Donna L. Berry, Fangxin Hong, Barbara Halpenny, and Ann H. Partridge, Dana-Farber Cancer Institute; Donna L. Berry and Ann H. Partridge, Harvard Medical School, Boston, MA; Jesse R. Fann, Upendra Parvathaneni, Anthony L. Back, and Dagmar Amtmann, University of Washington Medical Center; Jesse R. Fann, Anthony L. Back, Dagmar Amtmann, and Rosemary Ford, Seattle Cancer Care Alliance; Seth Wolpin and William B. Lober, University of Washington, Seattle; and Nigel E. Bush, National Center for Telehealth and Technology, US Department of Defense, Joint Base Lewis-McChord, Tacoma, WA.
J Clin Oncol. 2014 Jan 20;32(3):199-205. doi: 10.1200/JCO.2013.48.6662. Epub 2013 Dec 16.
The purpose of this trial was to evaluate the effect of a Web-based, self-report assessment and educational intervention on symptom distress during cancer therapy.
A total of 752 ambulatory adult participants were randomly assigned to symptom/quality-of-life (SxQOL) screening at four time points (control) versus screening, targeted education, communication coaching, and the opportunity to track/graph SxQOL over time (intervention). A summary of the participant-reported data was delivered to clinicians at each time point in both groups. All participants used the assessment before a new therapeutic regimen, at 3 to 6 weeks and 6 to 8 weeks later, completing the final assessment at the end of therapy. Change in Symptom Distress Scale-15 (SDS-15) score from pretreatment to end of study was compared using analysis of covariance and regression analysis adjusting for selected variables.
We detected a significant difference between study groups in mean SDS-15 score change from baseline to end of study: 1.27 (standard deviation [SD], 6.7) in the control group (higher distress) versus -0.04 (SD, 5.8) in the intervention group (lower distress). SDS-15 score was reduced by an estimated 1.21 (95% CI, 0.23 to 2.20; P = .02) in the intervention group. Baseline SDS-15 score (P < .001) and clinical service (P = .01) were predictive. Multivariable analyses suggested an interaction between age and study group (P = .06); in subset analysis, the benefit of intervention was strongest in those age > 50 years (P = .002).
Web-based self-care support and communication coaching added to SxQOL screening reduced symptom distress in a multicenter sample of participants with various diagnoses during and after active cancer treatment. Participants age > 50 years, in particular, may have benefited from the intervention.
本试验旨在评估基于网络的自我报告评估和教育干预对癌症治疗期间症状困扰的影响。
共有 752 名门诊成年参与者被随机分配至四个时间点进行症状/生活质量（SxQOL）筛查（对照组）或筛查、针对性教育、沟通辅导以及随时间跟踪/绘制 SxQOL 的机会（干预组）。在两组的每个时间点，都向临床医生提供了参与者报告数据的摘要。所有参与者在开始新的治疗方案前、3 至 6 周和 6 至 8 周后以及治疗结束时使用该评估。使用协方差分析和回归分析调整选定变量后，比较从治疗前到研究结束时的症状困扰量表-15（SDS-15）评分变化。
我们发现在从基线到研究结束时，研究组之间 SDS-15 评分变化的平均值存在显著差异：对照组（较高的困扰）为 1.27（标准差[SD]，6.7），而干预组（较低的困扰）为-0.04（SD，5.8）。干预组 SDS-15 评分估计降低了 1.21（95%置信区间，0.23 至 2.20；P =.02）。基线 SDS-15 评分（P <.001）和临床服务（P =.01）是预测因素。多变量分析表明年龄和研究组之间存在交互作用（P =.06）；在亚组分析中，干预的益处在年龄>50 岁的患者中最强（P =.002）。
基于网络的自我护理支持和沟通辅导加上 SxQOL 筛查，减少了多种诊断的参与者在积极癌症治疗期间和之后的症状困扰。特别是年龄>50 岁的参与者可能从干预中受益。
