Patients Who Quickly Report Cancer Complications Could Live Longer, Study Says
Could something as simple as faster communication be the key to longer survival for cancer patients? According to a new study, the answer is yes. Led by Dr. Ethan Basch of the University of North Carolina Comprehensive Cancer Center, the study involved 766 people, with a mean age of 61 (range 26-91), being treated for various types of advanced cancers at Memorial Sloan Kettering Cancer Center (MSKCC). Patients were randomly assigned either to the usual care group or the integrated electronic patient-reported outcomes (PROs) group.
The usual care group received the standard procedure for monitoring symptoms in oncology practice: symptoms were discussed during clinical encounters, and patients could contact the office by telephone between visits for concerning symptoms. The PRO group was provided with an online symptom tool (web-based PRO questionnaire platform) that allowed them to report their symptoms at least once a week—or sooner if they had a problem.
PRO patients were given a list of 12 common symptoms from the National Cancer Institute’s Common Terminology Criteria for Adverse Events. Symptoms included pain, diarrhea, appetite loss, constipation, nausea, cough, shortness of breath, fatigue, and hot flashes, to name a few. When a patient reported worsening or severe problems, the clinical nurse responsible for their care would receive an immediate email alert. Doctors received the reports at the patients usual office visit. When nurses received email alerts, they responded immediately almost 80 percent of the time. They called in medicines for pain, nausea, and other problems promptly.
The online tool proved easy to use. According to the study, 22 percent of participants had less than a high school education and 30 percent were computer inexperienced. According to Basch, “the older patients really grabbed onto it very quickly."
Within six months, health-related quality of life had improved for more of those in the PRO group and they made fewer trips to an emergency room. They also were able to stay on chemotherapy longer — eight months versus six, on average. Median survival in the online group was 31 months versus 26 months for the usual care group. Dr. Basch was “floored” by the results, and said, “We are proactively catching things early with online reporting. Patients were able to stick with treatment longer because their side effects were quickly addressed.”
Explained Dr. Richard Schilsky, Chief Medical Officer of the American Society of Clinical Oncology, “People shouldn’t assume that symptoms are an unavoidable part of cancer care. You want to be able to reach your provider as early and easily as possible, because a sign like shortness of breath may mean treatment isn’t working and needs to be changed.”
Though symptoms are common among patients receiving treatment for advanced cancers, they are undetected by clinicians up to half the time. Thanks to the success of the PRO study, an even larger study will now test the online reporting system nationwide.
The study was featured at the cancer group’s annual meeting in Chicago in June and published in the Journal of the American Medical Association (JAMA) on July 11, 2017.
Basch, Ethan, Allison M. Deal, and Amylou C. Dueck. "Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment." Journal of the American Medical Association (JAMA) 318.2 (2017): 197-98. JAMA Network. Web. 14 July 2017.
Marchione, Marilynn. "Quickly Reporting Cancer Complications May Boost Survival." ABC News. ABC News Network, 04 June 2017. Web. 14 July 2017.