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[JAMA发表论文]:电子症状监测对肿瘤转移患者自己报告预后的影响
2022年08月05日 时讯速递, 进展交流 暂无评论

Original Investigation 

June 5, 2022

Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer: A Randomized Clinical Trial

Ethan Basch, Deborah Schrag, Sydney Henson, et al

JAMA. Published online June 5, 2022. doi:10.1001/jama.2022.9265

Key Points

Question  In patients undergoing cancer treatment, does electronic symptom monitoring improve quality-of-life (QOL) outcomes?

Findings  In this cluster randomized trial that included 52 oncology practices and 1191 patients, an intervention consisting of patient-reported surveys completed electronically each week to monitor symptoms, compared with usual care, resulted in statistically significant improvements in QOL outcomes at 3 months (measured as difference in change from baseline using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire; range, 0-100 points) for physical function (mean difference, 2.47 points; minimum clinically important difference [MCID], 2-7), symptom control (mean difference, 2.56 points; no established MCID), and health-related QOL (mean difference, 2.43; no established MCID).

Meaning  Among adults receiving treatment for metastatic cancer, weekly electronic symptom monitoring resulted in statistically significant mean improvements of approximately 2.5 points on a 0- to 100-point scale in QOL outcomes at 3 months; the findings should be interpreted provisionally, pending results of the study’s primary outcome of survival.

Abstract

Importance  Electronic systems that facilitate patient-reported outcome (PRO) surveys for patients with cancer may detect symptoms early and prompt clinicians to intervene.

Objective  To evaluate whether electronic symptom monitoring during cancer treatment confers benefits on quality-of-life outcomes.

Design, Setting, and Participants  Report of secondary outcomes from the PRO-TECT (Alliance AFT-39) cluster randomized trial in 52 US community oncology practices randomized to electronic symptom monitoring with PRO surveys or usual care. Between October 2017 and March 2020, 1191 adults being treated for metastatic cancer were enrolled, with last follow-up on May 17, 2021.

Interventions  In the PRO group, participants (n = 593) were asked to complete weekly surveys via an internet-based or automated telephone system for up to 1 year. Severe or worsening symptoms triggered care team alerts. The control group (n = 598) received usual care.

Main Outcomes and Measures  The 3 prespecified secondary outcomes were physical function, symptom control, and health-related quality of life (HRQOL) at 3 months, measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30; range, 0-100 points; minimum clinically important difference [MCID], 2-7 for physical function; no MCID defined for symptom control or HRQOL). Results on the primary outcome, overall survival, are not yet available.

Results  Among 52 practices, 1191 patients were included (mean age, 62.2 years; 694 [58.3%] women); 1066 (89.5%) completed 3-month follow-up. Compared with usual care, mean changes on the QLQ-C30 from baseline to 3 months were significantly improved in the PRO group for physical function (PRO, from 74.27 to 75.81 points; control, from 73.54 to 72.61 points; mean difference, 2.47 [95% CI, 0.41-4.53]; P = .02), symptom control (PRO, from 77.67 to 80.03 points; control, from 76.75 to 76.55 points; mean difference, 2.56 [95% CI, 0.95-4.17]; P = .002), and HRQOL (PRO, from 78.11 to 80.03 points; control, from 77.00 to 76.50 points; mean difference, 2.43 [95% CI, 0.90-3.96]; P = .002). Patients in the PRO group had significantly greater odds of experiencing clinically meaningful benefits vs usual care for physical function (7.7% more with improvements of ≥5 points and 6.1% fewer with worsening of ≥5 points; odds ratio [OR], 1.35 [95% CI, 1.08-1.70]; P = .009), symptom control (8.6% and 7.5%, respectively; OR, 1.50 [95% CI, 1.15-1.95]; P = .003), and HRQOL (8.5% and 4.9%, respectively; OR, 1.41 [95% CI, 1.10-1.81]; P = .006).

Conclusions and Relevance  In this report of secondary outcomes from a randomized clinical trial of adults receiving cancer treatment, use of weekly electronic PRO surveys to monitor symptoms, compared with usual care, resulted in statistically significant improvements in physical function, symptom control, and HRQOL at 3 months, with mean improvements of approximately 2.5 points on a 0- to 100-point scale. These findings should be interpreted provisionally pending results of the primary outcome of overall survival.

Trial Registration  ClinicalTrials.gov Identifier: NCT03249090

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