Communicating advanced cancer patients' symptoms via the Internet: a pooled analysis of two randomized trials examining caregiver preparedness, physical burden, and negative mood

Abstract

Background: Using available communication technologies, clinicians may offer timely support to family caregivers in managing symptoms in patients with advanced cancer at home.

Aim: To assess the effects of an online symptom reporting system on caregiver preparedness, physical burden, and negative mood.

Design: A pooled analysis of two randomized trials (NCT00214162 and NCT00365963) was conducted to compare caregiver outcomes at 6 and 12 months after intervention between two randomized, unblinded groups using General Linear Mixed Modeling. Caregivers in one group (Comprehensive Health Enhancement Support System-Only) were given access to an interactive cancer communication system, the Comprehensive Health Enhancement Support System. Those in the other group (Comprehensive Health Enhancement Support System + Clinician Report) received access to Comprehensive Health Enhancement Support System plus an online symptom reporting system called the Clinician Report. Clinicians of patients in the Comprehensive Health Enhancement Support System + Clinician Report group received e-mail alerts notifying them when a symptom distress was reported over a predetermined threshold.

Setting/participants: Dyads (n = 235) of advanced-stage lung, breast, and prostate cancer patients and their adult caregivers were recruited at five outpatient oncology clinics in the United States.

Results: Caregivers in the Comprehensive Health Enhancement Support System + Clinician Report group reported less negative mood than those in the Comprehensive Health Enhancement Support System-Only group at both 6 months (p = 0.009) and 12 months (p = 0.004). Groups were not significantly different on caregiver preparedness or physical burden at either time point.

Conclusions: This study provides new evidence that by using an online symptom reporting system, caregivers may experience less emotional distress due to the Clinician Report's timely communication of caregiving needs in symptom management to clinicians.

Keywords: Caregivers; cancer; communication barriers; eHealth; palliative care; signs and symptoms.

Conflict of interest statement

Conflict of interest

The Authors declare that there is no conflict of interest.

Figures

Figure 1

Flow diagram PT: patients; CG: caregivers; Cov: covariates; Prep: preparedness; PB: physical burden; NM: negative mood; CHESS: Comprehensive Health Enhancement Support System; CR: Clinician Report; BC: Breast cancer; PC: Prostate cancer; LC: Lung cancer. “CG nonresponsive” means those caregivers who did not respond to previous posttest surveys and to project administrators’ contact. Because of their nonresponse, the project administrators decided to discontinue their Internet and CHESS access. “Lost to follow up” means those whose current posttest surveys were not returned. a In total, 561 breast and prostate cancer dyads received mailed invitations, and the others were approached at the clinic. b Because one lung cancer recruitment data have missing recruitment dates, approximate recruitment numbers were calculated by multiplying total recruitment numbers by the proportion of selected dyads in this study over total dyads recruited from this site: 28 (13 not eligible) × 57/90 =18 (8 not eligible).

Figure 2

Clinician Report screen shot CHESS, Comprehensive Health Enhancement Support System; ESAS: Edmonton Symptom Assessment System; ECOG: Eastern Cooperative Oncology Group.