A randomized trial evaluating the integration of online questionnaires into follow-up (FU) care for early-stage breast cancer (ESBC).

Abstract

9107 Background: Large numbers of cancer survivors have led to the need for FU care addressing lasting effects of BC and its treatment. We conducted a trial evaluating formats of FU care to determine if integration of remote electronic questionnaire FU provides for timely symptom management and more efficient care than routine clinic visits alone. Methods: Patients (pts) with ESBC were randomized to either usual care (UC, frequency of visits determined by oncology providers) with completion of an optional online health and symptom questionnaire (Q) before each clinic visit, or to SIS.NET FU care, in which pts were scheduled for up to 3 routine oncology related clinic visits over 18 mos and completed the online Q every 3 mos. Qs were reviewed by a survivorship nurse practitioner (NP) with pt phone contact for symptoms requiring urgent attention. We recorded the time between electronic symptom reporting and FU for pts in the SIS.NET arm. Data included the number of oncology related clinic visits, total number of physician visits, and number of medical tests including labs and imaging studies ordered. Kolmogorov-Smirnov tests for equal distributions were used to determine if there were any significant differences between SIS.NET and UC. Results: 100 pts were enrolled, 75 completed the 18 month study and 25 pts remain in FU. For the 75 pts, 85% received chemotherapy and 77% received hormone therapy. Pts in the SIS.NET arm completed an average of 3.8 out of 7.2 emailed surveys (52.6%), and pts in the UC arm completed an average of 2.2 out of 3.4 (69.1%) routine pre-clinic surveys. For pts in the SIS.NET arm, 75% of reported symptoms were reviewed by a NP in < 3 days. There was no significant difference between SIS.NET and UC FU for oncology related clinic appointments, total number of physician visits, or number of medical tests performed. Conclusions: Use of on-line health and symptom surveys with remote NP review provided timely symptom FU but did not reduce clinic visits or medical testing in pts with ESBC. Further analyses of these data as well as additional studies are necessary to understand the barriers to integration of web-based tools to achieve more efficient FU care for BC survivors.