Nurse Practitioner–Delivered Automated Telephone Remote Monitoring System Provides Good Control of Unrelieved Chemotherapy-Induced Symptoms

An automated computer-based telephone remote monitoring system with a built-in follow-up component involving nurse practitioners (NPs) appears to be feasible and effective for managing cancer patients’ unrelieved symptoms following chemotherapy. A study presented at the 2012 Annual Meeting of the American Society of Clinical Oncology showed that use of this system during chemotherapy cut the number of days with severe symptoms by two-thirds and the number of moderate symptom days by half, at the same time increasing the number of asymptomatic days and mild symptom days.

“This is a case management system in which we monitor symptoms with our automated system and then automatically triage unrelieved symptoms to the nurse practitioner for follow-up. With the case management component, the nurse practitioner is able to see the data on symptom severity and distress and symptom trends over time, and then use the national symptom guidelines for further assessment and intervention,” explained Kathi Mooney, PhD, RN, College of Nursing and Huntsman Cancer Institute, University of Utah, Salt Lake City.

Prior to initiating chemotherapy, 335 patients were randomized to telephone care (TC; n = 173) or usual care (UC; n = 162). Regardless of randomization assignment, all patients called in to a remote system daily and reported the presence, severity, and distress (on a scale from 0 to 10) for 11 common chemotherapy-associated symptoms (ie, fatigue, pain, insomnia, nausea, depression, anxiety, impaired thinking, numbness, diarrhea, mucositis, and appearance).

Patients assigned to TC also received automated tailored symptom self-care messages and telephone calls from NPs for further treatment of their symptoms. The NP’s intervention was triggered by automated alerts about any unrelieved symptoms at moderate to severe levels.

Participants’ median age was around 56 years, and about 77% were female. About 45% had breast cancer, 16% had lung cancer, and 10% had ovarian cancer; 45% of participants had stage IV cancer.

Patients in the TC group experienced a significantly lower number of severe symptom days (mean, 3.16 vs 10.24, respectively; P <.001) and moderate symptom days (mean, 8.91 vs 19.06, respectively; P <.001) versus the UC group. The TC group also experienced significantly more asymptomatic days (mean, 66.06 vs 52.02, respectively; P = .015) and a somewhat higher number of mild symptom days (mean, 19.85 vs 13.75, respectively; P = .06) versus the UC group.

The incidence of each of the 11 common symptoms was significantly lower in the TC group (P <.001), with the exception of diarrhea. The study found that TC intervention significantly reduced alerting symptoms within 4 days of the NP telephone calls (P <.001).

Mooney and colleagues hope to present further information about the system and both patient and NP satisfaction with using it at an Oncology Nursing Society meeting in the fall of 2012. In a separate interview, she explained that the system was first tested with symptom alerts sent to oncologists and nurses, and that the study showed no difference between UC and TC, because the providers did not follow up. Results of this new study, however, suggest that if there is follow-up, patients experience fewer days of unrelieved symptoms.

Reference

Mooney KH, Beck SL, Wong B, Dunson WA Jr, Wujcik D. Outpatient chemotherapy supportive care: trial of an IT integrated, NP delivered system for unrelieved symptoms. Poster presented at: 48th Annual Meeting of the American Society of Clinical Oncology; June 1-5, 2012; Chicago, IL. Abstract 9137.