Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial

Abstract

Purpose: Patients receiving cancer-related thoracotomy are highly symptomatic in the first weeks after surgery. This study examined whether at-home symptom monitoring plus feedback to clinicians about severe symptoms contributes to more effective postoperative symptom control.

Patients and methods: We enrolled 100 patients receiving thoracotomy for lung cancer or lung metastasis in a two-arm randomized controlled trial; 79 patients completed the study. After hospital discharge, patients rated symptoms twice weekly for 4 weeks via automated telephone calls. For intervention group patients, an e-mail alert was forwarded to the patient's clinical team for response if any of a subset of symptoms (pain, disturbed sleep, distress, shortness of breath, or constipation) reached a predetermined severity threshold. No alerts were generated for controls. Group differences in symptom threshold events were examined by generalized estimating equation modeling.

Results: The intervention group experienced greater reduction in symptom threshold events than did controls (19% v 8%, respectively) and a more rapid decline in symptom threshold events. The difference in average reduction in symptom interference between groups was -0.36 (SE, 0.078; P = .02). Clinicians responded to 84% of e-mail alerts. Both groups reported equally high satisfaction with the automated system and with postoperative symptom control.

Conclusion: Frequent symptom monitoring with alerts to clinicians when symptoms became moderate or severe reduced symptom severity during the 4 weeks after thoracic surgery. Methods of automated symptom monitoring and triage may improve symptom control after major cancer surgery. These results should be confirmed in a larger study.

Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.

CONSORT diagram.

Fig 2.

Sample e-mail alert.

Fig 3.

Mean symptom threshold events per patient.

Fig 4.

Cumulative number of symptom threshold events for the five targeted symptoms, which included (A) pain, (B) distress, (C) disturbed sleep, (D) shortness of breath, and (E) constipation. For each of the five targeted symptoms, at the end of the study period, the control group had a greater number of symptom threshold events than the intervention group. These graphs depict the number of symptom threshold events per symptom as they accumulated during the study period.

Fig 5.

Mean symptom interference from discharge to follow-up by group.