A web-based tool that enables patients with metastatic cancer to report their symptoms in real time, providing alerts to clinicians, has been shown to have major benefits, including longer survival rates.

In a randomized clinical trial of 766 patients, those who used the tool to regularly self-report symptoms while receiving chemotherapy lived a median of 5 months longer than those who did not use the tool. Results of the study were presented June 4 in the plenary session of the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.

The study was led by Ethan Basch, MD, professor of medicine at the Lineberger Comprehensive Cancer Center of the University of North Carolina, who was practicing at Memorial Sloan Kettering Cancer Center in New York when the clinical trial was conducted.

“Online technologies have transformed communications in practically every aspect of our lives, and now we're seeing they're also allowing patients to take an active role in their care and get immediate access to their care provider,” said Basch. “The improvement in survival we saw may seem modest, but it is greater than the effect of many targeted cancer drugs for metastatic cancer.”

“When you think about the cost of doing this, which is almost nil, versus the cost of drugs, it’s pretty darn remarkable,” Eric Topol, MD, director of the Scripps Translational Science Institute, told the 2017 AHIP Institute & Expo this week in Austin, Texas.

The web-based tool, called the Symptom Tracking and Reporting (STAR) system, was internally developed at Memorial Sloan Kettering Cancer Center for research purposes and is not commercially available.

“The goal of this study was really to see if you could use this web-based digital interface to allow patients to connect more readily to their medical team in the short term to see how that would affect quality of life and healthcare utilization,” says ASCO expert Harold Burstein, MD.

“Patients and medical teams deployed these digital communications and when they did so saw they saw dramatic improvement in patient quality of life, a reduction in the numbers of times patients went to the emergency room, patients were able to get more anti-cancer therapy that enabled treatment, as well as an improved overall survival benefit,” adds Burstein. “People actually lived longer with advanced cancer, and that’s really quite a remarkable thing.”

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Patients enrolled in the trial had advanced solid tumors—genitourinary, gynecologic, breast and lung— and were receiving outpatient chemotherapy. The intervention group patients were randomly assigned to use tablet computers to report on 12 common symptoms experienced during chemotherapy, including appetite loss, difficulty breathing, fatigue, hot flashes, nausea and pain, and to grade them on a five-point scale.

Patients could report their symptoms remotely from home or at the physician's office during oncology or chemotherapy visits, and nurses received email alerts when patients reported severe or worsening symptoms.

Compared with patients who received usual care, those who used the web tool to self-report symptoms had a longer median overall survival of 31.2 months versus 26 months.

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“These were very dramatic results, which is why they were included in the plenary session of our ASCO Annual Meeting last week,” observes Burstein. “The findings cut across all different kinds of cancers that affect all oncologists who work with cancer patients. It suggests that more intensive communication between the medical teams and the patients can help nip problems in the bud.

“We need to bring easy-to-use communications between patients and medical teams into real, daily practice,” concludes Burstein. “There are many companies making mobile apps, but this particular web interface was designed to immediately ping the nursing staff involved with the patients’ care. So, you need systems that enable that kind of connectivity.”

A larger clinical trial is planned for community practices across the United States that will involve an updated, more user-friendly online tool that works on both personal computers and mobile devices.

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