Lead study author Ethan Basch, an oncologist at Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, acknowledges that a five-month improvement might sound modest. But, he notes, it is a greater benefit than what's provided by many targeted drugs for metastatic cancer.
Results of Basch's randomized, controlled trial were published Sunday morning in JAMA and will be presented at the plenary session of the American Society of Clinical Oncology annual meeting in Chicago. Only four studies, thought to have the greatest potential to affect patient care, are being highlighted at that session.
The trial involved 766 patients who were receiving outpatient chemotherapy at Memorial Sloan Kettering Cancer Center in New York, where Basch practiced before moving to Lineberger. The patients had a variety of cancer types, including prostate, breast and lung.
One group was directed to report the common side effects of chemo — including nausea, pain, fatigue and difficulty in breathing — at least once a week using an electronic tablet or other kind of computer. Nurses got email alerts when participants reported worsening symptoms.
The other group reported side effects in the usual way — during monthly meetings with oncologists and by telephone if concerns came up between visits.
The study found that patients who reported their side effects more frequently via the Web-based tool got quick attention from nurses, who frequently adjusted medications for nausea, constipation and pain. As a result, Basch said, those patients had fewer emergency room visits, were able to tolerate chemo longer and were more active — all factors that contributed to their living five months longer than the patients who were not in the real-time reporting group.
Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research at the Fred Hutchinson Cancer Research Center in Seattle, said Basch's approach represents a “promising, low-cost way to reduce suffering and save millions of dollars in preventable emergency-department visits.”
Ramsey, who was not involved in the study, said that most oncology practices rely on patients to contact their offices when they run into trouble during chemotherapy. “But unfortunately, most patients don’t know when to call for help and often wait until it’s too late,” he said. In Washington state, more than 50 percent of chemotherapy patients end up at the E.R. or in the hospital within six months of starting treatment, according to Ramsey.
Basch is now leading a national trial involving 1,000 patients being treated in community oncology practices around the country. It uses a tool that works on cellphones.
Challenges confront the implementation of real-time symptom reporting, including the way that electronic medical records are set up and a lack of reimbursement for physicians, Basch said. But those obstacles are surmountable, he added.
“We have limited time to see a lot of people as oncologists,” he said. “But we can harness technology to improve the quality of how we practice and to bring us closer to our patients.”