Pilot Randomized Trial of an Electronic Symptom Monitoring Intervention for Hospitalized Patients with Cancer.

Background: Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased healthcare utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer.

Patients and Methods: We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary endpoint of the study was feasibility. We defined the intervention as feasible if > 75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine if clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS).

Results: Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B=0.12, P=0.008), but no significant difference in the proportion of days with improved ESAS-physical symptoms (B=0.07, P=0.138). Intervention patients had lower readmission risk (hazard ratio=0.68, P=0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B=0.16, P=0.862).

Conclusions: This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk. ClinicalTrials.gov identifier NCT02891993.