Reducing Symptom Distress in Patients With Advanced Cancer Using an e-Alert System for Caregivers: Pooled Analysis of Two Randomized Clinical Trials

Abstract

BackgroundSymptom distress in patients toward the end of life can change rapidly. Family caregivers have the potential to help patients manage those symptoms, as well as their own stress, if they are equipped with the proper resources. Electronic health (eHealth) systems may be able to provide those resources. Very sick patients may not be able to use such systems themselves to report their symptoms but family caregivers could.ObjectiveThe aim of this paper was to assess the effects on cancer patient symptom distress of an eHealth system that alerts clinicians to significant changes in the patient’s symptoms, as reported by a family caregiver.MethodsA pooled analysis from two randomized clinical trials (NCT00214162 and NCT00365963) compared outcomes at 12 months for two unblinded groups: a control group (Comprehensive Health Enhancement Support System [CHESS]-Only) that gave caregivers access to CHESS, an online support system, and an experimental group (CHESS+CR [Clinician Report]), which also had CHESS but with a CR that automatically alerted clinicians if symptoms exceeded a predetermined threshold of severity. Participants were dyads (n=235) of patients with advanced lung, breast, or prostate cancer and their respective family caregivers from 5 oncology clinics in the United States of America. The proportion of improved patient threshold symptoms was compared between groups using area-under-the-curve analysis and binomial proportion tests. The proportion of threshold symptoms out of all reported symptoms was also examined.ResultsWhen severe caregiver-reported symptoms were shared with clinicians, the symptoms were more likely to be subsequently reported as improved than when the symptoms were not shared with clinicians (P<.001). Fewer symptom reports were completed in the group of caregivers whose reports went to clinicians than in the CHESS-Only group (P<.001), perhaps because caregivers, knowing their reports might be sent to a doctor, feared they might be bothering the clinician.ConclusionsThis study suggests that an eHealth system designed for caregivers that alerts clinicians to worrisome changes in patient health status may lead to reduced patient distress.Trial RegistrationClinicaltrials.gov NCT00214162; https://clinicaltrials.gov/ct2/show/NCT00214162 (Archived by WebCite at http://www.webcitation.org/6nmgdGfuD) and Clinicaltrials.gov NCT00365963; https://clinicaltrials.gov/ct2/show/NCT00365963 (Archived by WebCite at http://www.webcitation.org/6nmh0U8VP)

Management of Adverse Events During Rucaparib Treatment for Relapsed Ovarian Cancer: A Review of Published Studies and Practical Guidance

“…Notably, recent surveys indicate that patients taking oral anticancer medications are interested in technologies to help them manage their treatment, such as pill reminders and apps that allow reporting of symptoms to physicians [24,26]. Electronic medication reminders have been shown to encourage adherence [27,28], and the ability to report symptoms to clinicians or other healthcare team members via the internet has been associated with improvements in patient quality of life, better management of AEs, decreased hospitalizations, and longer overall survival [27,[29][30][31][32].…”

“…Although generally low grade, diarrhea often occurs when patients initiate rucaparib (median time to onset [95% CI], 29 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] days) [21]. Clinicians should exclude other causes (e.g.…”

Development of an eHealth information resource for family carers supporting a person receiving palliative care on the island of Ireland

“…The proliferation and acceptability of the internet has provided an alternative format for sharing health-related information which is convenient, accessible and allows the user the opportunity to remain anonymous. The effectiveness of using a web-based approach to deliver health care interventions has been demonstrated elsewhere [ 20 , 21 ] and has been recommended as a medium to help increase awareness and improve capacity regarding the provision of palliative care [ 22 ]. However, we should recognise that the use of websites to provide health related information may not be appropriate for all user groups particularly those who may not be regular internet users [ 20 , 23 ].…”

Cancer Informatics in 2018: The Mysteries of the Cancer Genome Continue to Unravel, Deep Learning Approaches the Clinic, and Passive Data Collection Demonstrates Utility

“…Gupta, et al , 18 carried out a feasibility study of using physical activity monitors as a surrogate for clinician-ascertained performance status. Gustafson, et al , 19 conducted two sizeable randomized clinical trials examining the utility of a caregiver e-alert system to reduce patients’ distress from symptoms.…”