Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA.
Cancer. 2013 May 1;119(9):1744-51. doi: 10.1002/cncr.27939. Epub 2013 Jan 25.
In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non-small cell lung cancer (NSCLC).
In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint-patient symptom distress-was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale.
Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm. Significant differences were observed at 4 months (P = .031; Cohen d = .42) and at 6 months (P = .004; d = .61). Similar but marginally significant effects were observed at 2 months (P = .051; d = .39) and at 8 months (P = .061; d = .43). Exploratory analyses indicated that survival curves did not differ significantly between the arms (log-rank P = .172), although a survival difference in an exploratory subgroup analysis suggested an avenue for further study.
The current results indicated that an online support system may reduce patient symptom distress. The effect on survival bears further investigation.
本研究旨在考察在线支持系统（全面健康增强支持系统[CHESS]）与互联网在缓解非小细胞肺癌（NSCLC）患者躯体症状困扰方面的效果。
共有 285 对非专业照护者-患者随机分配，接受为期 25 个月的标准照护以及互联网使用和肺癌相关网站（互联网组）或 CHESS（CHESS 组）培训和使用培训。照护者同意使用 CHESS 或互联网，并每两个月完成一次调查；患者是否完成这些任务则是可选的。主要终点——患者症状困扰——通过照护者使用改良版埃德蒙顿症状评估量表报告来测量。
CHESS 组的照护者报告患者躯体症状困扰始终低于互联网组。在 4 个月（P =.031；Cohen d =.42）和 6 个月（P =.004；d =.61）时观察到显著差异。在 2 个月（P =.051；d =.39）和 8 个月（P =.061；d =.43）时观察到类似但略有统计学意义的差异。探索性分析表明，两组的生存曲线无显著差异（对数秩 P =.172），尽管探索性亚组分析中的生存差异提示进一步研究的方向。
目前的结果表明，在线支持系统可能减轻患者的症状困扰。其对生存的影响需要进一步研究。
