A provocative study at the 2017 American Society of Clinical Oncology (ACSO) Annual Meeting reported that metastatic cancer patients who self-reported their symptoms to their doctors on a weekly basis lived 5.2 months longer on average, likely due to more proactive symptom management.
Dr. Ethan Basch, a medical oncologist at The University of North Carolina at Chapel Hill, conducted a clinical trial in which 766 metastatic cancer patients undergoing routine chemotherapy were randomized to either standard symptom monitoring or a self-reporting intervention, in which weekly text and email reminders directed patients to a website where they could report on 12 common symptoms. Clinical nurses were alerted by the system if a patient reported severe or worsening symptoms, and would immediately follow-up with the patient. The system also produced reports for doctors to guide symptom discussions during doctor visits.
In addition to increasing median overall survival by over 5 months, the study found that 31% more patients who self-reported symptoms experienced a quality of life benefit, with 15% more reporting improved quality of life and 16% fewer reporting worsened quality of life. Also, 7% fewer patients who self-reported symptoms ended up visiting the emergency room.
Symptom management is a critical part of cancer care, as keeping patients feeling better, more functional, and more self-sufficient, not only increases quality of life, but also extends it. However, doctors are typically unaware of up to half of patients’ symptoms, leading to delays in symptom management until after symptoms have gotten worse or caused further complications. This study found that weekly self-reporting enabled doctors to more proactively manage patient symptoms and keep patients more functional, which was likely the largest factor contributing to the life-extending effects of this intervention. Patients who self-reported symptoms were also able to stay on chemotherapy for ~2 months longer, which likely improved cancer control and contributed to survival and quality of life benefits.
“[A] lit match analogy is very similar to our patients’ experience with symptoms. Their symptoms are like little matches, and if we can intervene early, we can put them out before a fire starts,” said Dr. Monika Krzyzanowska, of the Princess Margaret Cancer Center, who discussed Basch’s study at ASCO. Dr. Krzyzanowska pointed out that patient self-reporting of symptoms extended life longer than five of the six FDA approvals for metastatic cancer in 2016 that reported effects on patient survival.
“This approach should be considered for inclusion as a part of standard symptom management, as a component of high-quality cancer care,” said Basch during his presentation at ASCO.
A national trial to further explore these results is underway. Results from the trial have also been published in the Journal of the American Medical Association.