Department of Medicine, University Health Network, Toronto, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
J Geriatr Oncol. 2023 Apr;14(3):101469. doi: 10.1016/j.jgo.2023.101469. Epub 2023 Mar 12.
Emerging data support multiple benefits of remote symptom monitoring (RSM) during chemotherapy to improve outcomes. However, these studies have not focused on older adults and do not include treatments beyond chemotherapy. Although chemotherapy, androgen receptor axis-targeted therapies (ARATs), and radium-223 prolong survival, toxicities are substantial and increased in older adults with metastatic prostate cancer (mPC). We aimed to assess RSM feasibility among older adults receiving life-prolonging mPC treatments.
Older adults aged 65+ starting chemotherapy, an ARAT, or radium-223 for mPC were enrolled in a multicentre prospective cohort study. As part of the RSM package, participants completed the Edmonton Symptom Assessment Scale (ESAS) daily and detailed questionnaires assessing mood, anxiety, fatigue, insomnia, and pain weekly online or by phone throughout one treatment cycle (3-4 weeks). Alerts were sent to the clinical oncology team for severe symptoms (ESAS ≥7). Participants also completed an end of study questionnaire that assessed study burden and satisfaction. Descriptive statistics were used to determine recruitment and retention rates, participant response rates to daily and weekly questionnaires, clinician responses to alerts, and participant satisfaction rates. An inductive descriptive approach was used to categorize open-ended responses about study benefits, challenges, and recommendations into relevant themes.
Ninety males were included (mean age 77 years, 48% ARAT, 38% chemotherapy, and 14% radium-223). Approximately 38% of patients preferred phone-based RSM. Patients provided RSM responses in 1216 out of 1311 daily questionnaires (93%). Over 93% of participants were satisfied (36%), very satisfied (43%), or extremely satisfied (16%) with RSM, although daily reporting was reported by several (8%) as burdensome. Nearly 45% of patients reported severe symptoms during RSM. Most symptom alerts sent to the oncology care team were acknowledged (97%) and 53% led to follow-ups with a nurse or physician for additional care.
RSM is feasible and acceptable to older adults with mPC, but accommodation needs to be made for phone-based RSM. The optimal frequency and duration of RSM also needs to be established.
新出现的数据支持在化疗期间进行远程症状监测（RSM）以改善预后，这具有多种益处。然而，这些研究并未关注老年人，也未包括化疗以外的治疗方法。尽管化疗、雄激素受体轴靶向治疗（ARAT）和镭-223 可延长生存时间，但毒性在转移性前列腺癌（mPC）的老年患者中是实质性的且增加。我们旨在评估接受延长生命的 mPC 治疗的老年患者进行 RSM 的可行性。
开始接受化疗、ARAT 或镭-223 治疗 mPC 的 65 岁以上老年人被纳入一项多中心前瞻性队列研究。作为 RSM 包的一部分，参与者在一个治疗周期（3-4 周）内每天完成埃德蒙顿症状评估量表（ESAS），每周在线或通过电话完成详细问卷，评估情绪、焦虑、疲劳、失眠和疼痛。当出现严重症状（ESAS≥7）时，向临床肿瘤学团队发出警报。参与者还在研究结束时完成了一份问卷，评估研究负担和满意度。使用描述性统计来确定招募和保留率、参与者对每日和每周问卷的回复率、临床医生对警报的反应以及参与者的满意度。采用归纳描述性方法将关于研究益处、挑战和建议的开放式回答分为相关主题。
90 名男性被纳入（平均年龄 77 岁，48%接受 ARAT，38%接受化疗，14%接受镭-223）。大约 38%的患者更喜欢基于电话的 RSM。患者在 1311 份每日问卷中提供了 1216 份 RSM 回复（93%）。尽管有几位患者（8%）认为每天报告有负担，但超过 93%的参与者对 RSM 表示满意（36%）、非常满意（43%）或极其满意（16%），尽管如此。在 RSM 期间，近 45%的患者报告出现严重症状。发送给肿瘤学护理团队的大多数症状警报都得到了确认（97%），其中 53%导致与护士或医生进行随访以获得额外的护理。
RSM 对 mPC 的老年患者是可行且可接受的，但需要为基于电话的 RSM 做出调整。还需要确定 RSM 的最佳频率和持续时间。
