Symptom Alerts Linked to Longer Cancer Survival

(Gerd Altmann, Pixabay)

4 June 2017. A clinical trial shows cancer patients using an online system to report their symptoms have somewhat longer survival times than patients not using this service. Findings from the trial appear in today’s issue of Journal of the American Medical Association, and reported yesterday at a meeting of American Society of Clinical Oncology in Chicago.

The team led by cancer specialist and researcher Ethan Basch at University of North Carolina in Chapel Hill sought to determine more key clinical benefits of using online reporting systems with cancer patients. The authors cite earlier studies showing related benefits of these systems, such as higher satisfaction and quality of life by patients, and more efficient use of emergency room resources, but overall survival time had not yet been measured.

The technology assessed in this case is the Symptom Tracking and Reporting, or STAR, system at Memorial Sloan-Kettering Cancer Center in New York. The system uses terminals in waiting rooms for patients at Memorial Sloan-Kettering arriving for chemotherapy treatments, where they can report on 12 common adverse effects as determined by National Cancer Institute, as well as quality of life and other factors. Patients can also use the STAR system over the Internet between visits. When severe or worsening symptoms are reported, an e-mail alert is sent to a clinical nurse responsible for the patient, with the symptoms listed in a report for the patient’s cancer physician.

The clinical trial evaluated the system among 766 patients receiving treatment for metastatic solid tumor cancers. Participants were randomly assigned to use the STAR system to report on their symptoms and related issues, or the usual cancer care, which included paper questionnaires. The trial looked primarily at clinical benefits and quality of life factors for patients. The study ran from 2007 to 2011, but patients could continue using the STAR system, with some patients voluntarily tracked for as long as 7 years, or until they ceased cancer care, dropped from the trial, entered hospice care, or died.

Among participants using the STAR system, the median overall survival time was 31 months, compared to a median of 26 for patients receiving the usual care. The 5 month difference in survival time was large enough to be statistically reliable. An earlier report from the trial shows greater improvements in health-related quality of life reported by participants using the system than those receiving the usual care. Participants ranged in age from 26 to 91, with a median age of 61. About 2 in 10 participants (22%) had less than a high school education and 3 in 10 (30%) were inexperienced with computers.

The authors attribute the longer survival time to more timely and responses by clinicians. Basch and colleagues report that nurses responded to e-mail alerts 77 percent of the time, with  counseling, medications, changes in chemotherapy, or other actions. Users of the STAR system also reported a longer tolerance of chemotherapy, 8.2 months on average, compared to 6.3 months for patients receiving the usual care.

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