Effect of a Symptom Monitoring Intervention for Patients Hospitalized With Advanced Cancer

Abstract

IMPORTANCE Symptom monitoring interventions are increasingly becoming the standard of care in oncology, but studies assessing these interventions in the hospital setting are lacking.OBJECTIVE To evaluate the effect of a symptom monitoring intervention on symptom burden and health care use among hospitalized patients with advanced cancer. DESIGN, SETTING, AND PARTICIPANTSThis nonblinded randomized clinical trial conducted from February 12, 2018, to October 30, 2019, assessed 321 hospitalized adult patients with advanced cancer and admitted to the inpatient oncology services of an academic hospital. Data obtained through November 13, 2020, were included in analyses, and all analyses assessed the intent-to-treat population.INTERVENTIONS Patients in both the intervention and usual care groups reported their symptoms using the Edmonton Symptom Assessment System (ESAS) and the 4-item Patient Health Questionnaire-4 (PHQ-4) daily via tablet computers. Patients assigned to the intervention had their symptom reports displayed during daily oncology rounds, with alerts for moderate, severe, or worsening symptoms. Patients assigned to usual care did not have their symptom reports displayed to their clinical teams. MAIN OUTCOMES AND MEASURESThe primary outcome was the proportion of days with improved symptoms, and the secondary outcomes were hospital length of stay and readmission rates. Linear regression was used to evaluate differences in hospital length of stay. Competing-risk regression (with death treated as a competing event) was used to compare differences in time to first unplanned readmission within 30 days. RESULTSFrom February 12, 2018, to October 30, 2019, 390 patients (76.2% enrollment rate) were randomized. Study analyses to assess change in symptom burden included 321 of 390 patients (82.3%) who had 2 or more days of symptom reports completed (usual care, 161 of 193; intervention, 160 of 197). Participants had a mean (SD) age of 63.6 (12.8) years and were mostly male (180; 56.1%), self-reported as White (291; 90.7%), and married (230; 71.7%). The most common cancer type was gastrointestinal (118 patients; 36.8%), followed by lung (60 patients; 18.7%), genitourinary (39 patients; 12.1%), and breast (29 patients; 9.0%). No significant differences were detected between the intervention and usual care for the proportion of days with improved ESAS-physical (unstandardized coefficient [B] = −0.02; 95% CI, -0.10 to 0.05; P = .56), ESAS-total (B = −0.05; 95% CI, -0.12 to 0.02; P = .17), PHQ-4-depression (B = −0.02; 95% CI, -0.08 to 0.04; P = .55), and PHQ-4-anxiety (B = −0.04; 95% CI, -0.10 to 0.03; P = .29) symptoms. Intervention patients also did not differ significantly from patients receiving usual care for the secondary end points of hospital length of stay (7.59 vs 7.47 days; B = 0.13; 95% CI, -1.04 to 1.29; P = .83) and 30-day readmission rates (26.5% vs 33.8%; hazard ratio, 0.73; 95% CI, 0.48-1.09; P = .12). CONCLUSIONS AND RELEVANCEThis randomized clinical trial found that for hospitalized patients with advanc...

Electronic patient-reported outcomes (e-PROMs) in palliative cancer care: a scoping review

“…K was 0.89 with excellent agreement. Thirteen studies were included, of which nine were quantitative [47][48][49][50][51][52][53][54] (one was a protocol used to evaluate new software [55]), two were qualitative [56,57] and two had a mixed-method design [58,59]. The search and decision-making process is described using the PRISMA flow diagram [43] in Fig.…”

“…The studies were published from 2011 to 2022 and carried out in several European and non-European countries; the most active country publishing on the topic was the USA [47-49, 54, 58]. In seven studies, the e-PROMS were administered through a touchscreen tablet [48,49,[51][52][53][54]56] and a pen/stylus [51]. Two studies reported the use of smartphones [55,57], and two used computers [58,59].…”

“…Regarding the frequency of use, studies indicated that patients were asked to complete the measurement during visits [48,49,51,53,56], daily [47,50,54,59], weekly [52,59] and when indicated by clinicians [55]. The Karamanidou et al and Kallen et al studies [57,58] did not note any required frequency of completion.…”

“…Six studies dealt with outpatients [48,50,53,55,57,59], five with inpatients [49,52,54,56,58] and two with both [47,51].…”

“…Seventy percent of the assessments were developed to measure the evaluation of symptoms [47,49,50,[54][55][56][57][58][59], and 15% were concerned with quality of life (QoL) [52,53] or both [48,51]. Different e-PROMs were used; in particular, four studies used the ESAS scale [51,54,58,59], and three used the EORTC QLQ-C30 [51][52][53].…”