Real-Time Patient-Reported Side Effects Linked With Improved Survival

Ethan M. Basch, MD

CHICAGO-A Web-based tool that enables patients to report their symptoms in real time, triggering alerts to clinicians, may provide significant health benefits, including longer survival, according to a randomized clinical trial of 766 patients. Researchers reported at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2–6, that 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 (abstract LBA2).

“This new study provides a solution. It shows that we can alleviate suffering and improve outcomes by providing more patient-centered care. This is achieved through a simple intervention, an online system for patients to self-report symptoms that sends alerts to nurses whenever patients have a severe or worsening symptom,” said lead study author Ethan M. Basch, MD, professor of medicine at the University of North Carolina at Chapel Hill.

He noted that patients receiving chemotherapy often have severe symptoms, but clinicians are unaware of these symptoms up to half of the time. Using a Web-based symptom reporting system that alerts the care team appears to lead to actions that alleviate pain and improve patient outcomes.

A previous analysis demonstrated that the use of the tool was associated with better quality of life, fewer visits to the emergency room, and fewer hospitalizations. Compared with patients who received usual care, patients who used Web-based symptom monitoring were also able to tolerate chemotherapy longer.

Basch said that the improvements in survival may seem modest, but it is greater than the effect of many targeted cancer drugs for metastatic cancer. “This approach reduces emergency room visits by 7%, improves quality of life by 31%, lengthens time that patients tolerate chemotherapy by 2 months, and ultimately lengthens survival by a median of 5 months,” he reported.

The study enrolled 766 patients with advanced solid tumors (genitourinary, gynecologic, breast, and lung) who were receiving outpatient chemotherapy. The median age of patients was 61 years (range, 26–91 years), and 86% were white. Among the patients, 58% were women, and 22% had less than a high school education. 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.

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. 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 with 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).