A randomized trial of weekly symptom telemonitoring in advanced lung cancer

J Pain Symptom Manage. 2014 Jun;47(6):973-89. doi: 10.1016/j.jpainsymman.2013.07.013. Epub 2013 Nov 7.

Abstract

Context: Lung cancer patients experience multiple, simultaneous symptoms related to their disease and treatment that impair functioning and health-related quality of life (HRQL). Computer technology can reduce barriers to nonsystematic, infrequent symptom assessment and potentially contribute to improved patient care.

Objectives: To evaluate the efficacy of technology-based symptom monitoring and reporting in reducing symptom burden in patients with advanced lung cancer.

Methods: This was a prospective, multisite, randomized controlled trial. Two hundred fifty-three patients were enrolled at three sites and randomized to monitoring and reporting (MR) or monitoring alone (MA). Patients completed questionnaires at baseline, 3, 6, 9, and 12 weeks and symptom surveys via interactive voice response weekly for 12 weeks. MR patients' clinically significant symptom scores generated an e-mail alert to the site nurse for management. The primary endpoint was overall symptom burden; secondary endpoints included HRQL, treatment satisfaction, symptom management barriers, and self-efficacy.

Results: This randomized controlled trial failed to demonstrate efficacy of symptom monitoring and reporting in reducing symptom burden compared with monitoring alone in lung cancer. HRQL declined over 12 weeks in both groups (P < 0.006 to P < 0.025); at week 12, treatment satisfaction was higher in MA than MR patients (P < 0.012, P < 0.027). Adherence to weekly calls was good (82%) and patient satisfaction was high.

Conclusion: Feasibility of using a technology-based system for systematic symptom monitoring in advanced lung cancer patients was demonstrated. Future research should focus on identifying patients most likely to benefit and other patient, provider, and health system factors likely to contribute to the system's success.

Keywords: Lung cancer; health information technology; randomized controlled trial; symptoms; telemonitoring.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / physiopathology
  • Carcinoma, Non-Small-Cell Lung / psychology
  • Carcinoma, Non-Small-Cell Lung / therapy*
  • Cost of Illness
  • Female
  • Humans
  • Lung Neoplasms / physiopathology
  • Lung Neoplasms / psychology
  • Lung Neoplasms / therapy*
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods*
  • Patient Satisfaction
  • Prospective Studies
  • Self Efficacy
  • Small Cell Lung Carcinoma / physiopathology
  • Small Cell Lung Carcinoma / psychology
  • Small Cell Lung Carcinoma / therapy*
  • Telemedicine / methods*
  • Time Factors
  • Treatment Outcome

Substances

  • Antineoplastic Agents