The effect of real-time electronic monitoring of patient-reported symptoms and clinical syndromes in outpatient workflow of medical oncologists: E-MO AIC, a multicenter cluster-randomized phase III study (SAKK 95/06)

Strasser, Florian; Blum, David; Moos, Roger von; Cathomas, Richard; Ribi, Karin; Aebi, Stefan; Betticher, Daniel; Hayoz, Stefanie; Klingbiel, Dirk; Brauchli, Peter; Haefner, Michael; Mauri, Sílvia; Kaasa, Stein; Koeberle, Dieter

doi:10.1093/annonc/mdv576

Cited by 104 publications

(80 citation statements)

References 24 publications

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“…It is important to note that patients' symptoms represent a potentially modifiable risk factor that, if properly addressed, may improve health care quality and delivery. Indeed, studies have demonstrated that targeted interventions aimed at improving symptom management can enhance patient‐reported outcomes . However, most of these efforts are targeting the symptom burden of patients with cancer in the ambulatory care setting .…”

Section: Discussionmentioning

confidence: 99%

The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer

Nipp

El‐Jawahri

Moran

et al. 2017

Cancer

169

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Background Patients with advanced cancer often experience frequent and prolonged hospitalizations; however factors associated with greater healthcare utilization have not been described. We sought to investigate the relationship between patients’ physical and psychological symptom burden and healthcare utilization. Methods We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type. Results We enrolled 1,036 of 1,152 (89.9%) consecutive patients approached. Over half reported moderate/severe fatigue, poor well-being, drowsiness, pain, and lack of appetite. Using the PHQ-4, 29% and 28% of patients had depression and anxiety symptoms, respectively. Mean hospital LOS was 6.3 days and 90-day readmission rate was 43.1%. Physical symptoms (ESAS: B=0.06, P<.001), psychological distress (PHQ-4 total: B=0.11, P=.040), and depression symptoms (PHQ-4 depression: B=0.22, P=.017) were associated with longer hospital LOS. Physical (ESAS: HR=1.01, P<.001) and anxiety symptoms (PHQ-4 anxiety: HR=1.06, P=.045) were associated with a higher likelihood for readmission. Conclusions Hospitalized patients with advanced cancer experience a high symptom burden, which is significantly associated with prolonged hospitalizations and readmissions. Interventions are needed to address the symptom burden of this population to improve healthcare delivery and utilization.

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Section: Discussionmentioning

confidence: 99%

The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer

Nipp

El‐Jawahri

Moran

et al. 2017

Cancer

169

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“…Both parameters were chosen on the basis of previous results relating altered circadian rest-activity rhythm to poor outcomes [23,25,27], body weight loss to circadian disruption [24], and both parameters to poor survival outcome on chronotherapy [38]. The proper tracking of the dynamic changes in these parameters entailed the need for daily measurements, whereas other authors have proposed evaluations of symptoms and quality of life once a week or at each clinic visit [4,5,34,35,39,40]. With an overall 59.7% per-protocol compliance rate, and with 95% of the days having at least one data, our study demonstrates the feasibility of cancer patients’ empowerment for gathering and teletransmitting both subjective and objective health-related data.…”

Section: Discussionmentioning

confidence: 99%

Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European Project

Innominato¹,

Komarzynski²,

Mohammad-Djafari³

et al. 2016

J Med Internet Res

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BackgroundTelehealth solutions can improve the safety of ambulatory chemotherapy, contributing to the maintenance of patients at their home, hence improving their well-being, all the while reducing health care costs. There is, however, need for a practicable multilevel monitoring solution, encompassing relevant outputs involved in the pathophysiology of chemotherapy-induced toxicity. Domomedicine embraces the delivery of complex care and medical procedures at the patient’s home based on modern technologies, and thus it offers an integrated approach for increasing the safety of cancer patients on chemotherapy.ObjectiveThe objective was to evaluate patient compliance and clinical relevance of a novel integrated multiparametric telemonitoring domomedicine platform in cancer patients receiving multidrug chemotherapy at home.MethodsSelf-measured body weight, self-rated symptoms using the 19-item MD Anderson Symptom Inventory (MDASI), and circadian rest-activity rhythm recording with a wrist accelerometer (actigraph) were transmitted daily by patients to a server via the Internet, using a dedicated platform installed at home. Daily body weight changes, individual MDASI scores, and relative percentage of activity in-bed versus out-of-bed (I

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“…The intervention arm was associated with a statistically and clinically significant improvement in ESAS symptom distress score (reduction of 5.4 points vs. worsening by 2.1 points, P=0.003). (115)…”

Section: Future Developmentsmentioning

confidence: 99%

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

Hui

Bruera

2017

Journal of Pain and Symptom Management

488

363

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Context Routine symptom assessment represents the cornerstone of symptom management. ESAS is one of the first quantitative symptom assessment batteries that allows for simple and rapid documentation of multiple patient-reported symptoms at the same time. Objective To discuss the historical development of ESAS, its current uses in different settings, and future developments. Methods Narrative review Results Since its development in 1991, ESAS has been psychometrically validated and translated into over 20 languages. We will discuss the variations, advantages and limitations with ESAS. From the clinical perspective, ESAS is now commonly used for symptom screening and longitudinal monitoring in patients seen by palliative care, oncology, nephrology, and other disciplines in both inpatient and outpatient settings. From the research perspective, ESAS has offered important insights into the nature of symptom trajectory, symptom clusters and symptom modulators. Furthermore, multiple clinical studies have incorporated ESAS as a study outcome and documented the impact of various interventions on symptom burden. On the horizon, multiple groups are actively investigating further refinements to ESAS, such as incorporating it in electronic health records, employing ESAS as a trigger for palliative care referral, and coupling ESAS with personalized symptom goals to optimize symptom response assessment. Conclusion ESAS has evolved over the past 25 years to become an important symptom assessment instrument in both clinical practice and research. Future efforts are needed to standardize this tool and explore its full potential to support symptom management.

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The effect of real-time electronic monitoring of patient-reported symptoms and clinical syndromes in outpatient workflow of medical oncologists: E-MO AIC, a multicenter cluster-randomized phase III study (SAKK 95/06)

Abstract: Monitoring of patient symptoms, clinical syndromes and their management clearly reduced patients' symptoms, but not QoL. Our results encourage the implementation of real-time monitoring in the routine workflow of oncologist with a computer solution.

Cited by 104 publications

References 24 publications

The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer

The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer

Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European Project

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

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