Rocque Gabrielle B, Halilova Karina I, Varley Allyson L, Williams Courtney P, Taylor Richard A, Masom David G, Wright William J, Partridge Edward E, Kvale Elizabeth A
Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Pain Symptom Manage. 2017 Jun;53(6):1071-1078. doi: 10.1016/j.jpainsymman.2016.12.345. Epub 2017 Feb 6.
Pain and fatigue are common symptoms among cancer patients and often lead to substantial distress. Innovative self-management programs for pain and fatigue are needed.
The primary objective was to assess the feasibility of a telehealth pain and fatigue self-management program among adult cancer patients. Secondary objectives included assessment of differences in patient characteristics, recruitment, and retention of patients based on two screening strategies: 1) navigator-collected, patient-reported pain or fatigue and 2) in-clinic, physician-identified pain or fatigue.
This prospective, nonrandomized, pre-post evaluation assessed feasibility, which was defined as 50% of eligible patients choosing to participate and completing the intervention. Patient demographics and patient-reported outcomes (patient activation, distress, symptoms, and quality of life) were collected at baseline and study completion. Differences in baseline characteristics were compared between cohorts and for patients who did vs. did not graduate from the program.
The program did not meet feasibility requirements because of only 34% of eligible patients choosing to participate. However, 50% of patients starting the program graduated. Differences in baseline characteristics and retention rates were noted by recruitment strategy. At baseline, 27.3% of navigated patients were at the highest activation level compared with 7.1% in the physician-referred, non-navigated patients (P = 0.17); more than 15% of non-completers were at the lowest activation level compared with 9% of completers (P = 0.85).
Telehealth self-management program for pain and fatigue may be better accepted among selected segments of cancer patients. Larger scale studies are needed to assess the efficacy of this program in a more selective activated population.
疼痛和疲劳是癌症患者常见的症状，常导致严重的痛苦。因此需要创新的疼痛和疲劳自我管理方案。
主要目的是评估远程医疗疼痛和疲劳自我管理方案在成年癌症患者中的可行性。次要目的包括基于两种筛查策略评估患者特征、招募情况和患者留存率的差异：1）由导航员收集、患者报告的疼痛或疲劳；2）在诊所由医生确定的疼痛或疲劳。
这项前瞻性、非随机、前后评估研究评估了可行性，可行性定义为50%的符合条件的患者选择参与并完成干预。在基线和研究结束时收集患者人口统计学数据和患者报告的结果（患者激活度、痛苦程度、症状和生活质量）。比较了不同队列之间以及完成和未完成该方案的患者的基线特征差异。
该方案未达到可行性要求，因为只有34%的符合条件的患者选择参与。然而，开始该方案的患者中有50%完成了方案。根据招募策略，注意到基线特征和留存率存在差异。在基线时，由导航员协助的患者中有27.3%处于最高激活水平，而医生推荐的非导航患者中这一比例为7.1%（P = 0.17）；超过15%的未完成者处于最低激活水平，而完成者中这一比例为9%（P = 0.85）。
针对疼痛和疲劳的远程医疗自我管理方案可能在部分癌症患者中更易被接受。需要进行更大规模的研究，以评估该方案在更具选择性的活跃人群中的疗效。
