title: Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial.
abstract: OBJECTIVE
  Patients receiving cancer-related thoracotomy are highly symptomatic in the first weeks after surgery. This study examined whether at-home symptom monitoring plus feedback to clinicians about severe symptoms contributes to more effective postoperative symptom control.
  
  
  METHODS
  We enrolled 100 patients receiving thoracotomy for lung cancer or lung metastasis in a two-arm randomized controlled trial; 79 patients completed the study. After hospital discharge, patients rated symptoms twice weekly for 4 weeks via automated telephone calls. For intervention group patients, an e-mail alert was forwarded to the patient's clinical team for response if any of a subset of symptoms (pain, disturbed sleep, distress, shortness of breath, or constipation) reached a predetermined severity threshold. No alerts were generated for controls. Group differences in symptom threshold events were examined by generalized estimating equation modeling.
  
  
  RESULTS
  The intervention group experienced greater reduction in symptom threshold events than did controls (19% v 8%, respectively) and a more rapid decline in symptom threshold events. The difference in average reduction in symptom interference between groups was -0.36 (SE, 0.078; P = .02). Clinicians responded to 84% of e-mail alerts. Both groups reported equally high satisfaction with the automated system and with postoperative symptom control.
  
  
  CONCLUSIONS
  Frequent symptom monitoring with alerts to clinicians when symptoms became moderate or severe reduced symptom severity during the 4 weeks after thoracic surgery. Methods of automated symptom monitoring and triage may improve symptom control after major cancer surgery. These results should be confirmed in a larger study.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Department of Symptom Research, 1515 Holcombe Blvd, Box 1450, Houston, TX 77030, USA. ccleeland@mdanderson.org
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.forename: Xin Shelley
authors.initials: XS
authors.lastname: Wang
authors.forename: Qiuling
authors.initials: Q
authors.lastname: Shi
authors.forename: Tito R
authors.initials: TR
authors.lastname: Mendoza
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Wright
authors.forename: Madonna D
authors.initials: MD
authors.lastname: Berry
authors.forename: Donna
authors.initials: D
authors.lastname: Malveaux
authors.forename: Pankil K
authors.initials: PK
authors.lastname: Shah
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Gning
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
mesh_terms: D000368:Aged; D020000:Decision Support Systems, Clinical; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D034742:Electronic Mail; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D010351:Patient Discharge; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D017010:Reminder Systems; D057566:Self Report; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D013781:Texas; D013908:Thoracotomy / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome