Weekly electronic symptom check-ins improve advanced cancer care

New results from an Alliance Foundation Trials (AFT) study reveal that a simple weekly electronic symptom check-in with care team, significantly improves the quality of life for individuals undergoing treatment for advanced cancer. The study found that the biggest improvements were seen among patient groups that have historically faced the greatest barriers to care, including Black patients and individuals with less formal education.

The findings, published in JCO Oncology Practice, show that using remote check-ins help bridge communication gaps between patients and their treatment teams, offering a powerful way to make cancer care more effective.

When novel technologies are developed, there is a risk that they might leave historically underserved groups behind, widening rather than reducing health disparities. Here, we see that the opposite seems to be happening. Rather than exacerbating disparities, implementation of remote symptom monitoring is bridging an important communication gap and improving healthcare access for underserved groups."

Victoria Blinder, MD, breast medical oncologist at Memorial Sloan Kettering Cancer Center and senior author of the study

While researchers already know that keeping a close eye on side effects helps cancer patients feel better and stay more active, this study looked at how different groups can benefit from remote symptom technology where patients can self-report issues to their treatment team in real-time.

AFT-39, the PRO-TECT (Patient Reported Outcomes To Enhance Cancer Treatment) trial, enrolled 1,191 adults with advanced cancer across 52 community oncology clinics in the United States. Half of the patients received their usual care, while the other half filled out a brief symptom survey every week from home. To ensure internet access wasn't a barrier, patients could choose to fill out their surveys online using a smartphone or computer, or over a standard telephone using an automated, voice-prompted system. If a patient reported severe or worsening side effects, an alert went directly to a nurse on their care team for intervention.

"By giving people a simple way to report health issues during cancer treatments, we were able to bypass common hurdles like communication gaps or clinician bias, sending patient concerns straight to the medical team for quick action, delaying emergency department visits and improving outcomes, said Allison M. Deal, MS, a Senior Biostatistician at the UNC Lineberger Comprehensive Cancer Center and a lead author of the study.

After three months, the group using the weekly check-ins showed major improvements in both overall symptom control and daily physical function compared to those receiving usual care. When looking at specific groups, the benefits were notable:

• By race: Both Black and White patients who used the system saw improvements in symptom control. However, the improvement among Black patients was larger, essentially erasing a baseline gap and bringing their symptom control on par with White patients by the third month. Black patients were also much more likely to report that the weekly surveys made them feel more in control of their own care and improved conversations with their care team.
• By education: Patients with a high school education or less experienced the single greatest boost in the study. They had higher rates of triggered alerts and went on to achieve improvements in both symptom control and physical function compared to similar patients receiving standard care. They also agreed that the weekly questions felt relevant to their daily lives.
• By age and sex: Women and younger patients (under age 65), two groups that traditionally report higher distress and more unpleasant side effects during cancer treatment, experienced substantial quality-of-life gains from the weekly check-ins compared to the standard care group.

The researchers say that widespread use of these routine symptom check-ins could be a gamechanger for lowering healthcare disparities and ensuring every cancer patient gets the responsive care they need. In addition, the tools were found to reduce or delay emergency department visits for patients, which are known to cause financial and emotional stress for patients and their families.

"Our results suggest that remote monitoring may provide underserved cancer patients with a new avenue to communicate concerns that might go underrecognized in routine practice," said Ethan Basch, MD, M.Sc., study chair of AFT-39 and the Richard M. Goldberg Distinguished Professor of Medicine at the University of North Carolina School of Medicine. "Broad implementation of these systems may represent an effective and highly practical strategy to advance health equity. Future studies should test technology with more general patient audiences."

In addition to the University of North Carolina, authors of the study included clinicians from the Alliance for Clinical Trials in Oncology, Duke University School of Medicine, HealthPartners/Park Nicollet, Johns Hopkins School of Medicine, Mayo Clinic, Michigan State University College of Nursing, Northwestern University Feinberg School of Medicine, Patient and Partners, and the University of Rochester Medical Center.