Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial

Abstract

PURPOSE We aimed to evaluate the efficacy and feasibility of patient-reported outcome (PRO)-based symptom management in the early period after lung cancer surgery. METHODS Before surgery, patients with clinically diagnosed lung cancer were randomly assigned 1:1 to receive postoperative PRO-based symptom management or usual care. All patients reported symptoms on MD Anderson Symptom Inventory-Lung Cancer presurgery, daily postsurgery, and twice a week after discharge for up to 4 weeks via an electronic PRO system. In the intervention group, treating surgeons responded to overthreshold electronic alerts driven by any of the five target symptom scores (score ≥ 4 on a 0-10 scale for pain, fatigue, disturbed sleep, shortness of breath, and coughing). The control group patients received usual care and no alerts were generated. The primary outcome was the number of symptom threshold events (any target symptom with a score of ≥ 4) at discharge. Per-protocol analyses were conducted. RESULTS Of the 166 participants, 83 were randomly allocated to each group. At discharge, the intervention group reported fewer symptom threshold events than the control group (median [interquartile range], 0 [0-2] v 2 [0-3]; P = .007). At 4 weeks postdischarge, this difference was maintained between the intervention and control groups (median [interquartile range], 0 [0-0] v 0 [0-1]; P = .018). The intervention group had a lower complication rate than the control group (21.5% v 40.6%; P = .019). Surgeons spent a median of 3 minutes managing an alert. CONCLUSION PRO-based symptom management after lung cancer surgery showed lower symptom burden and fewer complications than usual care for up to 4 weeks postdischarge.

The effectiveness of telephone and internet-based supportive care for patients with esophageal cancer on enhanced recovery after surgery in China: A randomized controlled trial

“…found that patient-reported outcome-based symptom management showed a lower symptom burden and fewer complications than usual care for lung cancer post-discharge. 68 The patient-reported outcome system may be applied in symptom management for esophageal patients' post-discharge in the future because patients find it to be more understandable. The patients may receive various forms of information, which could be searched and stored.…”

Postoperative Patient-Reported Outcomes after Uniportal Video-Assisted Thoracoscopic Surgery Using the Perioperative Symptom Assessment for Lung Surgery Scale

“…Dai Wei et al defined ≥4 on a 0–10 scale as a threshold symptom score after lung cancer surgery and stated that clinicians would respond when PRO scores reached the threshold. Their study showed the advantages and feasibility of PRO-based perioperative management [ 17 ]. Therefore, we divided patients under each item into the following two groups according to the patients’ symptom scores in the fourth week: 0–3 as good recovery, and >3 as poor recovery.…”

“…In fact, perioperative symptom assessment has been implemented in clinical practice; PRO-based symptom management decreased symptom burden and the incidence of complications compared with usual care, which was confirmed by a multicenter RCT [ 17 ]. Another study also showed that combining PROs with routine care could increase survival better than usual care for patients with metastatic cancer [ 13 ].…”

Shortness of Breath on Day 1 After Surgery Alerting the Presence of Early Respiratory Complications After Surgery in Lung Cancer Patients

“…30 Others were included bilobectomy, sleeve lobectomy, and sublobectomy plus sublobectomy or lobectomy. 31…”