptom treatment. Methods An automated IT-based telephone monitoring system was developed to enable oncology providers to receive and act on alert reports from patients about unrelieved symptoms during chemotherapy treatment. Daily, 250 participants (randomized to treatment or attentional control) were asked to call the automated system to report presence, severity, and distress for common chemotherapy-related symptoms (1–10 scale if present). For the treatment group, symptoms exceeding preset thresholds for moderate-to-severe intensity levels generated emailed alert reports to both the patient’s oncologist and oncology nurse. Results Patients reported high satisfaction and ease of use of the automated system. Over 80 % of providers reported usefulness of the symptom alert reports. Ten monitored symptoms resulted in, on average, nine moderate-to-severe intensity alerts per patient over 45 study days. However, providers rarely contacted patients after receiving alerts. There were no significant differences in change of symptom severity between the two groups (mean difference=0.06, p=0.58). Conclusion Despite patients’ use of a daily symptom monitoring system and providers’ receipt of information about unrelieved symptoms of moderate-to-severe intensity, oncology physicians and nurses did not contact patients to intensify symptom treatment nor did symptoms improve. Further research is indicated to determine if oncology providers initiated follow-up to intensify symptom treatment, whether symptom outcomes would improve.

Can patient-reported measurements of pain be used to improve cancer pain management? A systematic review and meta-analysis

“…Nine trials used pen and paper,19 23 25 26 28 34 40 45 four used touch screen devices or personal digital assistants to collect the data,20 36 37 41 three used automated telephone monitoring,17 18 35 one used web-based systems,21 and in two trials, the patient was interviewed by a nurse27 or a health educator29 for the data. One study offered a choice between automated telephone monitoring or online monitoring 33…”

“…The coaching messages typically focused on how to communicate about unrelieved symptoms with professionals. Four interventions17 18 27 35 contained automatic alerts to physicians based on predetermined symptom thresholds. One study19 also used a symptom threshold concept within their paper diary intervention, instructing patients to contact their nurse if pain intensity or analgesic use crossed a threshold.…”

“…Mooney et al 35 reported that only 20 of 167 (12%) automated alerts to physicians of symptoms exceeding a threshold resulted in a provider-initiated unscheduled contact. Hoekstra et al 28 reported that despite patients being advised to take their symptom monitor to all medical appointments, it was used in only 232 of 1291 (18%) consultations.…”

Development of a Web Portal for Physical Activity and Symptom Tracking in Oncology Patients: Protocol for a Prospective Cohort Study (Preprint)

“…Symptom tracking and reporting using PRO has been shown to improve patient outcomes in cancer care [12]. Historically, paper or phone based interactive voice response systems have been used [13][14][15]. The novel approach of using a WP for the collection and communication of PRO may provide a more effective platform for healthcare professionals to facilitate long-term behaviour change in cancer survivors.…”

Approach to Fever Assessment in Ambulatory Cancer Patients Receiving Chemotherapy: A Clinical Practice Guideline

“…Fever was included as one among several symptoms (for example, fatigue, pain, nausea, and vomiting) in some studies of the management of adverse effects of chemotherapy. Approaches to symptom management in those studies included patient-initiated drop-in clinics 22,23 , health care provider-initiated case management programs 24,25 , and various remote monitoring strategies using cellphone applications, Web-based and touch-tone telephone interfaces, and automated programs [26][27][28][29][30] . Evaluation of those symptom management systems is an active area of current research.…”