Exploring the efficacy of an electronic symptom assessment and self-care intervention to preserve physical function in individuals receiving neurotoxic chemotherapy

Evaluating the effect of a mobile-based symptom monitoring system for improving physical function in patients with cancer during chemotherapy: study protocol for a multicentre randomised controlled trial

INTRODUCTION

Symptoms due to chemotherapy are common in patients with cancer. Cancer-related symptoms are closely associated with the deterioration of physical function which can be associated with decreased quality of life and increased mortality. Thus, timely symptom identification is critical for improving cancer prognosis and survival. Recently, remote symptom monitoring system using digital technology has demonstrated its effects on symptom control or survival. However, few studies examined whether remote monitoring would contribute to retaining physical function among patients with cancer. Therefore, this study aimed to evaluate the effectiveness of mobile-based symptom monitoring in improving physical function among patients with cancer under chemotherapy.

METHODS AND ANALYSIS

This study is a multicentre, open-label, parallel-group, randomised controlled trial. We will recruit 372 patients at three tertiary hospitals located in Seoul, South Korea. Study participants will be randomly assigned to either an intervention group receiving the ePRO-CTCAE app and a control group receiving routine clinical practice only. The primary outcome is changes in physical function from commencement to completion of planned chemotherapy. A linear mixed model will be performed under the intention-to-treat principle. The secondary outcomes include physical activity level; changes in pain interference; changes in depressive symptom; unplanned clinical visits; additional medical expenditure for symptom management; completion rate of planned chemotherapy; changes in symptom burden and health-related quality of life; and 1-year overall mortality.

ETHICS AND DISSEMINATION

The study has been approved by the institutional review board and ethics committee at the three university hospitals involved in this trial. Written informed consent will be obtained from all the participants. The results of the trial will be submitted for publication in peer-reviewed academic journals and disseminated through relevant literatures.

TRIAL REGISTRATION NUMBER

KCT0007220.

A qualitative evaluation of the oncologists', neurologists', and pain specialists' views on the management and care of chemotherapy-induced peripheral neuropathy in The Netherlands

PURPOSE

In treating cancer, different chemotherapy regimens cause chemotherapy-induced peripheral neuropathy (CIPN). Despite recent international guidelines, a gold standard for diagnosis, treatment, and care is lacking. To identify the current clinical practice and the physicians' point of view and ideas for improvement, we evaluated CIPN care by interviewing different specialists involved.

METHODS

We performed semi-structured, audio-recorded, transcribed, and coded interviews with a purposive sample of oncologists, pain specialists, and neurologists involved in CIPN patients' care. Data is analyzed by a constant comparative method for content analysis, using ATLAS.ti software. Codes, categories, and themes are extracted, generating common denominators and conclusions.

RESULTS

With oncologists, pain specialists, and neurologists, nine, nine, and eight interviews were taken respectively (including three, two, and two interviews after thematic saturation occurred). While useful preventive measures and predictors are lacking, patient education (e.g., on symptoms and timely reporting) is deemed pivotal, as is low-threshold screening (e.g., anamnesis and questionnaires). Diagnosis focusses on a temporal relationship to chemotherapy, with adjuvant testing (e.g., EMG) used in severe or atypical cases. Symptomatic antineuropathic and topical medication are often prescribed, but personalized and multidimensional care based on individual symptoms and preferences is highly valued. The limited efficacy of existing treatments, and the lack of standardized protocols, interdisciplinary coordination, and awareness among healthcare providers pose significant challenges.

CONCLUSION

Besides the obvious need for better therapeutic options, and multidisciplinary exploration of patients' perspectives, a structured and collaborative approach towards diagnosis, treatment, referral, and follow-up, nurtured by improving knowledge and use of existing CIPN guidelines, could enhance care.

Non-pharmacological therapy for chemotherapy-induced peripheral neurotoxicity: a network meta-analysis of randomized controlled trials

BACKGROUND

Chemotherapy-induced peripheral neurotoxicity (CIPN) is the most common adverse effect in patients undergoing chemotherapy, and no effective interventions are currently available for its prevention and treatment. Non-pharmacological therapies appear to be beneficial for the prevention and treatment of CIPN, but it remains unclear which therapy is most effective. The aim of this study was to identify the most effective non-pharmacological therapy for CIPN patients.

METHODS

PubMed, Web of Science, Embase, and Cochrane Library were searched for randomized controlled trials on non-pharmacological therapies for CIPN. The primary outcomes included pain and peripheral neuropathological symptoms, and the secondary outcomes included quality of life, sensory and motor symptoms. The pairwise analysis and a network meta-analysis were performed using a random effects model.

RESULTS

A total of 46 articles were included in this study, involving 2,878 participants. Our study showed that massage was more effective in pain-alleviating compared with acupuncture [SMD = 0.81, 95%CI (0.04, 1.57)], vitamin and gabapentin [SMD = 2.56, 95%CI (1.39, 3.74)], and usual care and placebo [SMD = 0.9, 95%CI (0.31, 1.49)]. As for attenuating peripheral neuropathological symptoms, massage was more effective than usual care and placebo [SMD = 0.75, 95%CI (0.33, 1.17)], sensorimotor training [SMD = 1.17, 95%CI (0.24, 2.10)], electrostimulation [SMD=-1.18, 95%CI (-2.14, -0.21)], multimodal exercise [SMD=-0.82, 95%CI (-1.57, -0.08)], and resistance training [SMD = 1.03, 95%CI (0.11, 1.95)]. Massage was also more effective than other non-pharmacological therapies in improving quality of life, sensory and motor symptoms.

CONCLUSIONS

According to our study, massage has advantages in alleviating pain, improving quality of life, and improving peripheral neuropathological symptoms and has better effect than other non-pharmacological interventions, representing certain clinical significance. However, the results of this study should be interpreted with caution due to the limitations of the included studies. In the future, more high-quality multi arm randomized controlled trials can be attempted to provide direct comparisons of the relative effects of non-pharmacological interventions.

The effectiveness of symptom management interventions based on electronic patient-reported outcomes (ePROs) for symptom burden, quality of life, and overall survival among patients with cancer: A meta-analysis of randomized controlled trials

OBJECTIVE

To explore the effectiveness of ePRO-based symptom management interventions on symptom burden, quality of life, and overall survival among patients with cancer for the first time and to explore the effects of different types of these interventions.

BACKGROUND

Since advances in screening and treatment have transformed cancer into a chronic illness rather than a fatal disease, symptom management has become increasingly critical in oncology nursing. In recent decades, ePROs have been increasingly used in the symptom management of cancer patients to improve their symptom burden, quality of life and overall survival, but the existing findings are still inconsistent and equivocal.

METHODS

A literature search was conducted in PubMed, Web-of-Science, CENTRAL, and CINAHL-Plus-with-Full-Text from inception to January 31, 2023. The quality of methodology and evidence were evaluated by the revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation framework. All data were analyzed using R within the RStudio platform, and the effects of interventions were determined by calculating SMD, HR and 95 %CI. Subgroup analysis, sensitivity analysis and cumulative meta-analysis were performed, and statistical heterogeneity was examined by I2 statistic, P value, and Egger's or arcsine test. Statistical significance was defined as a two-tailed P value <0.05.

RESULTS

A total of 23 randomized controlled trials with 7231 patients were included. The results indicated that ePRO-based symptom management interventions could improve the symptom burden (SMD = -0.19, 95 % CI [-0.33, -0.05], P < 0.01), quality of life (SMD = 0.16, 95 % CI [0.06, 0.25], P < 0.01) and overall survival (HR = 0.84, 95 % CI [0.73, 0.97], P = 0.02) of cancer patients. Subgroup analysis showed that targeted interventions for patients undergoing specific treatments were effective in relieving the symptom burden and enhancing quality of life. Short-term (≤3 months) interventions or reporting via telephone call contributed to alleviating the symptom burden, while quality of life improved when the intervention was more than three months in duration or not reported by telephone call. The pooled results of symptom burden and quality of life were stable, and the beneficial trends of all three outcomes were steady. The overall quality of methodology and evidence was moderate.

CONCLUSIONS

We found that ePRO-based symptom management interventions are conducive to improving symptom burden, quality of life, and overall survival of cancer patients. In addition to encouraging the integration of ePRO-based interventions into routine oncology care, interventions with tailored plans, proper intensity and multidimensional supports need to be developed in the future to optimize the symptom management of cancer patients.

REGISTRATION

CRD42023393330.

Exploring Patients' Understanding of Chemotherapy-Induced Peripheral Neuropathy

Little quantitative evidence exists surrounding patients' level of understanding of chemotherapy-induced peripheral neuropathy (CIPN) symptoms (numbness, tingling, pain in the hands/feet) and consequences (e.g., negatively affect physical functioning or chemotherapy dosing) at the beginning of chemotherapy. The purpose of this cross-sectional, secondary analysis was to describe CIPN knowledge and education patterns among adults early in a course of neurotoxic chemotherapy for the treatment of cancer (< three infusions). Following consent, participants completed an electronic questionnaire about their perceptions of CIPN symptoms, incidence, and education. Participants (N = 92) were mainly female (76%), white (91%), and diagnosed with breast (46%) or gastrointestinal (40%) cancers. Most participants without CIPN (n = 48) did not expect to develop CIPN (45%) or were unaware of CIPN as a side-effect (30%). Furthermore, 71% of participants without CIPN (n = 31) estimated CIPN to occur in ≤ 30% of patients receiving neurotoxic chemotherapy. Overall, participants learned about CIPN from their doctor or nurse prior to beginning chemotherapy (90%). Clinicians delivered education about CIPN symptoms (75%), but less frequently delivered education about CIPN management (14%), or the impact of CIPN on the ability to continue chemotherapy (16%) or physical functioning (24%). Finally, participants reported that a discussion with their doctor/nurse would be the best way to learn about CIPN (92%). Results revealed that participants without CIPN were largely unaware of the adverse consequences or incidence of CIPN during treatment. Further research is needed to investigate optimal methods to promote patient-clinician communication about CIPN during chemotherapy to enhance patients' retention of CIPN information and activation in their care.

Randomized clinical trial quantifying the effectiveness of a self-monitoring intervention in cancer patients with peripheral neuropathy: A quantitative study

Objective

The aim of this study was to quantitatively evaluate the efficacy of a self-monitoring intervention for the management of persistent chemotherapy-induced peripheral neuropathy (CIPN).

Methods

A randomized controlled clinical trial was conducted on 65 outpatients receiving taxane or platinum-based anticancer drugs. Participants were assigned to the control group (CG; n ​= ​32) or the self-monitoring group (SMG; n ​= ​33) and followed for 6 weeks. Non-interveners were blinded. Participants in the intervention group self-monitored and recorded. The researchers provided feedback on the recorded symptoms and coping strategies once every 3 weeks. The efficacy of the 6-week self-monitoring intervention was assessed, using various measures, at baseline (T0), 3 weeks (T1), and 6 weeks (T2). Scores of CIPN, Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity, Distress and Impact Thermometer, Self-Efficacy Scale for Advanced Cancer, and Functional Assessment of Cancer Therapy-General of both groups were compared. Safety behavior in daily life was also compared. The study was conducted from August 9, 2017 to March 30, 2020 in outpatient clinics at three hospitals. Analysis was conducted using the t-test, Mann-Whitney U test, χ² test, and two-way repeated-measures analysis of variance (two-way RMANOVA).

Results

No significant differences were noted between the two groups in the CIPN score, the Distress and Impact Thermometer score, and in safety behavior in daily life. The mean Self-Efficacy Scale for Advanced Cancer score at T1 differed between the two groups (CG mean ​± ​SD: 358.44 ​± ​109.90; SMG mean ​± ​SD: 421.21 ​± ​85.54), which was significantly higher in the SMG (P ​= ​0.012). Two-way RMANOVA revealed an interaction between the CG and SMG (F ​= ​5.689, P ​= ​0.004). Quality of life scores were higher in the SMG than in the CG at T0, T1, and T2. Two-way RMANOVA analysis showed an effect of the intervention (F ​= ​7.914, P ​= ​0.007).

Conclusions

The self-monitoring intervention maintained the participants' quality of life. This finding suggests its effectiveness in patients with peripheral neuropathy.

Evidence-based nursing intervention can improve the treatment compliance, quality of life and self-efficacy of patients with lung cancer undergoing radiotherapy and chemotherapy

OBJECTIVE

To investigate the improvement effect of evidence-based nursing intervention on treatment compliance, quality of life and self-efficacy of patients with lung carcinoma (LC) undergoing radiotherapy and chemotherapy.

METHODS

From May 2018 to August 2019, 183 patients with LC who received radiotherapy and chemotherapy in our hospital were selected and divided into two groups in accordance with different nursing methods. Among them, 85 patients who received routine nursing intervention were included in the control group (CG), and 98 patients who received evidence-based nursing intervention were included in the research group (RG). The improvement of pulmonary function indexes [(FVC), forced expiratory volume in one second (FEV₁), ratio of forced expiratory volume in one second to forced vital capacity (FEV₁/FVC)] was observed before and after nursing. The pain degree was evaluated by the visual analogue scale (VAS). The treatment compliance between groups was compared. The psychological emotions of the patients were evaluated by a self-rating anxiety scale (SAS) and a self-rating depression scale (SDS). The General Self-efficacy Scale (GSES) was applied to assess the self-efficacy and the Quality of Life (SF-36) scale was applied to evaluate the quality of life. The incidence of secondary infection was observed in the two groups. The nursing satisfaction was evaluated by a nursing satisfaction questionnaire made by our hospital.

RESULTS

After nursing, the improvement of FEV₁, FVC and FEV₁/FVC levels in the RG were obviously better than that in the CG; The scores of VAS, SAS and SDS and total incidence of secondary infection in the RG were obviously lower than those in the CG; The treatment compliance, GSES and SF-36 scores, and nursing satisfaction scores of patients in the RG were obviously higher than that in the CG.

CONCLUSION

Evidence-based nursing intervention can improve treatment compliance, lung function, self-efficacy and quality of life for patients with LC undergoing radiotherapy and chemotherapy.

Receptivity to a Nurse-Led Symptom Management Intervention Amongst Highly Symptomatic Patients with Cancer

BACKGROUND

The symptom burden associated with cancer and its treatment can negatively impact patients' quality of life and survival. Symptom-focused collaborative care model (CCM) interventions can improve outcomes, but only if patients engage with them. We assessed the receptivity of severely symptomatic oncology patients to a remote nurse-led CCM intervention.

METHODS

In a pragmatic, cluster-randomized, stepped wedge trial conducted as part of the NCI IMPACT Consortium (E2C2, NCT03892967), patients receiving cancer care were asked to rate their sleep disturbance, pain, anxiety, emotional distress, fatigue, and limitations in physical function. Patients reporting at least one severe symptom (≥7/10) were offered phone consultation with a nurse symptom care manager (RN SCM). Initially, patients had to "opt-in" to receive a call, but the protocol was later modified so they had to "opt-out" if they did not want a call. We assessed the impact of opt-in vs. opt-out framing and patient characteristics on receptiveness to RN SCM calls. All statistical tests were 2-sided.

RESULTS

Of the 1204 symptom assessments (from 864 patients) on which at least one severe symptom was documented, 469 (39.0%) indicated receptivity to an RN SCM phone call. The opt-out period (odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.12 to 2.32, p=.01), receiving care at a tertiary care center (OR = 3.59, 95% CI = 2.18 to 5.91, p<.001), and having severe pain (OR = 1.80, 95% CI = 1.24 to 2.62, p=.002), were associated with statistically significantly greater willingness to receive a call.

CONCLUSION

Many severely symptomatic patients were not receptive to an RN SCM phone call. Better understanding of reasons for refusal and strategies for improving patient receptivity are needed.

Patient-centric decision framework for treatment alterations in patients with Chemotherapy-induced Peripheral Neuropathy (CIPN)

Recently updated American Society of Clinical Oncology (ASCO) guidelines for Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy (CIPN) in Survivors of Adult Cancers make a single recommendation to alter treatment by delaying, decreasing, or discontinuing dosing in patients who develop CIPN during neurotoxic chemotherapy treatment. Dosing guidelines have inconsistent recommendations for when (i.e., what CIPN severity) and how (i.e., delay, decrease, or discontinue) to alter neurotoxic chemotherapy treatment in patients with CIPN. Clinical decision making requires an understanding the benefits and risks of treatment alteration, in addition to consideration of other disease and patient factors. This review summarizes four areas of literature and culminates in a patient-centric decision framework to guide clinicians in helping patients to make treatment alteration decisions. First, we describe the current practice of altering treatment due to CIPN, including treatment alteration recommendations and published rates. Second, we summarize the potential benefits of treatment alteration including the reduction in CIPN severity and persistence. Third, we evaluate the potential risk of treatment alteration in compromising treatment efficacy by reviewing prospective trials comparing dosing regimens and retrospective analyses of the effect of relative dose intensity on efficacy. Fourth, we summarize disease and patient factors that should be considered when making a treatment alteration decision for a patient. We then propose a patient-centric decision framework that clinicians can use to assess an individual patient's current and anticipated future CIPN severity and compare that to their maximum tolerable severity to determine whether they should continue, delay, decrease, or discontinue neurotoxic chemotherapy.