Patients with advanced cancer live a significant 5 months longer using a web-based system for realtime self-reported symptoms
A randomized clinical trial of 766 patients shows that a web-based tool, that enables patients to report their symptoms in real time, triggering alerts to clinicians, can have major benefits, and can lead to a longer survival. In fact, 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.
An earlier report from the same study showed that use of the tool was associated with a 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 study at hand enrolled 766 patients with advanced solid tumors (genitourinary, gynaecologic, 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 their chemotherapy. Nurses took immediate clinical actions more than three-quarters of the time when patients reported severe or worsening of symptoms. Compared to patients who received usual care, patients who used the web tool to self-report symptoms had a 5 months longer median overall survival (31.2 vs. 26 months; p= 0.03). In the multivariable model, results remained statistically significant with a hazard ratio of 0.832 (95%CI: 0.696-0.995; p= 0.04). After 5 years, 8% more patients were alive in the self-reporting group compared to the control arm: 41% vs. 33% (p=0.03).
These data show that using a web-based symptom reporting system that alerts the care team about side effects, or other problems, leads to actions that alleviate suffering and improve patient outcomes. The improvement in survival in this study may at first sight be modest, but it is greater than the effect of many targeted cancer drugs for metastatic cancer. These findings are currently 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.
Basch E, Deal A, Rogak L, et al. Overall survival results of a randomized trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. Presented at ASCO 2017; Abstract LBA2.