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Senior Citizen and Internet
Internet Proves to be Valuable Aide to Better Cancer
Therapy
Cancer therapies can be highly toxic, early
detection of symptoms and timely treatment is vital
 Nov. 30, 2007 – The cultural changes created by the
Internet has now reached cancer care – cancer patients, even the sickest
patients, are willing to “self-report” symptoms over the Internet to
supply key data in real time to their healthcare providers. Senior
citizens who have avoided becoming familiar with computers and the
Internet may want to rethink that decision.
Seniors and other cancer patients can wait for the
scheduled doctor’s visit to explain all the symptoms and side effects of
their treatment, just as they have always done. However, potentially
serious consequences could arise if important symptoms go unreported
during those visits because they occur between appointments.
A new study by researchers at Memorial
Sloan-Kettering Cancer Center (MSKCC) finds that even the sickest cancer
patients are willing and able to “self-report” symptoms using the
Internet.
Published in the December 1, 2007, issue of the
Journal of Clinical Oncology, the study suggests a new direction in
cancer care. According to the authors, supplementing traditional office
visit discussions with online patient self-reporting can fill important
gaps in clinicians’ knowledge and in doing so may significantly improve
patient safety and quality of care.
“Cancer care has become increasingly complex,
causing office visits to become more compressed. This makes it
challenging for the clinician to comprehensively assess each patient’s
symptoms in that brief window of time,” said the study’s lead author,
Ethan Basch, MD, a medical oncologist at MSKCC.
“Because cancer therapies can be highly toxic,
early detection of symptoms and timely treatment is vital. What is
exciting to us about online self-reporting is that patients can alert
clinicians to crucial symptoms in real time.”
The research team developed a Web-based system that
patients in the study could access using computers in waiting-room
kiosks and at home to communicate their symptoms directly to clinicians.
Investigators adapted the National Cancer Institute’s standard
terminology for tracking patient toxicities in clinical trials and
translated it into patient-friendly language.
The new terms were uploaded to a secure Web site
called Symptom Tracking and Reporting (STAR). Participants used the
system to report their cancer- and chemotherapy-related side effects,
including pain, fatigue, constipation, diarrhea, nausea, vomiting,
shortness of breath, and decreased mobility, as well as their overall
quality of life.
From June 2005 through March 2006, 107 lung cancer
patients receiving outpatient chemotherapy at MSKCC enrolled in the
study. Patients were followed for up to 16 months and 40 visits. Most
enrollees were between the ages of 50 and 69, although 28 percent were
older than 70. Patients were more likely to use the system if they had
prior computer experience; however, age, gender, and cancer stage had no
effect on log-in rates.
Researchers found that 100 percent of patients used
the waiting room kiosks at some or all of their office visits. An
average of 78 percent of participants logged in to the system at any
given office visit.
According to the findings, patients were satisfied
with the system. Most respondents (98 percent) found STAR easy to use,
90 percent said it was useful, and 77 percent expressed that it improved
the quality of their discussions with clinicians.
“Our study suggests that the broader use of patient
self-reporting in oncology would be beneficial,” said study co-author
Mark G. Kris, MD, Chief of the Thoracic Oncology Service at MSKCC. “STAR
makes it easier for patients to provide information to their doctors
about their symptoms and side effects. The fact that this information
can be collected anywhere and immediately stored and shared hastens and
expands our research efforts as well.”
Optional home access to STAR was also offered to
study participants. Home users accessed STAR more frequently than
clinic-only users, with an average of 23 online sessions versus nine,
respectively. Although 76 percent of patients had home computers, only
15 percent reported from home, possibly due to a lack of regular
reminders, and to the perception among participants that self-reported
information was not being explicitly addressed by clinicians.
Patients were informed that no clinician would
regularly monitor STAR reports between visits, and therefore should
contact staff directly if severe of disabling symptoms occurred at home.
Nonetheless, an automated “alert” system was integrated so that anytime
a patient entered a symptom above a certain level of severity, an
on-screen message appeared encouraging the patient to contact a
clinician, and an e-mail warning was automatically sent to a designated
nurse.
Although the study focused on the patient
experience, its results suggest that self-reported data is a potentially
valuable resource for clinicians as well. At each follow-up office
visit, symptom reports were printed for clinical nurses. It was left to
the discretion of patients and clinicians whether and how to incorporate
STAR reports into their discussions.
“All of the nurses who participated in the study
understood the reports and felt this information was highly useful for
clinical decisions, documentation, and discussions,” said Ann Culkin,
RN, a nurse on the Thoracic Oncology Service at MSKCC and a co-author of
the study.
The nurses all noted that they had altered
management based on patient-reported information and alerts from STAR,
including recommending medication and lifestyle changes and arranging
for additional physician consultations.
The authors concluded that online self-reporting is
a feasible long-term strategy for monitoring toxicities during
chemotherapy, even among very ill patients. However, explicit reminders
to log in and clinician feedback on self-reported information are
important to maintain patients’ continued interest and participation
between visits.
“These findings lay the groundwork for future
research to assess whether patient self-reporting improves the
efficiency and comprehensiveness of toxicity monitoring in clinical
trials, and whether this approach can improve the quality of routine
cancer care by expediting detection of severe or disabling toxicities,”
said Dr. Basch. These questions are currently being explored by Dr.
Basch and his colleagues in a large randomized study at MSKCC and an
NCI-sponsored multicenter trial, with results expected in 2009.
Funding support for the study was provided in part
by the Steps for Breath Fund for Lung Cancer Research and The Society of
Memorial Sloan-Kettering Cancer Center.
Memorial Sloan-Kettering Cancer Center is the
world’s oldest and largest private institution devoted to prevention,
patient care, research, and education in cancer. Our scientists and
clinicians generate innovative approaches to better understand,
diagnose, and treat cancer. Our specialists are leaders in biomedical
research and in translating the latest research to advance the standard
of cancer care worldwide.
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