The effectiveness of symptom management interventions based on electronic patient-reported outcomes (ePROs) for symptom burden, quality of life, and overall survival among patients with cancer: A meta-analysis of randomized controlled trials

Electronic Patient Reported Outcome Measures and quality of life in cancer (E-PROMISE): systematic review of the evidence and meta-analysis

OBJECTIVE

The objective of this systematic review and meta-analysis (SRMA) was to evaluate the impact of electronic patient-reported outcomes (ePROs) on health-related quality of life (HRQoL) in patients with cancer.

DESIGN

We performed SRMA of randomised controlled trials (RCTs) comparing ePRO interventions with usual care in patients with cancer. The primary outcome was HRQoL. We used a random effects model a priori due to the anticipated clinical heterogeneity. Subgroup analyses and meta-regressions were performed to explore sources of heterogeneity. After assessing the risk of bias using risk-of-bias tool (RoB V.2), we rated the evidence certainty using the Grading of Recommendations, Assessment, Development and Evaluations framework.

ELIGIBILITY CRITERIA

We included studies meeting the following criteria: (1) RCTs; (2) patients diagnosed with any type of cancer, undergoing or having completed treatment; (3) comparing ePROs with usual care without ePRO interventions; (4) assessing the effect on HRQoL.

INFORMATION SOURCES

We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to April 2024.

RESULTS

We screened 7706 records to include 36 RCTs with 9608 patients. ePRO interventions showed a standardised mean difference (SMD) of 0.35; 95% CI 0.18 to 0.51 compared with usual care. Patients receiving ongoing therapy had an SMD of 0.39 (95% CI 0.21 to 0.58), while those who had completed therapy had an SMD of 0.12 (95% CI 0.01 to 0.22), with a significant subgroup difference (p=0.01). No statistically significant differences were observed across the method of ePRO assessment, cancer site, metastasis status, therapy status, average age or duration of ePRO use. The results remained consistent with Bayesian and other sensitivity analyses.

CONCLUSIONS

ePRO interventions improve HRQoL more than usual care in patients with cancer, with greater effect in those currently undergoing therapy. This improvement is independent of cancer type, duration of ePRO use or patient age. Future research should address sources of heterogeneity, explore long-term impacts and develop strategies to increase patient engagement and adherence to ePRO systems.

PROSPERO REGISTRATION NUMBER

CRD42024531708.

Patterns in Symptoms Preceding Acute Care in Patients With Cancer

Importance

Patients with cancer frequently experience unplanned acute care with emergency department visits and hospitalization due to disease or treatment complications, which impacts outcomes, quality of life, and health care costs. There remains a knowledge gap in understanding patterns of symptoms that precede acute care events. Natural language processing (NLP) may enable greater understanding of the symptoms and identify differences across patient and cancer characteristics.

Objective

To characterize symptoms preceding acute care in patients with cancer and quantify differences in symptom documentation across sociodemographic and cancer histologic subgroups.

Design, Setting, and Participants

A cohort study in a single tertiary-care institution, including all acute care (emergency department and hospitalization) encounters for patients aged 18 years or older with a primary cancer diagnosis identified between January 1, 2013, and December 31, 2023.

Main Outcomes and Measures

Natural language processing was used to identify routine clinical documentation to characterize symptoms documented in the 30 days preceding acute care. Logistic regression analyses was used to examine the possible association between sex, age, race and ethnicity, insurance coverage, cancer histologic characteristics, and reported symptoms.

Results

Overall, 28 708 patients with cancer had 70 606 acute care visits with 854 830 associated preceding documented symptoms. Median age was 61 (IQR, 48-70) years. Men (37 861 encounters [53.62%]) and patients of White race (39 989 encounters [56.64%]) accounted for most acute care encounters. Pain (7.54% of documented symptoms), nausea (6.74%), and vomiting (5.79%) were the most frequently documented symptoms. Acute care encounters with patients who were female (adjusted odds ratio [AOR], 1.14; 95% CI, 1.10-1.18; P < .001), Asian (AOR, 1.22; 1.17-1.28; P < .001), Black (AOR, 1.17; 95% CI, 1.10-1.25; P < .001), American Indian or Alaska Native (AOR, 1.21; 95% CI, 1.01-1.44; P = .04), or Medicaid-insured (AOR, 1.10; 95% CI, 1.05-1.14; P < .001) were associated with a high documented symptom burden (>10 unique symptoms) preceding acute care visits. Patients aged 65 years or older (AOR, 0.96; 95% CI, 0.92-1.00; P = .04) or uninsured (AOR, 0.58; 95% CI, 0.45-0.76; P < .001) were less likely to have a high symptom burden documented before acute care events.

Conclusions and Relevance

The findings of this study highlight common symptoms preceding acute care as well as the need for further research on interventions to reduce patient burden, improve quality of life, and reduce the use of acute care in patients with cancer.

Survival Endpoints: Patient-Reported Experience Measures and Patient-Reported Outcome Measures as Quality Indicators for Outcomes

Heterogeneity of cancer necessitates individualised cancer care as well as tailored survival endpoints-one size no longer fits all. In the past few years, apart from the standard clinical efficacy endpoints, patient reported outcomes have gathered a momentum as one among the quality indicators in the realm of practice changing oncology. These standardised and validated self-reporting instruments use a patients' viewpoint to assess the status of their health and their experience whilst receiving health care. This review explores the relevance of patient reported measures in the present clinical scenario and issues regarding its implementation amidst the barriers and challenges. These measures should be judiciously accounted as surrogate markers along with survival endpoints; for providing value based, highly comprehensive cancer care. New policy guidelines incorporating patient reported outcomes should be planned and formulated for future practice in oncology.

Effectiveness of Dyadic Interventions on Quality of Life for Cancer Patients and Family Caregivers: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

BACKGROUND

Increases in cancer survivorship negatively impact patients and family caregivers, decreasing quality of life. Previous dyadic interventions involved them as a unit and focused on their outcomes, but inconsistent results existed in influencing quality of life.

OBJECTIVES

To assess dyadic intervention effect on quality of life for cancer patients and family caregivers across different cancer types and intervention durations.

DESIGN

A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

METHODS

Six databases were searched from establishment until 14 January 2024. Two authors independently performed the search process, literature screening, and data extraction. The ROB version 2 and GRADE were respectively used to check the methodology and evidence quality. The data were analysed via RStudio, and intervention effects were estimated with 95% CIs and SMDs. The statistical heterogeneity was explored through the I2 statistic, P values, and Egger's test, and differences in overall effects were deemed statistically significant, having a P value < 0.05. Subgroup analysis was also conducted.

RESULTS

13 RCTs with 1625 participants, published from 2005 to 2021, were included. The results demonstrated that dyadic interventions enhanced quality of life for both cancer patients and family caregivers. Subgroup analysis suggested that family-centred interventions for patients with specific cancer types, which lasted for a long period (> 6 weeks), enhanced quality of life for cancer patients and family caregivers. The evidence and methodology were of a moderate quality.

CONCLUSIONS

Nurses are important practitioners of culture-oriented dyadic interventions. Long-term (> 6 weeks) and family-centred dyadic interventions for patients with a specific cancer type can enhance cancer patients' and family caregivers' quality of life, along with digital intelligence approaches to promote mutual communication and strengthen family relationships, thereby optimising oncology clinical nursing and enhancing the quality of life, health, and welfare of the entire family.

RELEVANCE TO CLINICAL PRACTICE

Dyadic interventions emphasising the involvement of both cancer patients and family caregivers should be considered and tailored by professionals and oncology nurses to establish harmonious family relationships, improve family coping techniques and decision-making to enhance the whole family's quality of life and well-being according to their cultural contexts, and promote more efficient, targeted, and economical oncology care.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution because all the involved participants were from existing studies, and the design, conduction, analysis, and interpretation of the data were completed by the authors in this article.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews: CRD42024519432; https://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Patient-reported outcome based symptom management is a better option for early postoperative recovery after breast cancer surgery: a parallel controlled randomized clinical trial

BACKGROUND

We aimed to assess the efficacy and feasibility of applying patient-reported outcome (PRO) based symptom management in the early postoperative period after breast cancer surgery.

MATERIALS AND METHODS

Before surgery, patients diagnosed with breast cancer who met the inclusion criteria were randomly assigned in a 1:1 ratio to receive either postoperative PRO-based symptom management or usual care. All patients completed the MD Anderson Symptom Inventory-Chinese version (MDASI-C) via the electronic PRO system preoperatively, on a daily basis postoperatively, and twice weekly after discharge, for a duration up to 2 weeks. In the PRO-based care group, in addition to receiving usual care, patients whose symptoms reported by completing MDASI-C with a score of ≥4 will be managed symptomatically by the attending surgeon. Patients in the usual care group received routine care and their MDASI-C scores were unknown to their attending surgeon. The primary outcome was the MDASI-C score of patients at the time of discharge. Analyses were conducted in accordance with the established protocol.

RESULTS

Of the 134 participants, 67 were randomly assigned to each group. At discharge, the total score of MDASI-C scale was significantly higher in the usual care group comapred to the PRO-based care group (median [interquartile range], 22 [19] vs. 35 [36]; P = 0.002). The score of FACT-B scale (adjusted mean difference, 0.39; 95% confidence interval, 0.11-1.06; P = 0.009) was significantly lower in the usual care group than in the PRO-based care group during the 14 days after surgery. In the PRO-based care group, 87.2% of patients found the PRO-based symptom management approach helpful in their early postoperative recovery.

CONCLUSION

The implementation of a PRO-based symptom management system within 2 weeks after breast cancer surgery effectively alleviates symptom burden and improves quality of life compared to usual care.

Impact of immigration background on feasibility of electronic patient-reported outcomes in advanced urothelial cancer patients

BACKGROUND

Electronic patient-reported outcomes (ePROs) have been shown to enhance healthcare quality by improving patient symptom management or quality of life (QoL). However, ePROs data for urothelial cancer (UC) patients receiving systemic therapies are scarce, and the application of ePROs in this patient cohort may need specific setups. This study tested the feasibility of ePROs for UC patients receiving systemic therapies in the outpatient clinic of a tertiary care center.

PATIENTS AND METHODS

From January 2022 to April 2023, 30 UC patients receiving systemic cancer therapies received ePROs based on the Common Terminology Criteria for Adverse Events (CTCAE) and European Organization for Research and Treatment of Cancer Core Quality of Life questionnaires (EORTC QLQ-30) to report their symptoms and QoL during systemic therapy, in total, 125 questions for every therapy cycle. The proportion of patients adherent to the ePROs was assessed to evaluate feasibility, with a preset threshold of 50%. At least half of all treatment cycles with a minimum of two consecutive ePROs (corresponding to two successive therapy cycles) had to be completed to be counted as adherent, and a maximum of six successive therapy cycles was followed by ePROs. Descriptive statistics were calculated for clinical and demographic patient characteristics. T-test and chi-square-test analyses were performed to study the association between ePROs adherence and clinical or demographic factors. The digital process was closely monitored for procedural impediments that could occur.

RESULTS

21 (70%) of the included 30 patients adhered to the provided ePROs, significantly higher than the predetermined threshold of 50%. Adherence remained above 70% until the end of the observation period. A significant negative effect of immigration background on ePROs compliance was observed (p = 0.006). No other variables were significantly associated with ePROs compliance.

CONCLUSIONS

In this study, ePROs were a feasible method to assess symptoms and QoL during the systemic cancer therapy of UC patients at our center. The compliance of patients with immigration backgrounds was the most significant barrier to using ePROs in this setting. However, the study is limited by the exclusion of patients without email access and the lack of assessment of physician compliance with the ePROs data, which may affect the generalizability and implementation of the findings.

Risk Prediction Models as an Emerging Trend for Managing Cancer-Related Fatigue: A Systematic Review

AIM

To systematically identify, describe and evaluate the existing risk prediction models for cancer-related fatigue.

DESIGN

Systematic review.

DATA SOURCES

Seven databases (EMBASE, Cochrane Database, MEDLINE, CINAHL, CNKI, SinoMed and Wanfang) were conducted from inception to August 14, 2023 and updated in September 15, 2024.

REVIEW METHODS

A systematic search was conducted to identify studies that reported the development of risk prediction models for cancer-related fatigue. Two researchers independently performed a comprehensive assessment of the included studies. The Prediction Model Risk of Bias Assessment Tool was used to assess the risk of bias and applicability.

RESULTS

Eighteen studies were included in this review. These models predicted cancer-related fatigue in various cancers, including breast cancer, prostate cancer, gynaecological tumours and lung cancer. The most commonly included predictors were anxiety and depression, age, chemotherapy status, sleep quality and pain. Thirteen studies assessed the model performance by using the receiver operating characteristic curve. Although most models exhibited good predictive performance, a higher risk of bias was observed because of inappropriate handling of missing data methods and an imbalance in events per variable.

CONCLUSION

Prediction models show promise for cancer-related fatigue management and precision care, but few are ready for clinical application due to methodological limitations.

IMPLICATIONS FOR THE PROFESSION

Future research should focus on improving the clinical utility of cancer-related fatigue models while balancing predictive accuracy with cost-effectiveness to promote equitable care.

IMPACT

This study critically systematically evaluated the prediction models of cancer-related fatigue. The existing prediction models have a weak methodological foundation, with only a few having the potential to be implemented in clinical practice.

REPORTING METHOD

The review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis in Systematic Reviews and Meta-Analyses checklist (TRIPOD-SRMA).

PUBLIC CONTRIBUTION

No patient or public contribution.

Qualitative Study of Health Care Team Perception of the Benefits and Limitations of Remote Symptom Monitoring

PURPOSE

Remote symptom monitoring (RSM) using electronic patient-reported outcomes (ePROS) connects patients and health care teams between appointments. Patient-perceived benefits and drawbacks of RSM are well-known, but health care team members' perceptions are less clear.

METHODS

Health care team members from the University of Alabama at Birmingham and the University of South Alabama Health Mitchell Cancer Institute participated in semi-structured qualitative interviews to explore their experiences and perspectives on RSM benefits and limitations. Interviews were audio-recorded, transcribed, and analyzed inductively using NVivo software to identify recurring themes and exemplary quotes.

RESULTS

Thirty oncology health care team members, including physicians (n = 9), nurse practitioners (n = 2), nurses (n = 8), nonclinical navigators (n = 7), and administrators (n = 4), were interviewed. Findings were organized into five major themes: three benefits (Proactive, Improved Patient-Health Care Team Relationship, and Patient Engagement and Symptom Reporting) and two limitations (Health Care Team-Perceived Limited Patient Buy-In or Awareness and Workload and Workflow Issues). Health care team members perceived that RSM improved their ability to support patients and the quality of care delivered to patients by promoting proactive management, strengthening the patient-health care team relationship, and engaging patients in symptom reporting. Despite positive perceptions, health care team members also voiced drawbacks of RSM related to the lack of patient buy-in or awareness and increased workload and disrupted workflow.

CONCLUSION

Although health care team members recognized the benefits of RSM as a standard of care, future work is necessary to address identified limitations to support wide-scale implementation of RSM in oncology practices.

Peripheral Neuropathy Instruments for Individuals with Cancer: A COSMIN-Based Systematic Review of Measurement Properties

Although the literature on patient-reported outcomes (PROMs) continues to expand, challenges persist in selecting reliable and valid instruments for assessing peripheral neuropathy (PN) in patients with cancer. This systematic review aimed to identify all validated self-report PN scales and critically appraise their measurement properties. This review was conducted using the COSMIN methodology for PROMs and the PRISMA statement. Five databases were searched from inception to August 2024, identifying 46 eligible studies and 16 PROMs. Evidence quality ranged from "very low" to "moderate", with notable inconsistencies in the content and structural validity phases of most instruments. Instruments such as the Chemotherapy-induced peripheral neuropathy assessment tool and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity demonstrated moderate quality and potential utility in clinical practice, while others, including the Location-based assessment of sensory symptoms in cancer and the Measure of Ovarian Symptoms and Treatment, had insufficient evidence to support their use. Importantly, all PROMs focused on chemotherapy-induced peripheral neuropathy, highlighting a significant gap in instruments addressing other PN causes, such as radiotherapy or tumor-related nerve damage. Further research should prioritize developing and validating instruments for distinct cancer populations, ensuring robust psychometric properties and clinical applicability.

Feasibility and usefulness of symptom monitoring with electronic patient-reported outcomes: an experience at single-center outpatient oncology clinic

PURPOSE

The benefit of patient-reported outcomes (PRO) in routine oncology practice is increasingly recognized. This study aimed to develop a team-based monitoring and intervention system using electronic PRO (ePRO) and to evaluate its impact at an outpatient oncology clinic.

METHODS

Patients receiving chemotherapy at our department were eligible for this study. Those who had access to a smartphone or tablet (Bring Your Own Device [BYOD]) and consented participated, and reported 28 symptoms weekly via 3H P-guardian downloaded on their BYOD. E-mail alerts were sent to attending healthcare providers when participants reported at least grade 3 severity for any of nine symptoms (decreased appetite, nausea, vomiting, diarrhea, shortness of breath, pain, insomnia, fatigue, and sadness), which prompted interventions. Comparisons of overall survival (OS), emergency room visits, and hospitalizations were conducted using propensity scores.

RESULTS

Among 203 patients who received chemotherapy from September 2021 to August 2023, 77 participated in ePRO monitoring. The overall response rate was 55% (1991 valid responses out of a total of 3597 expected time points), and the median individual response rate was 66% (range, 0-100%). Of 1991 valid responses, 250 (13%) prompted alerts, and most interventions were initiated by making telephone calls. OS and other clinical outcomes were better in ePRO participants compared with non-participants, but these outcomes did not differ significantly between the ePRO and pre-ePRO eras.

CONCLUSIONS

It was feasible to develop a multi-professional team-based monitoring and intervention system using ePRO at a single-center outpatient oncology clinic. Our results indicate that weekly monitoring of ePRO, along with corresponding interventions, may benefit patients receiving chemotherapy.

Effectiveness of ePRO-based symptom management for cancer patients: a systematic review and meta-analysis of randomized controlled studies

PURPOSE

To systematically synthesize the evidence on the effectiveness of electronic patient-reported outcome (ePRO)-based symptom management on readmission rate, quality of life, symptom burden, anxiety, depression, and mortality in adult cancer patients.

METHOD

A systematic review and meta-analysis were conducted according to the PRISMA guideline in PubMed, Web of Science, EMBASE, the Cochrane Library, CINAHL, and Scopus for studies of randomized controlled trials reporting ePRO-based symptom management from January 1st, 2018, to May 31st, 2023. Two reviewers independently assessed risk-of-bias using Cochrane Risk-of-Bias version 2 and extracted the data. Subgroup analysis was conducted to identify the source of heterogeneity. Sensitivity analysis was performed by using the leave-one-out method. The study protocol was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (DOI: https://doi.org/10.37766/inplasy2023.6.0010 ).

RESULTS

A total of 10 studies were included in our review, comprising a total of 5321 participants. The results showed ePRO-based symptom management can improve quality of life (QOL) (SMD = 4.42, 95% CI 0.14 to 8.69, P = 0.04) in cancer patients. No significant differences in the impact on the improvement of readmission rate (RR = 0.89, 95% CI 0.77 to 1.04, P = 0.15), symptom burden (SMD = 1.23, 95% CI - 1.34 to 3.79, P = 0.35), anxiety (SMD =  - 0.00, 95% CI - 0.34 to 0.34, P = 0.99), depression (SMD = 0.03, 95% CI - 0.17 to 0.24, P = 0.74), and mortality (RR = 0.59, 95% CI 0.19 to 1.83, P = 0.36) between the two groups. In the subgroup analysis, readmission rates more than 30 days were significantly lower in the intervention group compared to the control group (relative rate (RR) = 0.85, 95% CI 0.72 to 0.99, P = 0.03). Also, the intervention group's QOL significantly improved compared to the control group when assessed within 1 month after the intervention (SMD = 4.35, 95% CI 3.75 to 4.94, P < 0.00001). In the sensitivity analysis, it was found that the results for readmission rates and quality of life (QOL) were unstable, indicating that further research is needed in the future.

CONCLUSION

Cancer patients often have different symptoms. Symptom management in cancer patients is an emerging topic. However, due to the limited numbers of included studies, the long-term effect of ePRO-based symptom management still needed to be validated.

REGISTRATION DETAILS

inplasy (DOI: https://doi.org/10.37766/inplasy2023.6.0010 ).

The real experience of reporting electronic patient-reported outcomes in patients with inflammatory arthritis and factors influencing participation: a scoping review

Inflammatory arthritis can result in pain, stiffness, fatigue, and reduce quality of life. Frequent monitoring of disease activity is necessary for patients with inflammatory arthritis, and electronic patient-reported outcomes (ePROs) play a crucial role in this process. This study aimed to investigate the real experience of reporting ePROs in patients with inflammatory arthritis, as well as to identify factors influencing participation. The ultimate goal was to inform targeted strategies and develop interventions to enhance the utilization of ePROs in clinical settings. A scoping review was performed using PubMed, Web of science, Embase, and the Cochrane library from 2000 to the present and the literature search focused on the experience of reporting ePROs in inflammatory arthritis and the factors that influence participation. Screening articles based on inclusion and exclusion criteria. A total of 1478 studies were identified, out of which 26 were included in the review. The top experience of applications/platforms in patients was that they were easy to use and that the applications were clear, logical and intuitive. A summary of 18 potential influencing factors were identified and there was inconsistent evidence for five of these factors. The participation of reporting ePROs is influenced by various factors, and the experience is a crucial aspect in patients with inflammatory arthritis. Analyzing patients' experience and influencing factors provides a theoretical basis for future interventions to facilitate the clinical application of ePRO. However, further research is needed to fully understand the association between influencing factors and intervention outcomes.

Experiences of Patients With Cancer Using Electronic Symptom Management Systems: Qualitative Systematic Review and Meta-Synthesis

BACKGROUND

There are numerous symptoms related to cancer and its treatments that can affect the psychosomatic health and quality of life of patients with cancer. The use of electronic symptom management systems (ESMSs) can help patients with cancer monitor and manage their symptoms effectively, improving their health-related outcomes. However, patients' adhesion to ESMSs decreases over time, and little is known about their real experiences with them. Therefore, it is necessary to gain a deep understanding of patients' experiences with ESMSs.

OBJECTIVE

The purpose of this systematic review was to synthesize qualitative studies on the experiences of patients with cancer using ESMSs.

METHODS

A total of 12 electronic databases, including PubMed, Web of Science, Cochrane Library, EBSCOhost, Embase, PsycINFO, ProQuest, Scopus, Wanfang database, CNKI, CBM, and VIP, were searched to collect relevant studies from the earliest available record until January 2, 2024. Qualitative and mixed methods studies published in English or Chinese were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist) and the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) statement were used to improve transparency in reporting the synthesis of the qualitative research. The Critical Appraisal Skills Program (CASP) checklist was used to appraise the methodological quality of the included studies, and a meta-synthesis was conducted to interpret and synthesize the findings.

RESULTS

A total of 21 studies were included in the meta-synthesis. The experiences of patients with cancer using ESMSs were summarized into three major categories: (1) perceptions and attitudes toward ESMSs; (2) the value of ESMSs; and (3) barriers, requirements, and suggestions for ESMSs. Subsequently, 10 subcategories emerged from the 3 major categories. The meta-synthesis revealed that patients with cancer had both positive and negative experiences with ESMSs. In general, patients recognized the value of ESMSs in symptom assessment and management and were willing to use them, but they still encountered barriers and wanted them to be improved.

CONCLUSIONS

This systematic review provides implications for developing future ESMSs that improve health-related outcomes for patients with cancer. Future research should focus on strengthening electronic equipment and technical support for ESMSs, improving their functional contents and participation forms, and developing personalized applications tailored to the specific needs and characteristics of patients with cancer.

TRIAL REGISTRATION

PROSPERO CRD42023421730; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421730.

Perceptions of Telehealth Services Among Rural Lung Cancer Patients in China: A Qualitative Study Using the Technology Acceptance Model

OBJECTIVES

To describe the perceptions of telehealth services among lung cancer patients in rural areas of China, as well as to explore the potential of telemedicine to improve long-term health recovery at home for rural lung cancer patients.

METHODS

A qualitative descriptive study design was used in this study and we conducted semi-structured interviews with 14 rural Chinese lung cancer patients between December 2022 and March 2023. Interview content was analyzed using Nvivo software and a framework analysis was performed using the Technology Acceptance Model to identify meaningful themes.

RESULTS

Participants identified perceptual and technical factors related to perceived ease of use, benefits and drawbacks related to perceived usefulness, and facilitators and barriers related to intention to use. However, regional and disease features including literacy barriers, medical insurance condition, symptom burden, and rural cultural health seeking behavior conduct must be taken into account.

CONCLUSIONS

Lung cancer patients in rural China believe that telehealth services could be an alternative solution for addressing health and care needs, but various aspects, such as user interface design, cost-effectiveness, and technological anxiety, need to be optimized.

IMPLICATIONS FOR NURSING PRACTICE

More highly specialized nursing team, friendly telecare lung function modules, and media technology training courses should be developed for rural lung cancer patients to enhance the quality of their home care, meet their information needs and better control their disease progression.

Effect of Tele-exercise Interventions on Quality of Life in Cancer Patients: A Meta-analysis

PURPOSE

To evaluate the impacts of tele-exercise intervention with cancer patients' quality of life, taking into account the influence of the duration of tele-exercise intervention, type of intervention, and gender of cancer patients on quality of life.

METHODS

The PubMed (MEDLINE), Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and PsycINFO databases were searched from inception to August 21, 2023. The Cochrane Collaboration's risk of bias tool 2 was utilized to estimate the risk of bias, and the Grading of Recommendations, Assessment. For statistical analyses, R Studio was employed.

RESULTS

This meta-analysis contained eight trials. When compared to controls, tele-exercise interventions (SMD = 0.41, 95% CI: 0.12 to 0.70, p < .010; I2 = 54%, p = .030) have a positive influence on boosting the quality of life within cancer patients. Subgroup analyses demonstrated the greater effectiveness of tele-exercise in enhancing the quality of life of cancer patients when the duration was greater than or equal to 10 weeks. Furthermore, tele-exercise was found to have a stronger advantageous effect on quality of life among female cancer. In addition, among the types of interventions for tele-exercise, neither web-based nor telephone-based formats significantly enhanced quality of life among cancer patients.

CONCLUSION

Tele-exercise interventions are a cost-effective and feasible non-pharmacologic complementary way to promote cancer patients' quality of life. Additional large-sample, carefully designed randomized controlled trials are warranted to further validate the impact of tele-exercise concerning cancer patients' quality of life.

REGISTRATION NUMBER

CRD42023477147.

Patient-Reported Outcome Measures as an Intervention: A Comprehensive Overview of Systematic Reviews on the Effects of Feedback

OBJECTIVES

Patient-reported outcome measures (PROMs) have emerged as a promising approach to involve patients in their treatment process. Beyond serving as outcome measures, PROMs can be applied to provide feedback to healthcare providers and patients, thereby offering valuable insights that can improve health outcomes and care processes. This overview offers a comprehensive synthesis of the effects of PROM feedback, contributing to the evidence-based discussion on PROMs' potential to enhance patient care.

METHODS

Following Cochrane Collaboration recommendations, this overview included literature reviews across diverse treatment areas, investigating the impact of PROM feedback on patient health outcomes (including quality of life, symptoms, or survival) and care process outcomes (including communication, symptom identification, or clinical practice). The methodological quality of the evidence was assessed with a modified version of A Measurement Tool to Assess Systematic Reviews 2, and the potential overlap of primary studies was quantified. Results were narratively synthesized.

RESULTS

Forty reviews grouped into 4 categories of treatment areas were included. Overall, their methodological quality was low. The overall overlap of primary studies was 2.2%, reaching up to 15.7% within specific treatment areas. The results indicate that PROM feedback may enhance the quality-of-care processes, whereas its effects on patient health outcomes remained less conclusive.

CONCLUSIONS

PROM feedback positively influences the interaction between physicians and patients across the included treatment areas. Further research is needed to comprehend the trickle-down effects of PROM feedback and how to enhance its potential in yielding health benefits for patients.

Essential Components of an Electronic Patient-Reported Symptom Monitoring and Management System: A Randomized Clinical Trial

Importance

Multicomponent electronic patient-reported outcome cancer symptom management systems reduce symptom burden. Whether all components contribute to symptom reduction is unknown.

Objective

To deconstruct intervention components of the Symptom Care at Home (SCH) system, a digital symptom monitoring and management intervention that has demonstrated efficacy, to determine which component or combination of components results in the lowest symptom burden.

Design, Setting, and Participants

This randomized clinical trial included participants who were older than 18 years, had been diagnosed with cancer, had a life expectancy of 3 months or greater, were beginning a chemotherapy course planned for at least 3 cycles, spoke English, and had daily access and ability to use a telephone. Eligible participants were identified from the Huntsman Cancer Institute, University of Utah (Salt Lake City), and from Emory University Winship Cancer Institute, including Grady Memorial Hospital (Atlanta, Georgia), from August 7, 2017, to January 17, 2020. Patients receiving concurrent radiation therapy were excluded. Dates of analysis were from February 1, 2020, to December 22, 2023.

Interventions

Participants reported symptoms daily during a course of chemotherapy and received automated self-management coaching with an activity tracker without (group 1) and with (group 2) visualization, nurse practitioner (NP) follow-up for moderate-to-severe symptoms without (group 3) and with (group 4) decision support, or the complete SCH intervention (group 5).

Main Outcomes and Measures

The primary outcome, symptom burden, was assessed as the summed severity of 11 chemotherapy-related symptoms rated on a scale of 1 to 10 (with higher scores indicating greater severity), if present.

Results

The 757 participants (mean [SD] age, 59.2 [12.9] years) from 2 cancer centers were primarily female (61.2%). The most common cancer diagnoses were breast (132 [17.4%]), lung (107 [14.1%]), and colorectal (99 [13.1%]) cancers; 369 patients (48.7%) had metastatic disease. The complete SCH intervention including automated self-management coaching and NP follow-up with decision support (group 5) was superior in reducing symptom burden to either of the self-management coaching groups, as shown by the mean group differences in area under the curve (group 1, 1.86 [95% CI, 1.30-2.41] and group 2, 2.38 [95% CI, 1.84-2.92]; both P < .001), and to either of the NP follow-up groups (group 3, 0.57 [95% CI, 0.03-1.11]; P =.04; and group 4, 0.66 [95% CI, 0.14-1.19]; P = .014). Additionally, NP follow-up was superior to self-management coaching (group 1 vs group 3, 1.29 [95% CI, 0.72-1.86]; group 1 vs group 4, 1.20 [95% 12 CI, 0.64-1.76]; group 2 vs group 3, 1.81 [95% CI, 1.25-2.37]; and group 2 vs group 4, 1.72 [95% CI, 1.17-2.26]; all P < .001), but there was no difference between the 2 self-management coaching groups (-0.52 [95% CI, -1.09 to 0.05]; P = .07) or between the 2 NP groups (-0.10 [95% CI, -0.65 to 0.46]; P = .74).

Conclusions and Relevance

In this randomized clinical trial of adult participants undergoing chemotherapy treatment for cancer, the complete intervention, rather than any individual component of the SCH system, achieved the greatest symptom burden reduction. These findings suggest that a multicomponent digital approach to cancer symptom management may offer optimal symptom burden reduction.

Trial Registration

ClinicalTrials.gov Identifier: NCT02779725.

Examining the Effectiveness of Electronic Patient-Reported Outcomes in People With Cancer: Systematic Review and Meta-Analysis

BACKGROUND

Electronic patient-reported outcomes (ePROs) are commonly used in oncology clinical practice and have shown benefits for patients and health resource use.

OBJECTIVE

The aim of this study was to compare the isolated effect of administering ePROs to patients with cancer versus a control condition.

METHODS

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Randomized controlled trials evaluating ePRO interventions that aimed to improve health-related outcomes among patients with cancer were included. The primary outcome was health-related quality of life (HRQOL), and the secondary outcomes were symptoms, hospital admissions, unplanned visits, chemotherapy completion, survival, and satisfaction with care. The effect sizes of ePROs on health-related outcomes were analyzed as standardized mean differences (SMDs) with 95% CIs using a random effects model.

RESULTS

The search identified 10,965 papers, of which 19 (0.17%) from 15 studies were included. The meta-analysis showed an improvement in HRQOL at 3 months, measured by the Functional Assessment of Cancer Therapy–General (SMD 0.29, 95% CI 0.19 to 0.39), and at 6 months, assessed using various HRQOL measures (SMD 0.21, 95% CI 0.11 to 0.30). Of the 15 studies, 9 (60%) reported a positive signal on HRQOL, with two-thirds of the studies (n=6, 67%) including tailored patient advice and two-thirds (n=6, 67%) using clinician alert systems.

CONCLUSIONS

The meta-analysis showed an improvement in HRQOL at 6 months and in Functional Assessment of Cancer Therapy–General scores at 3 months for studies that included tailored advice and clinician alerts, suggesting that these elements may improve ePRO effectiveness. The findings will provide guidance for future use and help health care professionals choose the most suitable ePRO features for their patients.

TRIAL REGISTRATION

PROSPERO CRD42020175007; https://tinyurl.com/5cwmy3j6.

The Impact of Chronic Diseases on Mental Health: An Overview and Recommendations for Care Programs

PURPOSE OF REVIEW

The current achievement of medical advancement is noteworthy; however, the occurrence of chronic diseases is increasing day by day, with a significant percentage of affected people are suffering from a mental health crisis. This article aims to present a thorough yet brief review of methods that can be employed to build the emotional wellness of chronic patients.

RECENT FINDINGS

The mental health care strategies include resilience-building, coping skills training, professional counseling, and lifestyle adaptations. Additionally, the article highlights the efficacy of several modern interventions, such as mindfulness-based therapies, cognitive behavioral therapy, eye movement desensitization, and recovery from stress therapy. The global burden of chronic illness emphasizes the pressing need to mitigate mental health problems among chronic patients. By providing actionable insights, our study clears the path for targeted interventions and holistic approaches for chronic disease patients. Moreover, the article suggests to policymakers and clinicians the need for collaboration and multifaceted interventions.

Comparative efficacy of telehealth interventions on promoting cancer screening: A network meta-analysis of randomized controlled trials

BACKGROUND

Cancer screening is a pivotal method for reducing mortality from disease, but the screening coverage is still lower than expected. Telehealth interventions demonstrated significant benefits in cancer care, yet there is currently no consensus on their impact on facilitating cancer screening or on the most effective remote technology.

DESIGN

A network meta-analysis was conducted to detect the impact of telehealth interventions on cancer screening and to identify the most effective teletechnologies.

METHODS

Six English databases were searched from inception until July 2023 to yield relevant randomized controlled trials (RCTs). Two individual authors completed the literature selection, data extraction, and methodological evaluations using the Cochrane Risk of Bias tool. Traditional pairwise analysis and network meta-analysis were performed to identify the overall effects and compare different teletechnologies.

RESULTS

Thirty-four eligible RCTs involving 131,644 participants were enrolled. Overall, telehealth interventions showed statistically significant effects on the improvement of cancer screening. Subgroup analyses revealed that telehealth interventions were most effective for breast and cervical cancer screening, and rural populations also experienced benefits, but there was no improvement in screening for older adults. The network meta-analysis indicated that mobile applications, video plus telephone, and text message plus telephone were associated with more obvious improvements in screening than other teletechnologies.

CONCLUSION

Our study identified that telehealth interventions were effective for the completion of cancer screening and clarified the exact impact of telehealth on different cancer types, ages, and rural populations. Mobile applications, video plus telephone, and text message plus telephone are the three forms of teletechnologies most likely to improve cancer screening. More well-designed RCTs involving direct comparisons of different teletechnologies are needed in the future.

CLINICAL RELEVANCE

Telehealth interventions should be encouraged to facilitate cancer screening, and the selection of the optimal teletechnology based on the characteristics of the population is also necessary.

Efficacy of nonpharmacological interventions for severe radiation-induced oral mucositis among head and neck cancer patients: A network meta-analysis of randomised controlled trials

AIMS AND OBJECTIVES

To assess the effectiveness of different nonpharmacological treatments for severe radiation-induced oral mucositis in patients with head and neck cancer.

BACKGROUND

Radiation-induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation-induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear.

DESIGN

Systematic review and network meta-analysis based on the PRISMA-NMA guidelines.

METHODS

Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta-analysis was performed by R Studio. A network meta-analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation-induced oral mucositis in patients with head and neck cancer.

RESULTS

Fifty-two studies involving seven types of nonpharmacological interventions were enrolled. The network meta-analysis indicated that natural plant-based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation-induced oral mucositis. For reducing the incidence of severe oral mucositis-related pain, the pairwise meta-analysis showed that only natural plant-based therapies and health education interventions were effective.

CONCLUSIONS

Nonpharmacological interventions are effective in the management of severe radiation-induced oral mucositis among patients with head and neck cancer.

RELEVANCE TO CLINICAL PRACTICE

Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice.

TRIAL REGISTRATION DETAILS

CRD42023400745.

Mediating effect of social support between caregiver burden and quality of life among family caregivers of cancer patients in palliative care units

PURPOSE

To identify factors influencing the quality of life of family caregivers with terminal cancer in Chinese palliative wards and to test whether social support mediates the relationship between caregiver burden and caregiver quality of life.

METHODS

A cross-sectional study design was used. Sociodemographic data were collected and the Quality of Life Scale, the Caregiver Burden Scale, and the Social Support Rating Scale were administered to Chinese family caregivers from December 2021 to December 2022. The factors influencing quality of life and caregiver burden were examined using the Mann‒Whitney U test and the Kruskal‒Wallis H test. The mediating role of social support was assessed using the bootstrap method.

RESULTS

Family caregivers' quality of life in Chinese terminal cancer palliative units was related to caregivers' daily care time, the caregiver-patient relationship, and patient age. Caregiver quality of life was negatively associated with caregiver burden and positively associated with social support. In addition, social support mediated the relationship between caregiver burden and caregiver quality of life.

CONCLUSION

Social support mediated the impact of caregiver burden on caregiver quality of life. Family, society, and palliative care institutions should be integrated to take actions to reduce family caregiver burden, increase social support, and transfer the positive aspects of specific cultural contexts to the culture of palliative care in general to collaboratively cope with various problems related to end-stage cancer.

Symptom clusters and their impact on quality of life among Chinese patients with lung cancer: A cross-sectional study

PURPOSE

To investigate the symptom clusters of Chinese patients with lung cancer, and explore their impact on quality of life (QoL) and each of its functioning.

METHOD

A cross-sectional study was conducted between October 2022 and April 2023 among 219 lung cancer patients at a general hospital in Sichuan Province. Data were collected using a general information questionnaire, the MD Anderson Symptom Inventory, and the EORTC QLQ-C30. R within the RStudio platform was used to conduct descriptive statistics, exploratory factor analysis and multiple regression analysis.

RESULTS

Psychoneurological, respiratory, gastrointestinal and fatigue-related symptom clusters were identified, each of which was significantly negatively correlated with overall QoL, global health status/QoL and each functioning. The respiratory (β = -0.60, P = 0.02) and fatigue-related symptom cluster (β = -0.86, P = 0.02) were predictors of global health status/QoL; the fatigue-related symptom cluster predicted physical (β = -1.68, P < 0.01), role (β = -1.63, P < 0.01) and cognitive functioning (β = -1.45, P < 0.01); the psychoneurological symptom cluster was a predictor of patients' emotional functioning (β = -1.26, P < 0.01); and the psychoneurological (β = -0.81, P < 0.01) and gastrointestinal symptom cluster (β = -0.60, P = 0.05) predicted social functioning.

CONCLUSIONS

Respiratory and fatigue-related symptom clusters were strong predictors of global health status/QoL; fatigue-related, psychoneurological and gastrointestinal symptom clusters had a negative impact on patients' functioning. Nurse practitioners should pay more attention to monitoring respiratory and fatigue-related symptom clusters to identify high-risk populations in time, and tailored interventions based on symptom clusters are needed to synergistically reduce the symptom burden, thereby improving patients' QoL.

Association between BMI trajectories in late-middle age and subsequent dementia risk in older age: a 26-year population-based cohort study

BACKGROUND

The association between body mass index (BMI) and dementia risk differs depending on follow-up time and age at BMI measurement. The relationship between BMI trajectories in late-middle age (50-65 years old) and the risk of dementia in older age (> 65 years old) has not been revealed.

METHODS

In the present study, participants from the Health and Retirement Study were included. BMI trajectories were constructed by combining BMI trend and variation information. The association between BMI trajectories at the age of 50-65 years and dementia risk after the age of 65 years was investigated. Participants with European ancestry and information on polygenic scores for cognitive performance were pooled to examine whether genetic predisposition could modify the association.

RESULTS

A total of 10,847 participants were included in the main analyses. A declining BMI trend and high variation in late-middle age were associated with the highest subsequent dementia risk in older age compared with an ascending BMI trend and low variation (RR = 1.76, 95% CI = 1.45-2.13). Specifically, in stratified analyses on BMI trajectories and dementia risk based on each individual's mean BMI, the strongest association between a declining BMI trend with high variation and elevated dementia risk was observed in normal BMI group (RR = 2.66, 95% CI = 1.72-4.1). Similar associations were found when participants were stratified by their genetic performance for cognition function without interaction.

CONCLUSIONS

A declining BMI trend and high variation in late-middle age were associated with a higher risk of dementia. Early monitoring of these individuals is needed to prevent dementia in older individuals.