Oncology nurses are frequently the clinicians most aware of their patients’ symptoms. During clinic visits, patients share how their side effects from treatment and symptoms of the cancer are improving or getting worse. More than just a symbol of a patient’s quality of life, these symptoms are key pieces of information that are used to determine the need for treatment adjustments, the efficacy of patient’s treatment regimen, and the presence of a cancer progression. If patients share this information, then oncology nurses and other providers can provide evidence-based symptom management support and make appropriate treatment decisions. But systematic assessment of symptoms is still not considered standard care, and identifying ways to proactively monitor patients’ symptoms is a priority.
Recently, a team of researchers completed a study assessing the feasibility and acceptability of daily symptom monitoring among a large, diverse groups of patients starting systemic anti-cancer therapy. The team, led by Annemarie Coolbrandt, RN, PhD from the Department of Oncology at the University Hospitals Leuven in Belgium, published their results in Cancer Nursing, indicating strong, consistent patient interest and compliance.
The remote symptom monitoring system was located on a secure website linked to patients’ medical records. The results were integrated into patient records. The system consisted of several features:
- A daily diary (questionnaire) asking for patients’ self-reported symptoms. The questionnaire displayed a basic set of symptoms, including pain, fatigue, vomiting, diarrhea, rash, etc. and could be adjusted based on patients’ treatment.
- An optional questionnaire asking for patients’ intake of oral anticancer medication therapy.
- Automated feedback based on patients’ identified symptoms, including symptom self-management advice. In addition to standard self-management strategies, the system linked to additional resources within the hospital.
- Safety alerts for any severe symptom (grade 3 or higher) urging patients to contact their healthcare provider to discuss their symptoms. This also sent an automatic alert to patients’ healthcare providers for immediate support.
One hundred eleven adult patients with lung cancer, multiple myeloma, nonmetastatic breast cancer, or gastrointestinal cancer starting their first systemic anti-cancer treatment were recruited and able to use the system on their smartphone.
Among the enrolled patients, 78% used the mobile version, and 20% preferred the web version. Of note, 36% of patients first presented with the option to be involved in this study preferred to complete daily symptom assessments using paper-and-pencil, which was currently being used in the practice.
Two thirds (62%) of patients completed the symptom monitoring diary almost daily, and a small minority (6%) used it sporadically. Most patients (57%) found the daily reminders to complete the diary helpful, and only 7% found the reminders disturbing. The automated feedback was less consistently used by patients: 42% reviewed the feedback almost every day whereas 51% only sporadically looked at the feedback.
Notably, only 50% of patients perceived that their symptom reports were viewed by their oncology nurses, and only 31% thought their doctors used the symptom reports.
Study Compliance and Adoption of Findings
Overall, patients agreed that the system was usable and useful. Compliance was high (69% completed every day) at the start of the study and only dropped to 59% at the end of 12 weeks. When considering if patients completed a symptom diary at all during a week, compliance rates jumped to 88% and only fell to 80% at 12 weeks. Completeness of patient entries was about 90%.
These results show the strong potential for cancer clinics to pivot to remote symptom monitoring and implement daily monitoring for patients starting treatment. For those patients who were interested in the remote symptom monitoring system, their use and compliance with the daily monitoring was high and led to delivery of evidence-based symptom management strategies and safety protocols.
This study also points to additional research needed to promote systematic assessment of symptoms. Almost half of the approached patients were not interested in this program, and the researchers recognize the need to further explore barriers to interventions that prevent uptake of these technology-based interventions and clinical care solutions. Low perceived engagement by nurses and doctors also warrants additional investigation to understand how clinicians use this information and what additional supports can be given to ensure such systems promote patient-provider communication about symptom assessment and management.
The advantages of a remote symptom monitoring systems include the ability for immediate assessments and identification of severe treatment toxicities, identification of trends, and delivery of evidence-based symptom management strategies. As mobile health technologies become a standard part of healthcare delivery, patient uptake of these mobile assessments will provide clinicians accurate, timely information to support their patients. Oncology nurses should continue to be a part of the development of these remote symptom monitoring systems to ensure patient and workflow feasibility and efficacy.