Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial Journal Article


Authors: Basch, E.; Deal, A. M.; Kris, M. G.; Scher, H. I.; Hudis, C. A.; Sabbatini, P.; Rogak, L.; Bennett, A. V.; Dueck, A. C.; Atkinson, T. M.; Chou, J. F.; Dulko, D.; Sit, L.; Barz, A.; Novotny, P.; Fruscione, M.; Sloan, J. A.; Schrag, D.
Article Title: Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial
Abstract: Purpose There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited. Methods We randomly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians. Those with home computers received weekly e-mail prompts to report between visits. Treating physicians received symptom printouts at visits, and nurses received e-mail alerts when participants reported severe or worsening symptoms. The primary outcome was change in health-related quality of life (HRQL) at 6 months compared with baseline, measured by the EuroQol EQ-5D Index. Secondary endpoints included emergency room (ER) visits, hospitalizations, and survival. Results Among 766 patients allocated, HRQL improved among more participants in the intervention group than usual care (34% v 18%) and worsened among fewer (38% v 53%; P < .001). Overall, mean HRQL declined by less in the intervention group than usual care (1.4-v 7.1-point drop; P,.001). Patients receiving intervention were less frequently admitted to the ER (34% v 41%; P = .02) or hospitalized (45% v 49%; P = .08) and remained on chemotherapy longer (mean, 8.2 v 6.3 months; P = .002). Although 75% of the intervention group was alive at 1 year, 69% with usual care survived the year (P = .05), with differences also seen in quality-adjusted survival (mean of 8.7 v. 8.0 months; P = .004). Benefits were greater for participants lacking prior computer experience. Most patients receiving intervention (63%) reported severe symptoms during the study. Nurses frequently initiated clinical actions in response to e-mail alerts. Conclusion Clinical benefits were associated with symptom self-reporting during cancer care. (C) 2015 by American Society of Clinical Oncology
Keywords: chemotherapy; oncology; communication; toxicities; impact; quality-of-life; providers; care; clinical-practice; improvement
Journal Title: Journal of Clinical Oncology
Volume: 34
Issue: 6
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2016-02-20
Start Page: 557
End Page: 563
Language: English
ACCESSION: WOS:000374332900012
DOI: 10.1200/jco.2015.63.0830
PROVIDER: Thomson Reuters Web of Scienceā„¢
PROVIDER: wos
PMCID: PMC4872028
PUBMED: 26644527
Notes: Article -- Source: Wos
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MSK Authors
  1. Joanne Fu-Lou Chou
    145 Chou
  2. Clifford Hudis
    819 Hudis
  3. Ethan Martin Basch
    151 Basch
  4. Dorothy Dulko
    13 Dulko
  5. Deborah Schrag
    126 Schrag
  6. Paul J Sabbatini
    191 Sabbatini
  7. Howard Scher
    787 Scher
  8. Mark Kris
    582 Kris
  9. Laura S Sit
    21 Sit
  10. Lauren Jayne Rogak
    44 Rogak