title: Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT.
abstract: Technology-aided remote interventions for poorly controlled symptoms may improve cancer symptom outcomes. In a randomized controlled trial, the efficacy of an automated symptom management system was tested to determine if it reduced chemotherapy-related symptoms. Prospectively, 358 patients beginning chemotherapy were randomized to the Symptom Care at Home (SCH) intervention (n = 180) or enhanced usual care (UC) (n = 178). Participants called the automated monitoring system daily reporting severity of 11 symptoms. SCH participants received automated self-management coaching and nurse practitioner (NP) telephone follow-up for poorly controlled symptoms. NPs used a guideline-based decision support system. Primary endpoints were symptom severity across all symptoms, and the number of severe, moderate, mild, and no symptom days. A secondary endpoint was individual symptom severity. Mixed effects linear modeling and negative binominal regressions were used to compare SCH with UC. SCH participants had significantly less symptom severity across all symptoms (P < 0.001). On average, the relative symptom burden reduction for SCH participants was 3.59 severity points (P < 0.001), roughly 43% of UC. With a very rapid treatment benefit, SCH participants had significant reductions in severe (67% less) and moderate (39% less) symptom days compared with UC (both P < 0.001). All individual symptoms, except diarrhea, were significantly lower for SCH participants (P < 0.05). Symptom Care at Home dramatically improved symptom outcomes. These results demonstrate that symptoms can be improved through automated home monitoring and follow-up to intensify care for poorly controlled symptoms.
authors.affiliation: Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah.
authors.forename: Kathi H
authors.identifier: 0000-0003-3371-5646
authors.initials: KH
authors.lastname: Mooney
authors.affiliation: Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Beck
authors.affiliation: Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah.
authors.forename: Bob
authors.initials: B
authors.lastname: Wong
authors.affiliation: Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah.
authors.forename: William
authors.initials: W
authors.lastname: Dunson
authors.affiliation: Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah.
authors.forename: Debra
authors.initials: D
authors.lastname: Wujcik
authors.affiliation: Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah.
authors.forename: Meagan
authors.initials: M
authors.lastname: Whisenant
authors.affiliation: Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah.
authors.forename: Gary
authors.initials: G
authors.lastname: Donaldson
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009369:Neoplasms / Q000188:drug therapy*; D024802:Nurse's Role; D017060:Patient Satisfaction; D012648:Self Care / Q000379:methods*; D057566:Self Report; D017216:Telemedicine; D013689:Telephone
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; decision support systems; eHealth; evidence-based clinical practice guidelines; patient-reported outcomes; symptom management; telehealth