In an analysis of data from 829 adult patients who had been randomly assigned to receive the 24-hour-monitoring or standard care at their cancer center through multiple cycles of chemotherapy, researchers found that for the intervention group, symptom burden remained at pre-chemotherapy levels, while controls reported an increase from cycle one onwards, according to the report published in The BMJ.
The intervention group participants were tracked with the Advanced Symptom Management System (ASyMS), a mobile based, remote patient monitoring system that provides real time, 24-hour monitoring and management of chemotherapy side-effects. Patients using ASyMS completed a series of questions on a mobile phone daily and at any time they felt unwell.
Symptoms data were automatically evaluated in ASyMS and patients were directed to evidence-based self-care advice. When necessary, two types of alerts to hospital clinicians were generated: amber, for persistent mild to moderate symptoms for which early intervention could prevent progression; and red, for chemotherapy emergencies, such as neutropenic sepsis. The required response times were eight hours for amber alerts and 30 minutes for red alerts.
"Our findings indicate that digital solutions for the remote monitoring and management of chemotherapy toxicity can be implemented across multiple European countries within diverse healthcare systems," said the study's lead author, Roma Maguire, a professor of digital health and care; director of health care futures at the University of Strathclyde in Glasgow, UK; and chief investigator for the eSMART study.
"Remote patient monitoring systems such as ASyMS can enhance cancer services for all, but may particularly help people who struggle to access services easily and quickly (e.g. those living in rural communities). However, they will be vital for future services, particularly with blended models of cancer care delivery arising from the COVID-19 pandemic," Maguire said.
To explore the efficacy of the remote system, the researchers conducted a multicenter, parallel group randomized controlled trial using 1:1 allocation of study participants between March 31, 2016 and March 31, 2019. Patients were all aged 18 or older and had been diagnosed with breast cancer, colorectal cancer, Hodgkin's disease, or non-Hodgkin's lymphoma. All were scheduled to receive at least three cycles of two, three or four weekly first line adjuvant chemotherapy or chemotherapy for the first time in five years. Patients were recruited from 12 cancer centers in Austria, Greece, Ireland, Norway, and the UK.
Patients completed the Daily Chemotherapy Toxicity Self-Assessment Questionnaire (DCTAQ), which assesses 10 symptoms - nausea, vomiting, diarrhea, constipation, mucositis, paresthesia, sore hands/feet, flu-like symptoms/infection, tiredness, pain - and up to six additional symptoms.
Use of ASyMS was associated with significant reductions in anxiety and improvements in several supportive care needs and self-efficacy domains, the study team notes. Safety of ASyMS was satisfactory, intervention-group patient adherence to the daily questionnaires was high (76%), and physician adherence to responding to alerts within the specified timeframe was also high (85%).
Among the study's limitations, the authors point out, is that almost three quarters of recruited patients had breast cancer, and a larger study is warranted to assess the use of ASyMS with Hodgkin's and non-Hodgkin's lymphoma patients.
"Continuously monitoring patients during chemotherapy enables clinicians to detect and manage symptoms earlier and more proactively," said Carissa A. Low, a biobehavioral oncologist at UPMC Hillman Cancer Center and assistant professor and director of the Mobile Sensing + Health Institute at the University of Pittsburgh.
"This study provides strong evidence that real-time remote symptom monitoring can reduce symptom burden, improve quality of life, and reassure and empower patients during cancer treatment," Low, who was not involved in the research, said in an email. "Since most cancer patients own a mobile phone, it is easier than ever to collect daily symptom ratings as patients go about their daily lives and to deliver personalized symptom self-management instructions as soon as persistent or worsening symptoms are detected."
SOURCE: https://bit.ly/3rv6pFD The BMJ, online July 22, 2021.
By Linda Carroll
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