An eHealth system supporting palliative care for patients with non-small cell lung cancer: a randomized trial.
BACKGROUND
In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non-small cell lung cancer (NSCLC).


METHODS
In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint-patient symptom distress-was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale.


RESULTS
Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm. Significant differences were observed at 4 months (P = .031; Cohen d = .42) and at 6 months (P = .004; d = .61). Similar but marginally significant effects were observed at 2 months (P = .051; d = .39) and at 8 months (P = .061; d = .43). Exploratory analyses indicated that survival curves did not differ significantly between the arms (log-rank P = .172), although a survival difference in an exploratory subgroup analysis suggested an avenue for further study.


CONCLUSIONS
The current results indicated that an online support system may reduce patient symptom distress. The effect on survival bears further investigation.
Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA. dhgustaf@wisc.edu
David H
DH
Gustafson
Lori L
LL
DuBenske
Kang
K
Namkoong
Robert
R
Hawkins
Ming-Yuan
MY
Chih
Amy K
AK
Atwood
Roberta
R
Johnson
Abhik
A
Bhattacharya
Cindy L
CL
Carmack
Anne M
AM
Traynor
Toby C
TC
Campbell
Mary K
MK
Buss
Ramaswamy
R
Govindan
Joan H
JH
Schiller
James F
JF
Cleary
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000451:nursing / Q000628:therapy*; D017028:Caregivers; D006801:Humans; D020407:Internet; D008175:Lung Neoplasms / Q000451:nursing / Q000628:therapy*; D008875:Middle Aged; D010166:Palliative Care