Improved Lung Cancer Survival With Web-Based Symptom Monitoring

By Will Boggs MD

January 23, 2019

NEW YORK (Reuters Health) - After treatment for lung cancer, web-based monitoring of patient-reported outcomes is associated with improved overall survival, according to final results from a randomized trial.

"Electronic patient-reported symptom monitoring should be considered for patients with lung cancer who have received treatment as a part of high-quality cancer care," Dr. Fabrice Denis from Institut Inter-regional de Cancerologie Jean Bernard, Le Mans, France told Reuters Health. "This is where technology can help in better communication with the patients (and) provide oncologists the crucial information in order to provide the right treatment at the right time."

Earlier, Dr. Denis and colleagues reported results of a planned interim analysis (at the 9-month follow-up) of the web-based monitoring system trial, which found a significant survival benefit (median overall survival, 19 months in the monitored group versus 12 months in the usual care control group).

In their current research letter online January 22 in JAMA, they present the final overall survival analysis.

In the monitored group, patients were asked to complete weekly online self-reports of 13 common symptoms between visits. The system automatically triggers an alert email to the treating oncologist when patient-reported symptoms matched predefined criteria for severity and worsening.

With two years of follow-up, there were 29 deaths in the intervention group (47.5%) and 40 deaths in the control group (66.7%). Median overall survival was 22.5 months in the intervention group versus 14.9 months in the control group without censoring for the crossover of control patients which occurred after the interim analysis (P=0.03).

With censoring of crossover, median overall survival was 22.5 months in the intervention group and 13.5 months in the control group (P=0.005).

"We are going to start an international multicenter study for all cancer indications together to extend the benefit of Moovcare and to make it accessible to cancer patients all over the world," Dr. Denis said by email.

Dr. Judd E. Hollander, Senior Vice President for Healthcare Delivery Innovation at Sidney Kimmell Medical College, Thomas Jefferson University, Philadelphia, told Reuters Health by email, "All too often, patients need to feel so sick that they reach something I refer to as the 'activation threshold' before engaging their providers. Symptom monitoring should enhance communication long before patients reach that threshold, allowing earlier intervention when things are starting to get worse."

"The main problem with making symptom reporting standard of care, is that it will only work if someone monitors the data on the provider side," he said. "This takes time (and therefore money). The current fee-for-service environment just makes this another non-reimbursed activity for the practices, making it doomed to failure. As we move toward a value-based system, we need to help support the infrastructure (and extra personnel) needed to make optimal use of these types of data inputs."

"Providers and payer partners need to work together to both share costs and share savings before we can expect new innovations (like these) to translate into improved patient outcomes," he said.

"Better patient engagement is not just something that makes people feel good," Dr. Hollander said. "It actually saves lives."

Sivan Innovation, which developed the Moovcare monitoring application used in this study, provided funding for the study and had various relationships with two of the seven authors of this report.

Dr. Denis added, "Sivan has launched a pilot study in private and public hospitals in France and soon will launch a pilot trial in Israel and USA."


JAMA 2019.