June 8, 2017
Patients who receive treatment for advanced cancers commonly experience symptoms that go unreported to and undetected by clinicians. In an effort to improve patient survival and quality of life, a new study examines the impact of patients having the opportunity to report symptoms electronically at the time of occurrence.
Ethan Basch, MD, MSc, professor of health policy and management at the UNC Gillings School of Global Public Health and of hematology and oncology at the UNC School of Medicine, is lead author of the study, published online June 4 in the Journal of the American Medical Association (JAMA).
Basch also is director of the Cancer Outcomes Research Program at UNC Lineberger Comprehensive Cancer Center and associate editor of JAMA.
Basch and colleagues from other major U.S. cancer centers invited 766 patients receiving chemotherapy for metastatic cancer at Memorial Sloan Kettering Cancer Center to take part in a randomized clinical trial, in which a control group received regular follow-up care and a study group self-reported 12 common symptoms in the course of their therapy.
When a patient in the study group reported a new or worsening symptom, the clinical nurse in charge of that patient received an automatic email alert. The nurse filed a report for the treating oncologist that included all patient-reported symptoms.
Members of the control group discussed their symptoms with the physician during clinic visits and were told they could contact the office between visits to report any symptoms of concern.
The study period ran from September 2007 to January 2011. In June 2016, at a point when nearly 70 percent of the study participants had died, Basch and colleagues found that the median overall survival for the control group was 26.0 months, while the median survival for the group that reported symptoms electronically as they occurred was 31.2 months.
The study also found that patients in the self-reporting group had significantly fewer emergency room (ER) visits, better quality of life, and tolerated chemotherapy longer.
Although the study was limited to a single cancer center, the researchers say, the findings were sufficient to determine that the implementation of electronic patient-reported symptom monitoring can be an effective part of high-quality cancer care.
“Proactive symptom monitoring with patient-reported outcomes can catch symptoms early before they become severe and cause complications,” Basch said. “In this trial, self-reporting reduced ER visits, improved quality of life and enabled longer cancer treatment which, taken together, likely account for the striking finding of a five-month median overall survival benefit.”
Study co-authors are Allison M. Deal, MS, biostatistician at UNC Lineberger, Amylou C. Dueck, PhD, of the Mayo Clinic, in Scottsdale, Ariz., Howard I. Scher, MD, of Memorial Sloan Kettering Cancer Center, Mark G. Kris, MD, of Sloan Kettering; Clifford Hudis, MD, of the American Society of Clinical Oncology, in Alexandria, Va., and Deborah Schrag, MD, MPH, of the Dana-Farber/Harvard Cancer Center.