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 Researchers found that patients who used a website to report their
symptoms had better quality of life, were less likely to go to the
emergency room, stayed on treatment longer and survived longer than
people who were just monitored by their doctors.
"We asked people about the most common and impactful symptoms that
we would see across advanced cancers," said lead author Dr. Ethan
Basch. "This would be pain, vomiting, nausea, diarrhea,
constipation, energy loss, weight loss and sleep disturbances.
Things that are highly common, subjective and frequently missed."
The symptoms are also actionable, which means doctors and healthcare
providers can likely offer treatments or adjustments for
improvement, said Basch, of the Lineberger Comprehensive Cancer
Center at the University of North Carolina in Chapel Hill.
He and his colleagues write in the Journal of Clinical Oncology that
these so-called patient-reported outcome (PRO) standardized
questionnaires had been suggested as a way to improve symptom
control, but researchers didn't know whether the benefits outweighed
the cost and burden of using them.
For the new study, the researchers asked 539 patients with advanced
cancers at Memorial Sloan Kettering Cancer Center in New York to
report 12 symptoms using tablets that were provided to them or at a
computer kiosk. Doctors received printouts of the symptom surveys
when the patients came in for their next visit, and nurses received
emails if the patients reported severe or worsening symptoms.
"We know from this study that nurses took action 75 percent of the
time when they got one of these email alerts," Basch said.
Another 227 patients with advanced cancers received usual care,
which included normal symptom monitoring by their doctors.
The participants entered the study between September 2007 and
January 2011. They spent an average of about four months
participating in the study and had an average of 16 doctor visits in
that time.
Over the study period, people who answered the online surveys were
more likely to see improvements in their quality of life than those
in the usual care group. Patients who answered the surveys were also
less likely to report worsening quality of life.
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About a third of patients who answered the survey ended up in the
emergency department, compared to about 41 percent of the usual care
group. Patients using the symptom reporting tool also stayed on
their chemotherapy longer than those who didn't use it.
About 75 percent of patients who answered the surveys were alive
after one year, compared to 69 percent of those in the usual care
group.
"I think we take away a couple of things from this study," said
Basch.
Cancer care providers can improve the quality of their care by
having a better understanding of their patients, he said. And even
without these types of computer systems, patients can likely benefit
from closely following their own symptoms and reporting them to
their doctors.
"I think this study is really helpful in showing patient-reported
outcomes can be used to identify and address patient issues by both
improving the patient-centeredness of care and the precision of
care," said Claire Snyder, of the Johns Hopkins School of Medicine
and the Bloomberg School of Public Health in Baltimore.
The results also validate the value of having a standard practice in
place for collecting this information and tracking it over time,
said Snyder, who is president of the International Society for
Quality of Life Research and co-authored an editorial accompanying
the new study.
"We're beginning to really learn the best ways to implement routine
(patient-reported outcome) assessment," she said.
SOURCE: http://bit.ly/1OOxoEE and http://bit.ly/1OOxyvA Journal of
Clinical Oncology, online December 7, 2015.
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