Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial.

Cleeland CS, Wang XS, Shi Q, Mendoza TR, Wright SL, Berry MD, Malveaux D, Shah PK, Gning I, Hofstetter WL, Putnam JB, Vaporciyan AA
J Clin Oncol. 2011 29 (8): 994-1000

PMID: 21282546 · PMCID: PMC3068055 · DOI:10.1200/JCO.2010.29.8315

PURPOSE - Patients receiving cancer-related thoracotomy are highly symptomatic in the first weeks after surgery. This study examined whether at-home symptom monitoring plus feedback to clinicians about severe symptoms contributes to more effective postoperative symptom control.

PATIENTS AND METHODS - We enrolled 100 patients receiving thoracotomy for lung cancer or lung metastasis in a two-arm randomized controlled trial; 79 patients completed the study. After hospital discharge, patients rated symptoms twice weekly for 4 weeks via automated telephone calls. For intervention group patients, an e-mail alert was forwarded to the patient's clinical team for response if any of a subset of symptoms (pain, disturbed sleep, distress, shortness of breath, or constipation) reached a predetermined severity threshold. No alerts were generated for controls. Group differences in symptom threshold events were examined by generalized estimating equation modeling.

RESULTS - The intervention group experienced greater reduction in symptom threshold events than did controls (19% v 8%, respectively) and a more rapid decline in symptom threshold events. The difference in average reduction in symptom interference between groups was -0.36 (SE, 0.078; P = .02). Clinicians responded to 84% of e-mail alerts. Both groups reported equally high satisfaction with the automated system and with postoperative symptom control.

CONCLUSION - Frequent symptom monitoring with alerts to clinicians when symptoms became moderate or severe reduced symptom severity during the 4 weeks after thoracic surgery. Methods of automated symptom monitoring and triage may improve symptom control after major cancer surgery. These results should be confirmed in a larger study.

MeSH Terms (24)

Aged Decision Support Systems, Clinical Dyspnea Electronic Mail Female Humans Lung Neoplasms Male Middle Aged Pain, Postoperative Patient Discharge Postoperative Care Postoperative Complications Reminder Systems Self Report Severity of Illness Index Sleep Wake Disorders Surveys and Questionnaires Telemedicine Telephone Texas Thoracotomy Time Factors Treatment Outcome

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