Advanced Ca Patients Benefit from Online Symptom Reports

CHICAGO – Patients with metastatic cancer who reported symptom changes through an online network achieved statistically significant longer survival than patients who reported their problems at regular clinic visits, researchers said here.

The patients in the online group achieved a median survival of 31.2 months compared with 26.0 months for patients receiving usual care, for a 5.2-month difference (P=0.03), said Ethan Basch, MD, of the Lineberger Comprehensive Cancer Center at the University of North Carolina Chapel Hill.

In addition, patients who reported outcomes via email experienced better quality of life (QOL), and were able to accept chemotherapy for 8 months compared with an average of 6 months for patients who receiving standard of care follow-up, he said during a press conference at the American Society of Clinical Oncology annual meeting. The study result were simultaneously published in a research letter in JAMA.

Also, nurses responded to symptom alerts 77% of the time, with discrete clinical interventions, such as phone calls to provide symptom management counseling, supportive medications, chemotherapy dose modifications, and referrals.

"These factors in combination probably account for the most striking finding in the study, which was the overall survival results," Dr. Basch said. "We found in this study that for patients who were self-reporting their own symptoms, compared with standard of care, there was a 5-month median overall survival [OS] benefit compared with the standard of care patients. If we look at that in terms of OS at 5 years, 8% more patients in the self-reported symptoms group were alive than in the standard of care patients (P=0.02)."

Larry Norton, MD, of Memorial Sloan Kettering Cancer Center in New York City, told MedPage Today, "There was a time in our history when it was adequate for doctors to get to know the patient and to communicate efficiently ... but the modern world doesn't allow that. We need better tools to improve communication."

Face-to-face is good but it is intermittent. I think what we see now is that electronic tools can be used so there can be immediate connections. This study showed that, in the vast majority of cases, the immediate reporting of symptoms led to interventions, and those interventions [were] a very important part of the totality of care."

"Patients with advanced cancer often have severe symptoms, and we know from previous research that we as clinicians, unfortunately, are unaware of up to half of our patients' symptoms, Basch told MedPage Today. "We set out to answer a simple question: If we could better monitor our patients, particularly between visits, perhaps this could lead to better outcomes for patients? 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."

In the study, 766 patients were randomly assigned to one of two study arms. In the intervention arm, patients self-reported their own symptoms through an online tool with 12 common symptoms from the NCI's Common Terminology Criteria for Adverse Event.

"They reported these symptoms weekly from home. If the symptoms were severe or worsening, the report would trigger an automated email alert to the nurse and the nurse could then use that to intervene and take action," he said. "In addition, at follow-up visits, a full longitudinal report of symptoms would be printed for their oncologists to inspire discussion and clinical management."

The control patients received standard symptom care at in-clinic visits.

Patients remained on the study throughout their cancer treatment, and came off when they had completed all of their chemotherapy, or if they died or went to hospice, Basch noted.

Among the 766 patients randomized, the median age was 61, 86% were white, and 58% were women, while 22% had less than a high school education, and 30% were computer inexperienced.

OS was assessed in June 2016 after 517 of 766 participants (67%) had died.

"In the multivariable model, results remained statistically significant with a hazard ratio of 0.83 (95% C, 0.70-0.99, P=0 .04), the authors wrote.

Studly limitations included the fact that it was done at a single tertiary care cancer center. Also, there was no subanalysis by cancer type as the numbers would have been too small, Basch explained.

"We are now building on these findings in a national study that ... will largely focus on implementation. But based on these findings that show such striking benefit, it really is time for implementation, and I think that will be the work moving forward," he said.

Norton, who was not involved in the study, highlighted the QOL improvement. "By being engaged in their treatment and able to identify issues early, there is an improvement in quality of life. We don't know all the biological consequences of a good, positive attitude, but it certainly isn't going to be detrimental, and it may be beneficial ... there are many studies that are actually looking at that right now," he said. He said he predicted more research with patient-reported outcomes in the future.