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ASCO 2017: Web-based patient reported symptom tool helps patients live longer

Ground breaking abstracts presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting in June not only reminded us about patients' willingness to use technologies as part of their health-care but demonstrated that these technologies are in fact resulting in better outcomes for patients.  The international oncology conference reported findings describing some of the direct benefits of web-based symptom tools to patients, during the course of their cancer treatment.  Web-based tools were shown to help patients by keeping them more informed during treatment, giving them immediate access to their care provider, which improved their quality of life and as one study demonstrated, also helped patients to "live longer". 

Web-based study findings:

In a randomised clinical trial (RCT) of metastatic cancer patients (766 patients with either genitourinary, gynaecologic, breast and lung cancer), undergoing outpatient chemotherapy; patients who regularly used a web-based tool to report their symptoms lived a median of 5 months longer than those who did not use the tool.  The web-based tool allowed patients to report symptoms via tablet computers which in turn triggered alerts to clinicians. In the study, patients were randomised either to the web-based reporting tool or to a group whose symptoms were monitored and documented by clinicians, as standard of care, as well as being encouraged to telephone the office between visits if any concerning symptoms arose.  On a weekly basis, the participants of the patient reported tool reported on 12 common symptoms experienced during chemotherapy (e.g. appetite loss, difficulty in breathing, fatigue) and graded these symptoms on a 5-point scale.  Patients could report the symptoms remotely from home or at the doctor's office during visits using the tablet.  Even those with little experience prior to using the Internet were willing and able to regularly report their symptoms via the web throughout chemotherapy.  More than three quarters of the time that patients reported severe or worsening symptoms, nurses took immediate clinical actions.  Compared to patients who received usual care, the group reporting their symptoms on the web-based tool were able to tolerate chemotherapy longer and were shown to live a median of 5 months longer.

It has been suggested that patients receiving chemotherapy often have severe symptoms that doctors and nurses may be unaware of, and a web-based symptom reporting system alerts the care team to problems which may lead to actions that alleviate suffering and in turn improve patient outcomes.  The principal author of the work (Dr Basch) was reported to say; "the improvement in survival we saw may seem modest, but it is greater than the effect of many targeted cancer drugs for metastatic cancer". This study supports broader use of online tools in routine practice to enable patients to communicate symptoms to the care team in real time.

Next steps:

The findings will now be confirmed in a larger clinical trial, across the United States, using an updated and user friendly online tool working on both personal computers and mobile devices.

At the same conference, findings from a multicentre RCT showed that patients with early breast cancer who had been randomly assigned to use an interactive decision tool (iCanDecide) verses static online information had improved knowledge and were more prepared for complicated decision making than the patients with access to static online information.  Future work should now integrate such tools into the clinical workflow.

Implications:

These recent findings tell us about some of the benefits of web-based patient symptom reporting and other interactive tools.  It is exciting to see compelling digital health results reported at key conferences such as ASCO. Positive findings like these, coupled with recent initiatives announced by the FDA to outline clear regulations in the digital health space reminds us that this rapidly evolving field is now becoming critical for providing valuable data for drug companies, as well as enabling patients to take charge of their own health-care to ultimately improve their outcomes.

For further details of pH Associates (an OPEN Health company) and its Patient Centred Outcomes (PCO) offering, please get in touch with Angela Rylands, Patient Centred Outcomes Consultant at pH Associates (an OPEN Health company) either via email: AngelaRylands@phassociates.com or 'phone: 01628 481 112