A randomized clinical trial of 766 patients shows that a simple intervention—a web-based tool that enables patients to report their symptoms in real time, triggering alerts to clinicians—can have major benefits, including longer survival. Patients with metastatic cancer who used the tool to regularly report symptoms while receiving chemotherapy lived a median of 5 months longer than those who did not use the tool. These findings were presented at the 2017 ASCO Annual Meeting (Abstract LBA2).
“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 M. Basch, MD, MSc, FASCO, Professor of Medicine at the Lineberger Comprehensive Cancer Center of the University of North Carolina, Chapel Hill, who was practicing at Memorial Sloan Kettering Cancer Center in New York when the study was conducted. “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.”
An earlier report from the same study showed that use of the tool was associated with better quality of life, and fewer visits to the emergency room and hospitalizations. Compared to patients who received usual care, patients who used web-based symptom monitoring were also able to tolerate chemotherapy longer.
“The improvement in survival we saw may seem modest, but it is greater than the effect of many targeted cancer drugs for metastatic cancer,” Basch noted.
The study enrolled 766 patients with advanced solid tumors (genitourinary, gynecologic, breast, and lung) who were receiving outpatient chemotherapy. The patients were randomly assigned to report their symptoms via tablet computers (intervention group) or to a group whose symptoms were monitored and documented by clinicians, as is usual care in clinical practice. In the usual care group, patients discussed symptoms during visits with oncologists. They were also encouraged to telephone the office between visits if any concerning symptoms arose.
On a weekly basis, patients in the intervention group reported on 12 common symptoms experienced during chemotherapy, including appetite loss, difficulty breathing, fatigue, hot flashes, nausea, and pain, and graded them on a 5-point scale. The web-based tool, Symptom Tracking and Reporting or STAR, was developed for research purposes and is not commercially available. Patients could report the symptoms remotely from home or at the doctor's office during oncology or chemotherapy visits, using tablet computers or computer kiosks. Doctors received symptom reports during visits, and nurses received email alerts when patients reported severe or worsening symptoms.
All patients in the intervention group, including those with little prior experience using the internet, were willing and able to regularly report their symptoms via the web throughout chemotherapy. Nurses took immediate clinical actions more than three-quarters of the time when patients reported severe or worsening symptoms. Compared to patients who received usual care, patients who used the web tool to self-report symptoms had a longer median overall survival (31.2 months vs. 26 months).
These findings are being confirmed in a larger clinical trial, which uses an updated, more user-friendly online tool that works on both personal computers and mobile devices. The study is being conducted in community practices across the U.S.
“Symptom management is a central part of what oncology care teams do,” Basch said. He noted this study supports broader use of online tools in routine practice to enable patients to communicate symptoms to the care team in real time.
“Online technologies have transformed communications in practically every aspect of our lives, and now we're seeing they're also allowing patients to take an active role in their care and get immediate access to their care provider,” concluded ASCO Expert Harold J. Burstein, MD, PhD, FASCO. “It's impressive that something as simple as this not only improves quality of life, but in this case, helps patients live longer. I think we'll soon see more cancer centers and practices adopting this model.”