Previous research has found that clinicians believe symptom management is important, but also shows that they are often unaware of patients'symptoms. Computer applications to help medical oncologists address chemotherapy patients'symptoms and quality of life have been shown to improve communication, mental health outcomes, and quality of life, but similar systems have not been developed for radiotherapy patients. We hypothesize that providing patient-specific symptom information to radiation oncologists and patients at the point of care will improve doctor-patient communication about symptoms and lead to reduced symptom burden.
The specific aims for this study are to: 1) Develop a user-friendly computer application that will acquire symptom ratings from patients and generate printed summaries of symptom intensity and symptom trends for radiation oncologists and radiotherapy patients to use in their office visit. 2) Test the computer application in small randomized controlled trial to determine its feasibility, validity, and user-perceived usefulness. To achieve these aims, we will adapt a computer application we designed for medical oncologists and patients undergoing chemotherapy for radiation oncologists and patients undergoing radiotherapy. Prior to use in a clinical trial, the computer application and printed symptom summaries will undergo extensive user testing to ensure that patients can use the system efficiently and reliably and that the symptom summaries are easily interpreted and contain the necessary information. Next, the computer application will be pilot tested in a randomized controlled trial involving 100 patients beginning a new course of radiotherapy for cancer. Patients in the control arm will use the computer-based system to self-report symptoms using validated instruments (the Memorial symptom assessment scale and 0-10 Numeric Rating Scales). Patients in the intervention arm will provide data, but will also receive a printed symptom summary that displays their current symptoms and linear symptom trends over time. The main outcome to test our hypothesis will be the MSAS Global Distress Index, which summarizes subjects'scores for 10 common symptoms as a measure of overall symptom burden. In addition to testing this hypothesis we will also generate effect size estimates and other feasibility and validation data that will be used to design a fully powered randomized controlled trial. Secondarily, we will examine the intervention's effect on doctor-patient communication by analyzing tape recorded office visits and physician prescribing for symptom management.
Symptoms are a major problem across all phases of the cancer experience. Most people living with cancer eventually experience significant symptoms such as pain, nausea, dyspnea, fatigue, insomnia, anxiety, depression, constipation, and anorexia. Despite the presence of effective therapies for many of these symptoms, there is considerable room for improvement in cancer symptom control. The research proposed here uses computer technology to help radiation oncologists better manage symptoms and improve patients'quality of life.
|Fromme, Erik K; Holliday, Emma B; Nail, Lillian M et al. (2016) Computerized patient-reported symptom assessment in radiotherapy: a pilot randomized, controlled trial. Support Care Cancer 24:1897-906|