Pilot randomized trial of an electronic symptom monitoring and reporting intervention for hospitalized adults undergoing hematopoietic stem cell transplantation

Abstract

Purpose: Patients undergoing a hematopoietic stem cell transplantation (HCT) have varied symptoms during their hospitalization. This study examined whether daily symptom reporting (with electronic patient-reported outcomes [PROs]) in an inpatient bone marrow transplant clinic reduced symptom burden on post-transplant days +7, +10, and +14.

Methods: A prospective, single-institution 1:1 pilot randomized, two-arm study recruited HCT patients. HCT inpatients (N = 76) reported daily on 16 common symptoms using the PRO version of the Common Terminology for Adverse Events (PRO-CTCAE). Fisher's exact test was used to examine differences in the proportion of patients reporting individual symptoms. Multivariable linear regression modeling was used to examine group differences in peak symptom burden, while controlling for symptom burden at baseline, age, comorbidity, and transplantation type (autologous or allogeneic).

Results: HCT patients receiving the PRO intervention also experienced lower peak symptom burden (average of 16 symptoms) at days +7, +10, and +14 (10.4 vs 14.5, p = 0.03).

Conclusions: Daily use of electronic symptom reporting to nurses in an inpatient bone marrow transplant clinic reduced peak symptom burden and improved individual symptoms during the 2 weeks post-transplant. A multi-site trial is warranted to demonstrate the generalizability, efficacy, and value of this intervention.

Trial registration: ClinicalTrials.gov identifier: NCT02574897.

Keywords: Allogeneic stem cell transplantation; Autologous stem cell transplantation; Cancer; Electronic symptom reporting; Patient-reported outcomes; Symptoms.

Conflict of interest statement

Conflict of Interest

Figures

Figure 1.

Screening process in choosing eligible patients

Figure 2.

Peak Symptom Burden Groups Upper left: Mean symptom severities at days 7 (n=40), 10 (n=25), and 14 (n=20) of patients under ‘Autologous’ transplant. Upper right: Mean symptom severities at days 7 (n=23), 10 (n=17), and 14 (n=19) of patients under ‘Allogenic’ (right) transplant. Lower left: Mean symptom severities at days 7 (n=28), 10 (n=14), and 14 (n=15) of patients under ‘Control’ (no feedback). Lower right: Mean symptom severities at days 7 (n=35), 10 (n=28), and 14 (n=24) of patients under ‘Intervention’ (with feedback)