Symptom self-reporting web-based tool could be used to help extend oncology patients' lives, study finds

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Jun 5 2017

“Online technologies have transformed communications in practically every aspect of our lives, and now we’re seeing they’re also allowing patients to take an active role in their care and get immediate access to their care provider,” said ASCO Expert Harold J. Burstein, MD, PhD, FASCO. “It’s impressive that something as simple as this not only improves quality of life, but in this case, helps patients live longer. I think we’ll soon see more cancer centers and practices adopting this model.”

The study funded by the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO) has found that a simple intervention such as a web-based tool that facilitates patients to report their symptoms in real time, triggering alerts to clinicians, can have major benefits such as longer survival. Metastatic cancer patients who used the tool to regularly report their symptoms while receiving chemotherapy lived a median of 5 months longer compared with those who did not use the tool.

The study findings will be presented in ASCO’s Plenary Session. More than 5,000 abstracts featured as part of the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting. Of these, 4 abstracts are believed to have the greatest potential to impact patient care.

“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.”

The same study had reported earlier that tool usage was connected with better quality of life, fewer visits to the emergency room, and hospitalizations. Patients who used web-based symptom monitoring were also able to tolerate chemotherapy longer, compared with patients who received usual care.

“The improvement in survival we saw may seem modest, but it is greater than the effect of many targeted cancer drugs for metastatic cancer.” said Dr. Basch.

A randomized clinical trial enrolled 766 patients with advanced solid tumors, such as genitourinary, gynecologic, breast, and lung, who were receiving outpatient chemotherapy. The patients were randomly assigned to report their symptoms to the intervention group (through tablet computers) or to a usual care group.

In the usual care group, symptoms were observed and documented by clinicians as in clinical practice and patients discussed symptoms during visits with oncologists. They were also encouraged to call the office between visits if any symptoms arose that were of concern.

The patients in the intervention group reported on 12 common symptoms experienced during chemotherapy and graded them on a 5-point scale on a weekly basis. Symptom Tracking and Reporting (STAR) is the web-based tool developed for research purposes and is commercially unavailable. Using tablet computers or computer kiosks, patients could report symptoms such as appetite loss, difficulty in breathing, fatigue, hot flashes, nausea, and pain, remotely from home or at the physician’s office during oncology or chemotherapy visits. During the visits, doctors received symptom reports and nurses received email alerts when severe or worsening symptoms were reported by the patients.

The key findings revealed 1) that all the patients in the intervention group including those with minimal prior experience in using the Internet were willing and able to report their symptoms regularly through the web throughout chemotherapy. 2) When patients reported severe or worsening symptoms, nurses took immediate clinical actions more than three-quarters of the time. 3) Patients who used the web tool and self-reported their symptoms had a longer median overall survival of 31.2 months compared with patients (26 months survival) who received usual care.

As a next step, these findings are being confirmed in a larger clinical trial that uses an updated, more user-friendly online tool that works on both personal computers and mobile devices. Across the United States, the study is being conducted in community practices.

Dr. Basch said that symptom management is a central part of what oncology care teams do and noted that the study supports a broader usage of online tools in regular practice to allow patients to communicate symptoms in real time to the care team.