eCancer: A technological approach to symptom management from home to practice

DESCRIPTION (provided by applicant): Over 1,437,180 patients were diagnosed with cancer in 2008; over half were solid tumors. Cancer patients experience a number of life-altering symptoms during chemotherapy. Treatments have become more aggressive, are administered in outpatient settings, and in patients' homes. Despite pretreatment supportive care regimens for anemia, neutropenia, nausea and vomiting, levels of burden for such symptoms as pain, fatigue, shortness of breath and loss of appetite remain high. Patients who are experiencing high levels of symptom burden while undergoing treatment have lower physical functioning, lower social functioning, higher emotional distress and depression. This application explains how a technology based approach engages both patients and oncology providers to lower symptom burden during chemotherapy. This application proposes to enhance an automated telephone symptom monitoring system. In a recently completed randomized trial, this system proved to be effective in lowering cancer patients' reported symptom severity. When symptoms exceed pre-established severity thresholds patients are referred to written evidenced-based, behavioral self-management strategies designed to offer patients strategies to manage each symptom. Following each AVR call symptom reports are downloaded directly into the patient's electronic medical record. An EMR message alert is transmitted to the medical providers for any symptoms reported above pre-established thresholds so that follow up can occur. Addressing the symptoms with self care strategies enables the patients to have control of their lives and continue to participate in their usual daily activities which include their ability to maintain employment. This system complements conventional care available to patients, by offering specific strategies to manage symptoms at home while safeguarding patients who report symptom severity at thresholds above pre-established symptom thresholds. By combining patient self-reported symptoms and concerns with the on-going EMR providers are able to view a comprehensive picture of how the patient is doing. The proposed project has the potential to: 1) positively influence patients' self-care symptom management behaviors at home, 2) monitor patient's symptom status and identify potential urgent care issues which are then communicated to the busy oncology clinics for immediate medical intervention, 3) reduce the symptom burden for patients thus lowering visits to emergency departments and symptom related admissions to hospital and, thereby, lowering cost to the health care. Finally, this system can serve as an indicator of quality and pay for performance and is generalizable to managing symptom among patients with other chronic diseases. PUBLIC HEALTH RELEVANCE: The proposed project has the potential to: 1) positively influence patients' self-care symptom management behaviors at home, 2) monitor patients' symptom status and identify potential urgent care issues that are then communicated to the busy oncology clinics for immediate medical intervention, and 3) reduce the symptom burden for patients, thus lowering visits to emergency departments and symptom-related admissions to hospitals and, thereby, lowering cost to the health care system while improving the patients' quality of life.