eSMART trial adds support for remote symptom monitoring in people with cancer
medwireNews: Remote symptom monitoring (RSM) is associated with a reduced symptom burden and improved quality of life (QoL) in people with cancer receiving adjuvant chemotherapy, trial findings indicate.
Use of the Advanced Symptom Management System (ASyMS) also had a positive impact on anxiety, self-efficacy, and supportive care needs, report Roma Maguire (University of Strathclyde, Glasgow, UK) and colleagues in The BMJ.
The team notes that although “[s]imilar findings have been reported previously […], these earlier studies were conducted in a single country and healthcare system,” whereas the eSMART trial recruited participants from 12 cancer centers across Austria, Greece, Ireland, Norway, and the UK.
The study included 829 patients aged an average of 52.4 years with nonmetastatic cancer who were scheduled to receive at least three cycles of first-line adjuvant chemotherapy or chemotherapy for the first time in 5 years. Nearly three-quarters (71.4%) had breast cancer, while the remaining had a diagnosis of colorectal cancer, Hodgkin disease, or non-Hodgkin lymphoma.
Participants who were randomly assigned to the RSM group completed the Daily Chemotherapy Toxicity Self-Assessment Questionnaire on an ASyMS handset, which automatically generated alerts for clinicians if actions were required; patients also received evidence-based information for self-management. Those in the control group received usual care and were instructed to contact their clinician through standard mechanisms (most often telephone triage) if they developed symptoms.
The primary outcome of symptom burden over six chemotherapy cycles as assessed by the Memorial Symptom Assessment Scale (MSAS) remained at pretreatment levels throughout in the ASyMS group, but rose at cycle 1 in the control group before “slowly” reducing over subsequent cycles, report the study authors.
The adjusted least squares mean (LSM) difference between the groups was a significant –0.15 in favor of the intervention, which translated into a “medium” effect size of 0.50 by Cohen’s criteria, they explain.
Analysis of MSAS sub-domains showed that although global distress and psychological symptom scores decreased in both study arms after the initiation of chemotherapy, the scores were consistently lower in the intervention arm and equated to significant LSM differences of –0.21 and –0.16, respectively, favoring RSM.
The scores for the MSAS physical sub-domain rose during chemotherapy in both groups, but to a lesser degree in the ASyMS group, and once again the LSM difference significantly favored the intervention, at –0.21.
Patients assigned to undergo RSM reported better QoL than their counterparts assigned to receive usual care, as shown by the higher total scores on the Functional Assessment of Cancer Therapy—General (FACT-G) questionnaire, as well as its physical and functional domains, with significant LSM differences in favor of RSM of 4.06, 1.75, and 1.61, respectively.
The intervention also led to significant reductions in anxiety, as measured by the State-Trait Anxiety Inventory—Revised questionnaire, and supportive care requirements, with the largest benefits observed for physical and daily living, patient care and support, and sexuality needs.
ASyMS was associated with significantly better scores than usual care on the Communication and Attitudinal Self-Efficacy scale for cancer, which provides a measure of cancer patients’ confidence and ability to engage in their care, but there were no significant between-group differences on the Work Limitations Questionnaire, which was completed by the 251 participants who were employed.
Maguire and team point out that the study arms were “balanced” in terms of adverse events, with three deaths in each arm and comparable rates of planned and unplanned hospital admissions. The incidence of neutropenic events was higher in the ASyMS than control group (64 vs 36%), “but this was expected as greater identification was the intervention’s intent,” they write.
The study results “suggest that an evidence based remote monitoring intervention, such as ASyMS, has potential for implementation into routine care to make a meaningful difference to people with cancer,” say the researchers.
And they conclude: “Evaluation of the efficacy of remote symptom monitoring systems such as ASyMS for other treatment modalities (for example, targeted therapies) is needed.
“The ultimate vision is to have a multimodal seamless system of remote symptom monitoring used from the start of treatment and through survivorship.”
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