Cancer patients who used an online system to monitor their symptoms during chemotherapy had improved symptom control, according to a study published in the Journal of Clinical Oncology.
The phase 3 randomized study followed 508 patients in the Leeds Cancer Center, UK, for 18 weeks when they started systemic chemotherapy. The patients have been diagnosed with colon, breast, or gynecological cancer.
The patients were randomized into 2 groups. The control group received the usual care alone, while the intervention group received the usual care and used the online system for symptom monitoring – electronic patient self-reporting of adverse events: patient information and advice (eRAPID).
Patients in the eRAPID group used their phones or computers to send electronic reports of symptom outbreaks to their oncology team, in addition to weekly symptom scores. Once a report was submitted, patients received real-time training on how to manage mild or moderate symptoms, while severe symptoms triggered an alert to the medical team via a monitored email.
The degree of symptom control in all patients was assessed using the “Functional Assessment of Cancer Therapy Scale – General Physical Well-Being” subscale. This assessment includes common symptoms during chemotherapy and their effects on the patient’s ability to function: pain, nausea, lack of energy, time in bed, feeling sick, not meeting family needs, and annoyance from side effects.
Patients in both the eRAPID and control arms completed the paper ratings at weeks 6, 12, and 18.
The researchers found that the eRAPID participants had improved their physical well-being compared to the control group after 6 weeks and 12 weeks (P = .028 and P = .039, respectively), but not after 18 weeks (P = .69).
However, patients in the eRAPID group had significantly better self-efficacy scores after 18 weeks (P = 0.0073).
The researchers also found that a smaller percentage of patients in the eRAPID group had clinically significant deterioration after 6 weeks (43% vs. 48%) and 12 weeks (47% vs. 56%).
No significant differences were found between groups when comparing hospital admissions, emergency calls, or chemotherapy administrations.
In a subgroup analysis, the researchers found that the beneficial effects of eRAPID were limited to patients with non-metastatic disease. In patients with metastases (n = 191), no significant difference in well-being was found between the eRAPID and the standard care group.
However, the researchers noted that their study may have been limited by the relatively small number of patients with metastases and the brevity of the study. With extended monitoring, symptoms of relapse may have been identified that would lead to treatment interventions in the metastatic population.
Other limitations of the study included potential contamination bias as oncologists observed patients in both arms of the study, which may affect their interactions in assessing symptom management.
In addition, the average adherence rate for the weekly eRAPID assessment was only 64.6%, although the researchers found this rate to be similar to that seen in other online monitoring studies.
“The eRAPID approach offers a model for alternative care during curative chemotherapy,” the researchers concluded.
Disclosure: This study was supported by the National Institute for Health Research
Cancer research. Several study authors stated links to the pharmaceutical industry. For a full list of the author’s disclosures, see the original reference.
K. Absolom, L. Warrington, E. Hudson et al. Randomized controlled phase III study of eRAPID: eHealth intervention during chemotherapy. JClin Oncol. 2021; 39 (7): 734-747. doi: 10.1200 / JCO.20.02015