title: SIS.NET: a randomized controlled trial evaluating a web-based system for symptom management after treatment of breast cancer.
abstract: BACKGROUND
  As cancer survivorship increases, health care systems will be challenged to meet patient needs. With the limited availability of clinician time and resources, novel methods of using patient-reported outcomes may improve the quality and efficiency of follow-up care in patients with breast cancer.
  
  
  METHODS
  The authors conducted a randomized trial in patients with TNM stage I to III breast cancer comparing standard care with SIS.NET (System for Individualized Survivorship Care, based on patient self-reported data, with review by Nurse practitioners, targeted Education, and Triage), a follow-up protocol including integration of online health questionnaires at 3-month intervals and the evaluation of self-reported symptoms monitored and addressed remotely by a nurse practitioner (NP). The primary endpoint was to quantify the time between symptom reporting and remote evaluation of symptoms. The secondary endpoint was to compare use of health care resources (breast cancer-related visits, total medical appointments, and laboratory and imaging studies) over an 18-month period.
  
  
  RESULTS
  A total of 102 participants were enrolled; 2 patients were excluded due to cancer recurrence. In the SIS.NET arm, 74% of new or changed self-reported symptoms were reviewed by a NP in <3 days. SIS.NET patients reported more new or changed symptoms compared with standard care patients (7.36 vs 3.2; P = .0045). During the 18-month trial, there were no statistically significant differences noted between the SIS.NET and standard care arms with regard to oncology-related appointments (mean, 4.2 vs 4.1 appointments), number of physician visits (mean, 10.8 vs 9.6 visits), or medical tests (mean, 5.5 vs 5 tests).
  
  
  CONCLUSIONS
  Integration of online health questionnaires with remote review by a NP facilitated symptom reporting and may provide a means of convenient symptom assessment, but it did not appear to reduce health care resource use.
authors.affiliation: School of Medicine, University of Massachusetts School of Medicine, Worcester, Massachusetts.
authors.forename: Alyse E
authors.initials: AE
authors.lastname: Wheelock
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Bock
authors.forename: Eva L
authors.initials: EL
authors.lastname: Martin
authors.forename: Jimmy
authors.initials: J
authors.lastname: Hwang
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Ernest
authors.forename: Hope S
authors.initials: HS
authors.lastname: Rugo
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Melisko
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors; D017216:Telemedicine / Q000379:methods*
keywords: adult; breast neoplasms; female; health status; quality of life; questionnaires; randomized control trial; self-report; survivors