R D Nipp1, A El-Jawahri2, M Ruddy2, C Fuh2, B Temel2, S M D'Arpino3, B J Cashavelly2, V A Jackson4, D P Ryan2, E P Hochberg2, J A Greer3, J S Temel2. 1. Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA. Electronic address: rnipp@mgh.harvard.edu. 2. Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA. 3. Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, USA. 4. Division of Palliative Care, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
Abstract
BACKGROUND:Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased health care utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer. PATIENTS AND METHODS: We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary end point of the study was feasibility. We defined the intervention as feasible if >75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine whether clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS). RESULTS: Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B = 0.12, P = 0.008), but no significant difference in the proportion of days with improved Edmonton Symptom Assessment System-physical symptoms (B = 0.07, P = 0.138). Intervention patients had lower readmission risk (hazard ratio = 0.68, P = 0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B = 0.16, P = 0.862). CONCLUSIONS: This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk.ClinicalTrials.gov identifier NCT02891993.
RCT Entities:
BACKGROUND: Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased health care utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer. PATIENTS AND METHODS: We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary end point of the study was feasibility. We defined the intervention as feasible if >75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine whether clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS). RESULTS: Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B = 0.12, P = 0.008), but no significant difference in the proportion of days with improved Edmonton Symptom Assessment System-physical symptoms (B = 0.07, P = 0.138). Intervention patients had lower readmission risk (hazard ratio = 0.68, P = 0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B = 0.16, P = 0.862). CONCLUSIONS: This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk.ClinicalTrials.gov identifier NCT02891993.
Authors: Massimo Di Maio; Ciro Gallo; Natasha B Leighl; Maria Carmela Piccirillo; Gennaro Daniele; Francesco Nuzzo; Cesare Gridelli; Vittorio Gebbia; Fortunato Ciardiello; Sabino De Placido; Anna Ceribelli; Adolfo G Favaretto; Andrea de Matteis; Ronald Feld; Charles Butts; Jane Bryce; Simona Signoriello; Alessandro Morabito; Gaetano Rocco; Francesco Perrone Journal: J Clin Oncol Date: 2015-01-26 Impact factor: 44.544
Authors: Daniel E Lage; Ryan D Nipp; Sara M D'Arpino; Samantha M Moran; P Connor Johnson; Risa L Wong; William F Pirl; Ephraim P Hochberg; Lara N Traeger; Vicki A Jackson; Barbara J Cashavelly; Holly S Martinson; Joseph A Greer; David P Ryan; Jennifer S Temel; Areej El-Jawahri Journal: J Clin Oncol Date: 2017-10-25 Impact factor: 44.544
Authors: F Strasser; D Blum; R von Moos; R Cathomas; K Ribi; S Aebi; D Betticher; S Hayoz; D Klingbiel; P Brauchli; M Haefner; S Mauri; S Kaasa; D Koeberle Journal: Ann Oncol Date: 2015-12-08 Impact factor: 32.976
Authors: Ethan Basch; Allison M Deal; Mark G Kris; Howard I Scher; Clifford A Hudis; Paul Sabbatini; Lauren Rogak; Antonia V Bennett; Amylou C Dueck; Thomas M Atkinson; Joanne F Chou; Dorothy Dulko; Laura Sit; Allison Barz; Paul Novotny; Michael Fruscione; Jeff A Sloan; Deborah Schrag Journal: J Clin Oncol Date: 2015-12-07 Impact factor: 44.544
Authors: Ashley Leak Bryant; Erin Coffman; Brett Phillips; Xianming Tan; Elizabeth Bullard; Rachel Hirschey; Joshua Bradley; Antonia V Bennett; Angela M Stover; Lixin Song; Thomas C Shea; William A Wood Journal: Support Care Cancer Date: 2019-06-20 Impact factor: 3.603
Authors: Chris Gibbons; Ian Porter; Daniela C Gonçalves-Bradley; Stanimir Stoilov; Ignacio Ricci-Cabello; Elena Tsangaris; Jaheeda Gangannagaripalli; Antoinette Davey; Elizabeth J Gibbons; Anna Kotzeva; Jonathan Evans; Philip J van der Wees; Evangelos Kontopantelis; Joanne Greenhalgh; Peter Bower; Jordi Alonso; Jose M Valderas Journal: Cochrane Database Syst Rev Date: 2021-10-12
Authors: R D Nipp; N K Horick; A M Deal; L J Rogak; C Fuh; J A Greer; A C Dueck; E Basch; J S Temel; A El-Jawahri Journal: Ann Oncol Date: 2020-01 Impact factor: 32.976
Authors: Lindsey A Herrel; Ziwei Zhu; Jennifer J Griggs; Deborah R Kaye; James M Dupree; Chandy S Ellimoottil; David C Miller Journal: JCO Oncol Pract Date: 2020-02-18
Authors: Evan Tang; Sumaya Dano; Nathaniel Edwards; Sara Macanovic; Heather Ford; Susan Bartlett; Doris Howell; Madeline Li; Marta Novak; Istvan Mucsi Journal: Qual Life Res Date: 2021-06-17 Impact factor: 4.147