ASCO 2017: Electronic Self-Reported Symptom Monitoring Prolongs Metastatic Cancer OS

Simple web-based tool to self-report chemotherapy side effects helps extend overall survival of patients with metastatic solid tumours

medwireNews: Data presented during the plenary session at the annual meeting of the American Society of Clinical Oncology in Chicago, Illinois, USA, show that web-based symptom monitoring during outpatient chemotherapy may prolong overall survival (OS) over usual care.

During a median 7-year follow-up period, patients with metastatic solid tumours who were randomly assigned to self-report 12 common adverse event symptoms via tablet computers (n=441) lived approximately 5 months longer than those assigned to usual care (n=325), with median OS times of 31.2 and 26.0 months, respectively.

“Patients receiving chemotherapy often have severe symptoms, but doctors and nurses are unaware of these symptoms up to half of the time”, said lead study author Ethan Basch, from the University of North Carolina in Chapel Hill, USA, in a statement to the press.

“We show that using a web-based symptom reporting system that alerts the care team about problems leads to actions that alleviate suffering and improve patient outcomes.”

The web-based system allowed patients to report symptoms remotely from home as they occurred or at the doctor’s office during oncology or chemotherapy visits, using tablet computers or computer kiosks. Treating physicians received symptom reports during visits, and nurses received email alerts when patients reported severe or worsening symptoms.

In the usual care group, patients discussed symptoms during clinical visits and could contact the doctor’s office by telephone between visits if they had any concerns.

Basch and team previously reported that the use of the tool was associated with significant improvements in quality of life, patient satisfaction and emergency room utilisation outcomes.

The current survival analysis, which included patients with genitourinary (32%), gynaecological (23%), breast (19%) or lung cancer (26%), showed that those using the tool had a significant 17% lower risk of death than those receiving usual care, after adjustment for potential confounders such as age, gender, tumour type and prior computer use.

The researchers write in an article published simultaneously in JAMA that the reduced risk may be linked to an early response to symptoms “preventing adverse downstream consequences.”

Indeed, they say: “Nurses responded to symptom alerts 77% of the time with discrete clinical interventions including calls to provide symptom management counseling, supportive medications, chemotherapy dose modifications, and referrals.”

In addition, patients using the web-based tool received chemotherapy for a significantly longer period than those receiving usual care, at an average of 8.2 versus 6.3 months.

Speaking to delegates, Ethan Basch recommended that the web-based approach to symptom monitoring should be “considered for inclusion as a part of standard symptom management, as a component of high-quality cancer care.”

Explaining that the approach is now being tested in a national study, he concluded: “Moving forward, future efforts should focus on implementation strategies for integrating patient self-reporting into electronic health record systems and into the work flow of oncology practice.”

Discussing the results at the session, Monika Krzyzanowska, from Princess Margaret Cancer Centre in Toronto, Ontario, Canada, compared the OS benefit with electronic symptom monitoring to that achieved by six agents with OS data that were approved by the US Food and Drug Administration in 2016.

“The study presented by Dr Basch performed better than all of these agents, except for olaratumumab”, she noted.

References

Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA; Advance online publication 04 June 2017. doi: 10.1001/jama.2017.7156

Basch EM, Deal AM, Dueck AC, et al. Overall survival results of a randomized trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. J Clin Oncol 35, 2017 (suppl; abstr LBA2).

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