Dana-Farber Cancer Institute, Boston, MA, USA.
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
J Natl Cancer Inst. 2024 Jul 1;116(7):1137-1144. doi: 10.1093/jnci/djae049.
Optimal methods for deploying electronic patient-reported outcomes to manage symptoms in routine oncologic practice remain uncertain. The electronic symptom management (eSyM) program asks chemotherapy and surgery patients to self-report 12 common symptoms regularly. Feedback from nurses and patients led to changing the recall period from the past 7 days to the past 24 hours.
Using questionnaires submitted during the 16 weeks surrounding the recall period change, we assessed the likelihood of reporting severe or moderate and severe symptoms across 12 common symptoms and separately for the 5 most prevalent symptoms. Interrupted time-series analyses modeled the effects of the change using generalized linear mixed-effects models. Surgery and chemotherapy cohorts were analyzed separately. Study-wide effects were estimated using a meta-analysis method.
In total, 1692 patients from 6 institutions submitted 7823 eSyM assessments during the 16 weeks surrounding the recall period change. Shortening the recall period was associated with lower odds of severe symptom reporting in the surgery cohort (odds ratio = 0.65, 95% confidence interval = 0.46 to 0.93; P = .02) and lower odds of moderate and severe symptom reporting in the chemotherapy cohort (odds ratio = 0.83, 95% confidence interval = 0.71 to 0.97; P = .02). Among the most prevalent symptoms, 24-hour recall was associated with a lower rate of reporting postoperative constipation but no differences in reporting rates for other symptoms.
A shorter recall period was associated with a reduction in the proportion of patients reporting moderate-severe symptoms. The optimal recall period may vary depending on whether electronic patient-reported outcomes are collected for active symptom management, as a clinical trial endpoint, or another purpose. ClinicalTrials.gov ID NCT03850912.
在常规肿瘤学实践中，优化电子患者报告结局的使用方法以管理症状仍不确定。电子症状管理（eSyM）项目要求化疗和手术患者定期自我报告 12 种常见症状。护士和患者的反馈导致将回顾期从过去 7 天更改为过去 24 小时。
使用在回顾期改变前后的 16 周内提交的问卷，我们评估了在 12 种常见症状和 5 种最常见症状中报告严重或中度和严重症状的可能性。使用广义线性混合效应模型对中断时间序列分析模型进行了分析。分别分析手术和化疗队列。使用荟萃分析方法估计了整个研究的影响。
在回顾期改变前后的 16 周内，来自 6 个机构的 1692 名患者提交了 7823 份 eSyM 评估。缩短回顾期与手术队列中严重症状报告的可能性降低相关（比值比=0.65，95%置信区间=0.46 至 0.93；P=0.02），与化疗队列中中度和严重症状报告的可能性降低相关（比值比=0.83，95%置信区间=0.71 至 0.97；P=0.02）。在最常见的症状中，24 小时回顾与术后便秘报告率降低相关，但其他症状的报告率无差异。
较短的回顾期与报告中度至重度症状的患者比例降低相关。电子患者报告结局的最佳回顾期可能因是否用于主动症状管理、临床试验终点或其他目的而有所不同。ClinicalTrials.gov 编号 NCT03850912。
