As reported in the Journal of Clinical Oncology by Basch et al, a trial conducted among patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center indicated that patient use of tablet computers to report common symptoms was associated with better health-related quality of life compared with usual care consisting of symptom monitoring at clinician discretion. The intervention group also had fewer emergency room visits and stayed on chemotherapy longer.
In the study, 766 patients (227 computer-inexperienced and 539 computer-experienced) were enrolled between September 2007 and January 2011 and randomly assigned to the use of tablet computers to report 12 common symptoms (via STAR, Symptom Tracking and Reporting; n = 441, including 286 computer-experienced) or to receive usual care (n = 325, including 253 computer-experienced). Randomization was 1:1 in the computer-experienced subgroup and enriched at 2:1 in the computer-inexperienced subgroup.
Patients with home computers received weekly e-mail prompts to report symptoms between visits. Treating physicians received symptom printouts at visits, and nurses received e-mail alerts when patients reported severe or worsening symptoms. The primary outcome was change in health-related quality of life at 6 months on the EuroQol EQ-5D Index. A score change of 6 points on the 0 to 100 scale is considered clinically meaningful.
Differences in Health-Related Quality of Life
Improvement in health-related quality of life was more common (34% vs 18%) and worsening less common (38% vs 53%; P < .001) in the intervention group. An increase of at least 6 points on the scale occurred in 21% vs 11%, and a decrease of at least 6 points on the scale occurred in 28% vs 37% (P = .001). Overall, mean health-related quality of life declined less in the intervention group (decrease of 1.4 vs 7.1 points on the scale, P < .001).
Patients in the intervention group were admitted to the emergency room less often (34% vs 41%, P = .02), with the difference being greater in the computer-inexperienced subgroup (34% vs 56%, P = .02) than in the computer-experienced subgroup (34% vs 36%, P = .16). Hospitalization at 1 year occurred for 45% vs 49% (P = .08), with the difference being greater in the computer-inexperienced subgroup (44% vs 63%, P = .003) than in the computer-experienced subgroup (46% vs 45%, P = .75). Patients in the intervention group remained on chemotherapy longer (mean, 8.2 vs 6.3 months, P = .002).
One-year survival was 75% vs 69% (P = .05), with the difference being greater in the computer-inexperienced subgroup (74% vs 60%, P = .02) than in the computer-experienced subgroup (76% vs 71%, P = .45). Overall, quality-adjusted survival was superior in the intervention group (mean, 8.7 vs 8.0 months, P = .004).
The investigators concluded: “Clinical benefits were associated with symptom self-reporting during cancer care.”
The study was supported by the National Cancer Institute and the Society of Memorial Sloan Kettering.
Ethan Basch, MD, of UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, is the corresponding author of the Journal of Clinical Oncology article.
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