Telephone Interventions Might Relieve Some Symptoms in Adults With Cancer

By Will Boggs MD

July 03, 2020

NEW YORK (Reuters Health) - Telephone interventions offer some relief of depression and other symptoms in adults with cancer, but the certainty of evidence is generally low, according to a new Cochrane review.

"Telephone-delivered interventions could - and arguably should (especially in the light of COVID-19) - be options offered over and above attending clinics face-to-face for symptom support," Dr. Emma Ream of the University of Surrey, in Guildford, U.K., told Reuters Health by email. "For particular populations that live far away, are immunocompromised, or feeling too tired/unwell, this could increase access."

Telephone-delivered psycho-educational interventions are increasingly used to provide support for the management of a range of cancer symptoms. Whether these interventions are effective has not been clear.

Dr. Ream and colleagues assessed the effectiveness of telephone-delivered interventions for reducing symptoms associated with cancer and its treatment in a systematic review of 32 studies that included 6,250 participants.

Interventions, delivered primarily by nurses, addressed symptoms of anxiety, depression, emotional distress, uncertainty, fatigue, pain, sexually-related symptoms, and general symptom intensity and/or distress.

Most of 21 telephone-delivered interventions appeared to reduce symptoms of depression significantly, the researchers report in the Cochrane Database of Systematic Reviews.

Many telephone interventions appeared to be more effective than control in reducing anxiety, fatigue and emotional distress.

In contrast, no conclusion could be drawn regarding the effectiveness of telephone-delivered interventions to reduce uncertainty, pain, sexually-related symptoms, dyspnea, or general symptoms. And overall, the researchers found the certainty of evidence to be very low for all outcomes.

There were no clear patterns across studies regarding which forms of intervention (telephone alone versus augmented with other elements) are most effective.

Telephone interventions could save money, but none of the studies reviewed included any form of health-economic evaluation.

"Whilst the evidence is encouraging, it has to be recognized that confidence in the estimates is lower than one would like and so ongoing evaluation is needed," Dr. Ream said. "Further research is required to help build a robust evidence base regarding this."

Dr. Sevilay Hintistan of Karadeniz Technical University Health Sciences Faculty, in Trabzon, Turkey, who has studied the therapeutic effects of nurse telephone follow-up for lung-cancer patients, told Reuters Health by email, "Our study demonstrated that nurse telephone follow-up was influential in decreasing the side effects of chemotherapy in lung cancer patients and increasing the social function of their quality of life when compared with the control group."

"Nurse telephone follow-up can help to reduce chemotherapy symptoms and may enhance the adjustment level by improving patients' chemotherapy symptoms self-care ability," said Dr Hintistan, who was not involved in the review. "Nurse telephone follow-up may contribute positively to the well-being of patients with lung cancer."

Dr. Joseph G. Winger of Duke University Medical Center, in Durham, North Carolina, also recently evaluated a telephone symptom-management intervention for lung-cancer patients and their family caregivers. He told Reuters Health by email, "I primarily work with patients with advanced cancer and heavy symptom burden. They often tell me that they are feeling too ill to attend regular in-person appointments. Remotely delivered appointments, even before the COVID-19 pandemic, are really the only viable option they have for symptom management."

"Given the current COVID-19 pandemic, we are confronted with the reality that our patients with cancer are often immunocompromised and in need of help with their symptoms," he said. "Telephone-delivered interventions are certainly better than untreated symptoms."

Dr. Winger, who also wasn't involved in the review, added, "Our research laboratory, the Pain Prevention and Treatment Research Program at Duke University Medical Center, has had great success with videoconference-delivered symptom management interventions for patients with cancer. Videoconference can more closely approximate an in-person appointment. It can also help mitigate some of the issues that arise during telephone sessions, such as patients doing things (e.g., laundry, cooking) that divert their attention from the call."

SOURCE: Cochrane Database of Systematic Reviews, online June 2, 2020.


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