Massachusetts General Hospital, and.
Harvard Medical School, Boston, Massachusetts.
J Natl Compr Canc Netw. 2020 Feb;18(2):133-141. doi: 10.6004/jnccn.2019.7354.
Patients with cancer are increasingly prescribed oral therapies, bearing greater responsibility for self-management of treatment adherence and adverse events. We conducted a randomized trial to test the use of a smartphone mobile app to improve symptoms and adherence to oral cancer therapy.
From February 18, 2015, through December 31, 2016, 181 patients with diverse cancers who were prescribed oral therapy were randomized to receive either the smartphone mobile app or standard care. The mobile app included a medication plan with reminders, a symptom-reporting module, and patient education. Primary outcomes were adherence (per electronic pill caps), symptom burden (per MD Anderson Symptom Inventory), and quality of life (per the Functional Assessment of Cancer Therapy-General). Participants also completed self-report measures of medication adherence, anxiety and depression symptoms, social support, quality of care, and healthcare utilization. Linear regression was used to assess intervention effects on adherence and change in self-report outcomes from baseline to week 12, controlling for baseline scores and social support.
Study groups did not differ across any outcome measure, with an overall mean adherence of 78.81% (SD, 26.66%) per electronic pill caps. However, moderation analyses showed that intervention effects on the primary adherence measure varied by baseline self-reported adherence and anxiety symptoms. Specifically, adherence rates per electronic pill caps were higher in patients randomized to the mobile app versus standard care within the subsamples of patients who reported baseline adherence problems (mean difference, -22.30%; 95% CI, -42.82 to -1.78; P=.034) and elevated anxiety (mean difference, -16.08%; 95% CI, -31.74 to -0.41; P=.044).
Although the mobile app may not improve outcomes for all patients prescribed oral cancer therapy, the intervention may be beneficial for those with certain risk factors, such as difficulties with adherence or anxiety.
癌症患者越来越多地接受口服治疗，他们需要对治疗的依从性和不良反应的自我管理承担更大的责任。我们进行了一项随机试验，以测试使用智能手机移动应用程序来改善口服癌症治疗的症状和依从性。
从 2015 年 2 月 18 日至 2016 年 12 月 31 日，181 名接受口服治疗的不同癌症患者被随机分为接受智能手机移动应用程序或标准护理的组。移动应用程序包括带有提醒的药物计划、症状报告模块和患者教育。主要结局是依从性（通过电子药盒测量）、症状负担（通过 MD 安德森症状量表）和生活质量（通过癌症治疗功能评估-一般量表）。参与者还完成了关于药物依从性、焦虑和抑郁症状、社会支持、护理质量和医疗保健利用的自我报告测量。线性回归用于评估干预对依从性的影响以及从基线到第 12 周的自我报告结果的变化，控制基线得分和社会支持。
研究组在任何结果测量上均无差异，电子药盒测量的总体平均依从率为 78.81%（标准差，26.66%）。然而，调节分析表明，干预对主要依从性测量的影响因基线自我报告的依从性和焦虑症状而异。具体来说，在报告基线依从性问题（平均差异，-22.30%；95%CI，-42.82 至-1.78；P=.034）和焦虑升高（平均差异，-16.08%；95%CI，-31.74 至-0.41；P=.044）的患者亚组中，接受移动应用程序随机分组的患者的依从率高于接受标准护理的患者。
尽管移动应用程序可能不会改善所有接受口服癌症治疗的患者的结局，但对于那些存在依从性困难或焦虑等某些风险因素的患者，该干预可能是有益的。
