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, according to findings presented in a plenary session at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.1
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.
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. Physicians 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 of 31.2 months vs. 26 months.
“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, 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 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 United States.
The study was funded by the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO).
1. 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. 2017;35(suppl; abstr LBA2)
2. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. Journal Clin Onc. 2016; 34:557.