A comprehensive digital health intervention, combining automated self-management coaching with clinician follow-up, has demonstrated superior efficacy in reducing symptom burden among cancer patients undergoing chemotherapy, according to a recent study published in JAMA Network Open. The randomized clinical trial, involving 757 participants across two US cancer centers, deconstructed the Symptom Care at Home (SCH) system to identify which components were most effective in alleviating the severity of 11 common chemotherapy-related symptoms.
The study, conducted between August 2017 and January 2020, assigned participants to one of five groups: automated self-management coaching with a blinded activity tracker (group 1), automated self-management coaching with a visible activity tracker (group 2), nurse practitioner (NP) follow-up for moderate-to-severe symptoms without decision support (group 3), NP follow-up with decision support (group 4), or the complete SCH intervention (group 5), which included both automated self-management coaching and NP follow-up with decision support.
The primary outcome was symptom burden, assessed as the summed severity of 11 chemotherapy-related symptoms rated on a scale of 1 to 10. The results indicated that the complete SCH intervention (group 5) was significantly more effective in reducing symptom burden compared to any of the individual component groups. Specifically, the mean group differences in area under the curve showed a significant reduction in symptom burden in group 5 compared to the self-management coaching groups (group 1, 1.86 [95% CI, 1.30-2.41] and group 2, 2.38 [95% CI, 1.84-2.92]; both P < .001) and the NP follow-up groups (group 3, 0.57 [95% CI, 0.03-1.11]; P = .04; and group 4, 0.66 [95% CI, 0.14-1.19]; P = .014).
Key Findings
"The complete SCH intervention including automated self-management coaching and NP follow-up with decision support (group 5) was superior in reducing symptom burden," the authors noted. This suggests that the synergy between patient self-management strategies and clinician support is crucial for optimal symptom control.
NP follow-up was also found to be superior to self-management coaching alone (group 1 vs group 3, 1.29 [95% CI, 0.72-1.86]; group 1 vs group 4, 1.20 [95% CI, 0.64-1.76]; group 2 vs group 3, 1.81 [95% CI, 1.25-2.37]; and group 2 vs group 4, 1.72 [95% CI, 1.17-2.26]; all P < .001). However, there was no significant difference between the two self-management coaching groups (-0.52 [95% CI, -1.09 to 0.05]; P = .07) or between the two NP groups (-0.10 [95% CI, -0.65 to 0.46]; P = .74).
Implications for Clinical Practice
The study highlights the importance of comprehensive, multicomponent interventions in managing cancer-related symptoms. While self-management coaching alone had the least impact on lowering symptom burden, it added value when combined with clinician follow-up for poorly controlled symptoms. The researchers suggest that digital tools can efficiently provide tailored approaches, improving symptom outcomes by involving the oncology team only when warranted.
Study Limitations
The authors acknowledge several limitations, including that 12.3% of consented patients never participated in the SCH intervention, and 25.8% discontinued study participation before treatment protocol completion. These issues of uptake and sustained participation are common with ePRO systems and warrant further study.
Conclusion
Despite these limitations, the study provides strong evidence for the effectiveness of multicomponent digital interventions in reducing symptom burden among cancer patients undergoing chemotherapy. By integrating daily symptom assessment with automated self-management coaching and clinician follow-up, the SCH system offers a promising approach to improving the quality of life for patients undergoing cancer treatment.
