SUPPORT+ Digital Self-Management and Clinical Support for Advanced Cancer (SUPPORT+)

March 26, 2026 updated by: Wing Lok Wendy Chan, The University of Hong Kong

SUPPORT+ Digital Self-Management and Clinical Support for Patients With Advanced Cancer in the Community: A Randomized Controlled Trial

The goal of this clinical trial is to learn whether SUPPORT+, a digital symptom monitoring and self-management mobile application, can improve health-related quality of life and clinical outcomes in adults with advanced cancer receiving palliative care.

The main questions this study aims to answer are:

  • Does use of SUPPORT+ help maintain or improve health-related quality of life compared with usual palliative care?
  • Does SUPPORT+ reduce functional decline and acute health care use, such as hospitalisations, compared with usual care?

Researchers will compare patients using the SUPPORT+ mobile application with patients receiving usual palliative care to see if digital symptom monitoring combined with automated self-management guidance and nurse follow-up improves patient-reported and clinical outcomes.

Participants assigned to the SUPPORT+ arm will:

  • Use the SUPPORT+ mobile application for weekly symptom reporting using the Integrated Palliative Care Outcome Scale (IPOS)
  • Receive automated self-management advice based on reported symptoms
  • Receive follow-up contact from a nurse when severe or concerning symptoms are identified
  • Continue to receive usual palliative care throughout the study period

Participants assigned to the usual care arm will:

  • Receive usual palliative care provided by their clinical team
  • Complete study assessments at scheduled time points
  • Not receive digital symptom monitoring, automated self-management advice, or nurse follow-up through the SUPPORT+ application

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

Patients with advanced cancer often experience substantial physical and psychological symptom burden that negatively affects health-related quality of life and may lead to avoidable emergency department visits and hospitalisations. Digital symptom monitoring tools may support earlier identification of symptom deterioration and timely intervention, but evidence in palliative care populations remains limited.

This multicentre, randomised controlled trial evaluated whether adding SUPPORT+, a mobile application for symptom monitoring with automated self-management guidance and nurse follow-up, to usual palliative care could improve patient-reported outcomes and healthcare utilisation among adults with advanced cancer.

Community-dwelling adults aged 18 years or older with advanced malignancy who had decided not to pursue further systemic anticancer treatment and were receiving follow-up at palliative care clinics in six public hospitals in Hong Kong were recruited. Eligible participants were required to own a smartphone, have adequate cognitive capacity to provide informed consent, be willing to receive application notifications, and report at least one symptom related to advanced cancer. Patients with an estimated life expectancy of less than three months or an Eastern Cooperative Oncology Group (ECOG) performance status greater than 3 were excluded. Caregivers were permitted to act as proxy users when participants were unable to use the application independently.

Participants were randomly assigned in a 1:1 ratio to either the intervention group (SUPPORT+ plus usual care) or the usual care group. Randomisation was stratified by age, chronic opioid use, and app user (patient or caregiver proxy). Clinicians providing routine palliative care were not informed of group allocation.

All participants received standard palliative care according to usual clinical practice. Participants in the intervention group additionally received full access to the SUPPORT+ mobile application for 18 weeks. Weekly notifications prompted symptom reporting using the Integrated Palliative Care Outcome Scale (IPOS). Following each submission, participants received automated symptom-specific self-management advice. Reports containing any severe symptom triggered real-time alerts to palliative care nurses, who contacted participants during office hours to provide clinical guidance, including medication advice, self-management strategies, expedited clinic review, or recommendations for urgent care when appropriate. Participants could also initiate nurse contact through the application during office hours.

Assessments were conducted at baseline, week 9, and week 18. The primary outcome was change in health-related quality of life measured using the EQ-5D-5L utility score. Secondary outcomes included self-rated health (EQ-VAS), self-efficacy for managing chronic disease, ECOG performance status, emergency department visits, hospitalisations, length of hospital stay, and completion of advance directives. Healthcare utilisation data were retrieved from electronic medical records.

Study Type

Interventional

Enrollment (Actual)

633

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Hong Kong
      • Hong Kong, Hong Kong
        • 1. Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong SAR

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adults aged 18 years or older
  • Diagnosis of advanced malignancy
  • Decision not to pursue further systemic anticancer treatment
  • Receiving follow-up care at a participating palliative care clinic
  • Community-dwelling
  • Ownership of a smartphone
  • Adequate cognitive capacity to provide informed consent
  • Willingness to receive notifications from the SUPPORT+ mobile application
  • Presence of at least one symptom related to advanced cancer
  • Ability for the patient or a designated primary caregiver to use the mobile application

Exclusion Criteria:

  • Receiving systemic anticancer therapy with radical or palliative intent
  • Estimated life expectancy of less than 3 months
  • Eastern Cooperative Oncology Group (ECOG) performance status greater than 3

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: SUPPORT+ Plus Usual Palliative Care
Participants in this arm receive usual palliative care supplemented by SUPPORT+, a mobile application providing weekly digital symptom monitoring, automated self-management guidance, and nurse follow-up for severe symptoms, for a duration of 18 weeks. After each submission, participants received symptom-specific self-management advice. Any report containing a severe symptom was transmitted in real time to palliative care nurses, who contacted patients within one working day during office hours to provide clinical support, including medication adjustments, self-management strategies, expedited appointments, or advice to attend the emergency department or admit to hospital. Participants could also contact nurses during office hours via the "Nurse Consult" feature; outside these hours, they were advised to seek urgent medical care.
Behavioral: SUPPORT+ Digital Symptom Monitoring and Clinical Support
SUPPORT+ is a mobile application that prompts participants to complete weekly symptom reporting using the Integrated Palliative Care Outcome Scale (IPOS). After each submission, the application provides automated, symptom-specific self-management advice. Reports indicating severe symptoms trigger real-time alerts to palliative care nurses, who contact participants during office hours to provide clinical guidance, including medication advice, self-management strategies, expedited clinic review, or recommendations for urgent medical care when appropriate. Participants may also initiate nurse contact through the application during office hours.
No Intervention: Usual Palliative Care
Participants in this arm receive usual palliative care provided by their clinical team according to standard practice, without access to digital symptom monitoring, automated self-management guidance, or nurse follow-up through the SUPPORT+ application. They could access only the publicly available educational materials within the SUPPORT+ application.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Health-Related Quality of Life (EQ-5D-5L index)
Time Frame: Baseline to 18 weeks
Change in health-related quality of life measured using the EQ-5D-5L index (utility) score. The EQ-5D-5L assesses five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each rated on five levels from 1 (no problems) to 5 (extreme problems). Utility scores are derived using the Hong Kong value set and range from -0.865 (worst health state) to 1 (perfect health).
Baseline to 18 weeks
Change in Self-rated health measured by EQ-VAS
Time Frame: Baseline to 18 weeks
Change in self-rated health measured using the EQ-5D visual analogue scale (EQ-VAS), on which participants rate their overall health on a vertical scale from 0 (worst imaginable health) to 100 (best imaginable health).
Baseline to 18 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Emergency Department Visits
Time Frame: Baseline to 18 weeks
Number of emergency department visits recorded in electronic medical records.
Baseline to 18 weeks
Hospitalisations
Time Frame: Baseline to 18 weeks
Number of hospital admissions and total length of hospital stay recorded in electronic medical records.
Baseline to 18 weeks
Change in Self-Efficacy for Managing Chronic Disease
Time Frame: Baseline to 18 weeks
Change in self-efficacy measured using the 6-item Self-Efficacy for Managing Chronic Disease Scale (SEMCD-6S). The SEMCD-6S assesses an individual's confidence in managing symptoms and the impact of a chronic condition on daily life, including fatigue, pain, emotional distress, symptom control, and self-management activities. Each item is rated on a numeric scale from 1 (not at all confident) to 10 (totally confident). The overall score is calculated as the mean of the six items, with higher scores indicating greater self-efficacy.
Baseline to 18 weeks
Change in Eastern Cooperative Oncology Group (ECOG) Performance Status
Time Frame: Baseline to 18 weeks
Change in functional status measured using the Eastern Cooperative Oncology Group (ECOG) Performance Status scale. The ECOG scale is a clinician-rated measure of a patient's level of functioning and ability to perform daily activities, ranging from 0 to 4, with lower scores indicating better functional status. Scores are defined as follows: 0 = fully active with no restrictions; 1 = restricted in physically strenuous activity but ambulatory and able to perform light work; 2 = ambulatory and capable of all self-care but unable to work; 3 = capable of only limited self-care and confined to bed or chair more than 50% of waking hours; 4 = completely disabled and unable to perform any self-care.
Baseline to 18 weeks

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Advance care planning experience (including advance directive completion)
Time Frame: Baseline to 18 weeks
Proportion of participants with documented completion of advance directives.
Baseline to 18 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

The University of Hong Kong

Investigators

  • Principal Investigator: Wing-Lok Wendy Chan, MBBS, The University of Hong Kong

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 16, 2023

Primary Completion (Estimated)

December 31, 2026

Study Completion (Estimated)

December 31, 2026

Study Registration Dates

First Submitted

March 11, 2026

First Submitted That Met QC Criteria

March 11, 2026

First Posted (Actual)

March 16, 2026

Study Record Updates

Last Update Posted (Actual)

April 2, 2026

Last Update Submitted That Met QC Criteria

March 26, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • CIRB-2023-011-3

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared because data sharing was not approved by the Institutional Review Board and is restricted to protect participant privacy and confidentiality.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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