Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial
Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial
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DOI：
10.1200/jco.2015.63.0830
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发表时间：
2016-02-20
影响因子：
45.3
通讯作者：
Schrag, Deborah
中科院分区：
文献类型：
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作者：
Basch, Ethan;Deal, Allison M.;Schrag, Deborah
目的：在常规癌症治疗中，使用患者报告的结果来加强症状监测的兴趣越来越大，但对临床结果的影响证据有限。方法：我们随机分配在纪念斯隆凯特琳癌症中心接受常规门诊化疗的晚期实体瘤患者，通过平板电脑报告12种常见症状，或接受由临床医生自行决定的包括症状监测的常规护理。那些有家用电脑的人每周都会收到电子邮件，提示他们在两次访问之间进行报告。治疗医生在就诊时收到症状打印件，当参与者报告症状严重或恶化时，护士收到电子邮件提醒。主要结局是6个月时健康相关生活质量（HRQL）与基线相比的变化，由EuroQol EQ-5D指数衡量。次要终点包括急诊室（ER）就诊、住院和生存。结果在766例患者中，干预组HRQL改善的参与者多于常规治疗组（34% vs 18%），而恶化的参与者较少（38% vs 53%; P < .001）。总体而言，干预组的平均HRQL下降幅度小于常规护理组（1.4- 7.1点下降；P, 0.001）。接受干预的患者入院率（34% vs 41%; P = 0.02）或住院率（45% vs 49%; P = 0.08）较低，化疗持续时间较长（平均8.2 v 6.3个月；P = 0.002）。虽然75%的干预组在1年时存活，但69%的常规护理组存活了一年（P = 0.05），质量调整生存率也有差异（平均8.7个月vs 8.0个月；P = 0.004）。先前没有电脑经验的参与者受益更大。大多数接受干预的患者（63%）在研究期间报告了严重症状。护士经常发起临床行动，以回应电子邮件警报。结论临床获益与癌症治疗期间的症状自我报告有关。(C) 2015年由美国临床肿瘤学会出版
PurposeThere is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited.MethodsWe randomly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians. Those with home computers received weekly e-mail prompts to report between visits. Treating physicians received symptom printouts at visits, and nurses received e-mail alerts when participants reported severe or worsening symptoms. The primary outcome was change in health-related quality of life (HRQL) at 6 months compared with baseline, measured by the EuroQol EQ-5D Index. Secondary endpoints included emergency room (ER) visits, hospitalizations, and survival.ResultsAmong 766 patients allocated, HRQL improved among more participants in the intervention group than usual care (34% v 18%) and worsened among fewer (38% v 53%; P < .001). Overall, mean HRQL declined by less in the intervention group than usual care (1.4-v 7.1-point drop; P,.001). Patients receiving intervention were less frequently admitted to the ER (34% v 41%; P = .02) or hospitalized (45% v 49%; P = .08) and remained on chemotherapy longer (mean, 8.2 v 6.3 months; P = .002). Although 75% of the intervention group was alive at 1 year, 69% with usual care survived the year (P = .05), with differences also seen in quality-adjusted survival (mean of 8.7 v. 8.0 months; P = .004). Benefits were greater for participants lacking prior computer experience. Most patients receiving intervention (63%) reported severe symptoms during the study. Nurses frequently initiated clinical actions in response to e-mail alerts.ConclusionClinical benefits were associated with symptom self-reporting during cancer care. (C) 2015 by American Society of Clinical Oncology