Computerized patient-reported symptom assessment in radiotherapy: a pilot randomized, controlled trial

Fromme, Erik K.; Holliday, Emma B.; Nail, Lillian M.; Lyons, Karen S.; Hribar, Michelle R.; Thomas, Charles R.

doi:10.1007/s00520-015-2983-3

Cited by 14 publications

(11 citation statements)

References 33 publications

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“…40 Effect sizes of 0.01-0.21 for between group differences in MSAS global distress index were reported in a randomised controlled trial of computerised patient reported symptom monitoring during one to four weeks of radiotherapy. 41 eSMART showed significant improvements in anxiety, health related quality of life, self-efficacy, and supportive care needs in the intervention group. The improvements in health related quality of life are consistent with findings from recent trials using remote monitoring systems in chemotherapy care.…”

Section: Discussionmentioning

confidence: 90%

“…In a randomised controlled trial testing a symptom monitoring app during neoadjuvant chemotherapy for breast cancer, Fjell et al reported an effect size of 0.26 for between group differences in total MSAS (and 0.34 for MSAS global distress index scores) two weeks after treatment completion 40. Effect sizes of 0.01-0.21 for between group differences in MSAS global distress index were reported in a randomised controlled trial of computerised patient reported symptom monitoring during one to four weeks of radiotherapy 41…”

Section: Discussionmentioning

confidence: 99%

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Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART)

Maguire

McCann

Kotronoulas

et al. 2021

BMJ

115

136

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Objective To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. Design Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. Setting Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. Participants 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin’s disease, or non-Hodgkin’s lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. Intervention Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. Main outcome measures The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy—General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory—Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). Results For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference −0.15, 95% confidence interval −0.19 to −0.12; P<0.001; Cohen’s D effect size=0.5). Analysis of MSAS sub-domains indicated significant reductions in favour of ASyMS for global distress index (−0.21, −0.27 to −0.16; P<0.001), psychological symptoms (−0.16, −0.23 to −0.10; P<0.001), and physical symptoms (−0.21, −0.26 to −0.17; P<0.001). FACT-G scores were higher in the intervention group across all cycles (mean difference 4.06, 95% confidence interval 2.65 to 5.46; P<0.001), whereas mean scores for STAI-R trait (−1.15, −1.90 to −0.41; P=0.003) and STAI-R state anxiety (−1.13, −2.06 to −0.20; P=0.02) were lower. CASE-Cancer scores were higher in the intervention group (mean difference 0.81, 0.19 to 1.43; P=0.01), and most SCNS-SF34 domains were lower, including sexuality needs (−1.56, −3.11 to −0.01; P<0.05), patient care and support needs (−1.74, −3.31 to −0.16; P=0.03), and physical and daily living needs (−2.8, −5.0 to −0.6; P=0.01). Other SCNS-SF34 domains and WLQ were not significantly different. Safety of ASyMS was satisfactory. Neutropenic events were higher in the intervention group. Conclusions Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A “medium” Cohen’s effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients’ symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. Trial registration Clinicaltrials.gov NCT02356081 .

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART)

Maguire

McCann

Kotronoulas

et al. 2021

BMJ

115

136

View full text Add to dashboard Cite

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“…The study characteristics table (https://cdn. amegroups.cn/static/public/jhmhp-20-108-1.pdf) lists key characteristics of the included studies (38,(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68).…”

Section: Resultsmentioning

confidence: 99%

Challenges in the implementation of electronic systems for patient report of symptoms in oncology: a scoping review

Crane¹,

Gibbs²,

Nosich³

et al. 2021

J Hosp Manag Health Policy

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Background: Under-recognition and under-treatment of symptoms are prevalent throughout the health care system in the United States. While the reasons for this are complex, it is widely recognized that electronic symptom reports can improve clinicians' ability to manage symptoms. However, electronic symptom reporting has yet to be widely implemented. Electronic systems are most effective when tailored to the specific patient population or clinical setting. For example, numerous oncology-focused electronic symptom reporting systems have been developed for patients with cancer undergoing treatment in the United States. The objective of this scoping review was to identify challenges that arose in the implementation of electronic systems for patient-reported symptoms in oncology clinical practice, and approaches that were taken or recommended to overcome those challenges.Methods: This scoping review involved comprehensive searches of Medline, CINAHL, and the Cochrane Central Register of Controlled Trials, which yielded 3,133 articles. Following screening, 20 research studies met the inclusion criteria and were included in this review. Data were systematically extracted from the articles using a qualitative content analysis.Results: Challenges identified were thematically categorized as technical issues, system usability issues, patient lack of comfort/knowledge of technology, incomplete/missing data, lack of patient use of the system, other patient issues, difficulties timing completion with clinical processes, lack of clinic staff involvement/ engagement, and lack of clinician comfort/knowledge regarding the use of patient-reported outcome data.Discussion: The findings of this review highlight challenges that need to be addressed when implementing an electronic symptom reporting system for patients with cancer, and potential strategies for overcoming these challenges. This review may help hospital administrators and clinicians prepare for and improve the implementation of electronic symptom reporting systems into clinical practice, thereby providing evidence to enable their broader use.

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“…The CSS tool asks, “Did you find this survey to be helpful?” The majority of respondents answered yes to this question (18 = yes; 3 = no [2 males; 1 female]). It is also important to consider the patient perspective when evaluating the effectiveness of distress screening ( Chiang, Amport, Corjulo, Harvey, & McCorkle, 2015 ; Faller et al, 2016 ; Fromme et al, 2016 ). After screening, each participant received a minimum of one email or phone call to assess if they had attended a support group or other activity and if those referred for psychotherapy had accessed that referral.…”

Section: Methodsmentioning

confidence: 99%

Using a Quality Improvement Model to Implement Distress Screening in a Community Cancer Setting

Bush

Goebel

Hardan-Khalil

et al. 2020

JADPRO

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Background: Quality cancer care includes routine screening for psychosocial distress. This quality improvement project focused on the implementation of distress screening at a licensed affiliate of Cancer Support Community, a community-based non-profit organization that provides professionally led cancer support. Methods: An advanced practice oncology nurse assisted the staff in implementing and evaluating the process of distress screening. CancerSupportSource (CSS), a validated web-based distress screening program developed by Cancer Support Community for use in community cancer settings, was employed to screen for distress, identify potential resources, and improve in-house and community referrals. For purposes of this quality improvement project, CSS was administered in interview format by staff. The Plan-Do-Study-Act (PDSA) quality improvement approach was used to implement CSS. Results: To implement the practice of distress screening, 21 patient participants were initially screened and evaluated for distress, including risk for clinically significant levels of depression, using CSS. The tool identified participant concerns and flagged thirteen persons as at risk for depression. After implementation and evaluation of distress screening using PDSA, in a year, 51 participants were screened. Participants stated that distress screening allowed for discussion of intimate questions that may not have otherwise occurred in an intake interview. Conclusion: It was demonstrated that CSS identified psychosocial and practical needs, facilitating the referral process and identification of community resources. Application of the PDSA model was an effective quality improvement model that can be used for the implementation and sustainability of distress screening across settings.

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Computerized patient-reported symptom assessment in radiotherapy: a pilot randomized, controlled trial

Cited by 14 publications

References 33 publications

Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART)

Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART)

Challenges in the implementation of electronic systems for patient report of symptoms in oncology: a scoping review

Using a Quality Improvement Model to Implement Distress Screening in a Community Cancer Setting

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