Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Support Care Cancer. 2022 Sep;30(9):7119-7132. doi: 10.1007/s00520-022-07052-z. Epub 2022 Apr 14.
Patients receiving cancer treatments experience many treatment-related symptoms. Telehealth is increasingly being used to support symptom management. The overall aim was to determine the effectiveness of nurse-led telehealth symptom management interventions for patients with cancer receiving systemic or radiation therapy compared to usual care on health service use, quality of life, and symptom severity.
A systematic review was conducted following the Cochrane Handbook and PRISMA reporting guidelines. Five electronic databases were searched. Two independent reviewers screened articles and extracted data. Meta-analysis was performed if data were clinically and methodologically homogeneous. Subanalysis was conducted on reactive and scheduled telehealth interventions.
Of 7749 citations screened, 10 studies were included (8 randomized control trials, 2 quasi-experimental). Five were reactive telehealth interventions with patient-initiated contact and five evaluated scheduled telehealth interventions initiated by nurses. Compared to usual care (typically patient-initiated calls), nurse-led telehealth interventions for symptom management showed no statistically significant difference in hospitalizations, emergency department visits, or unscheduled clinic visits. Two of three studies of reactive telehealth interventions showed improved quality of life. All telehealth interventions showed reduction in the severity of most symptoms. Pain severity was significantly reduced (standard mean difference - 0.54; 95% CI - 0.88, - 0.19). Significant heterogeneity prevented meta-analysis for most outcomes.
Few studies evaluated nurse-led telehealth interventions for cancer symptom management. Compared to usual care, patients exposed to telehealth interventions had reduced symptom severity and no difference in health services use. Future research should focus on better reporting intervention characteristics and consistently measuring outcomes.
接受癌症治疗的患者会经历许多与治疗相关的症状。远程医疗越来越多地被用于支持症状管理。总体目标是确定与常规护理相比，护士主导的远程医疗症状管理干预措施对接受系统或放射治疗的癌症患者在卫生服务利用、生活质量和症状严重程度方面的有效性。
按照 Cochrane 手册和 PRISMA 报告指南进行系统评价。检索了五个电子数据库。两名独立审查员筛选文章并提取数据。如果数据在临床和方法上具有同质性，则进行荟萃分析。对反应性和计划的远程医疗干预进行了亚分析。
在筛选出的 7749 条引文中，有 10 项研究被纳入（8 项随机对照试验，2 项准实验）。其中 5 项为反应性远程医疗干预措施，患者发起联系，另外 5 项评估了由护士发起的计划性远程医疗干预措施。与常规护理（通常是患者发起的电话）相比，护士主导的远程医疗干预措施在住院、急诊就诊或非计划性门诊就诊方面没有统计学上的显著差异。三项反应性远程医疗干预研究中的两项显示生活质量有所改善。所有远程医疗干预措施均显示大多数症状严重程度减轻。疼痛严重程度显著降低（标准均数差 -0.54；95%置信区间 -0.88，-0.19）。由于存在显著的异质性，大多数结局无法进行荟萃分析。
很少有研究评估过护士主导的远程医疗干预措施对癌症症状管理的效果。与常规护理相比，接受远程医疗干预的患者症状严重程度减轻，但在卫生服务利用方面没有差异。未来的研究应侧重于更好地报告干预措施的特征，并始终如一地测量结果。
