An IT-integrated, computer-based telephone system for monitoring patient-reported symptoms: Result of two trials

2 Background: An automated remote monitoring system of patient reported symptoms was tested in two separate trials to determine if it improved unrelieved symptoms after outpatient chemotherapy. Methods: In Study 1,250 patients and Study 2,335 patients beginning a chemotherapy course were randomized to Telephone Care (TC) (n 129/174) or usual care (UC) (n 121/162). All called daily reporting presence, severity, and distress (0-10 scale) for 11 common symptoms. Those in the Study 1 TC group had reports of moderate to severe symptoms emailed to their oncologist and oncology nurse. Those in Study 2 TC group had similar moderate to severe symptom reports sent to a study Nurse Practitioner (NP) who responded by telephone utilizing evidence based guidelines to intensify symptom care. These patients also received automated tailored self-care messages based on their specific symptoms. Results: The majority of participants in both studies were white (91%; 84%) and female (76%; 77%). The mean age was 56 years, with breast cancer most common (40%; 45%). Mean study days were 45 (Study 1) and 73 (Study 2) with 66% and 87% call completion days respectively. Fatigue, pain, poor sleep, nausea and depressed mood were reported as moderate to severe by over 50% of patients in both studies. In Study 1 no difference was found in symptom severity between TC and UC. Oncology providers found the TC symptom alerts useful but rarely initiated symptom care intensification. In Study 2 the TC group mean symptom score was significantly lower than UC, p < .001. Poisson regression showed TC had fewer Severe symptom days than UC (est. means and SE) 3.16 (0.44) vs. 10.24 (1.84), p < .001; and fewer Moderate days 8.91 (1.04) vs. 19.06 (2.22), p < .001. TC had somewhat higher Mild days 19.85 (2.81) vs. 13.75 (1.85), p = .06; and more no symptom days 66.06 (3.82) vs 52.02 (4.15), p = .01. Conclusions: Remote monitoring of patient reported symptoms after chemotherapy is effective in identifying unrelieved symptoms. It can be used to track quality improvement as well as augment symptom care. Follow up to intensify symptom treatment utilizing guidelines is necessary to achieve significant reductions in symptom severity, distress and days of moderate or severe symptoms.