Ethan M. Basch, MD
Cell phones can help you hail cars, order dinner, or send electronic payments to friends with the tap of a button.
Tablets and laptops compute faster, store more, and are easier to afford than ever before.
You can take calls from your wrist, too.
That’s why it was only a matter of time before doctors and researchers discovered ways to make the pervasive handheld technology an integral instrument in collaborative medical treatment.
And they have, in the form of a web-based tool that allows cancer patients to report in real time their symptoms and side effects — and get better treatment as a result.
“[Self-reporting software] can fundamentally alter communication between patients and their oncology nurses and physicians by improving knowledge of symptoms and side effects,” said Ethan M. Basch, MD, professor of medicine at the Lineberger Comprehensive Cancer Center of the University of North Carolina. “This can enable earlier actions that avoid downstream complications.”
Earlier this year, Basch and colleagues released a first-of-its-kind study that looked at the impact of self-reporting software in helping patients get more medical attention during cancer treatment, and in turn, extending their lives.
Basch’s study, which included 766 patients at Memorial Sloan Kettering Cancer Center in New York, tested a simple web-based tool. Patients who were undergoing treatment for cancer used a computer program to report any symptoms, side effects, or concerns. (The program was designed specifically for this study and is not available commercially.)
The app also allowed doctors and nurses to monitor a patient’s recovery and follow up with additional treatment options. If a patient’s side effects were severe or worsening, nurses received an e-mail alert so they could call the patient to follow-up, or make sure a doctor reached out to the patient later.
During a patient’s appointment, findings from the tool were printed out and provided for the doctor and patient to discuss. And a detailed analysis helped the entire care team closely track symptoms, side effects, and complications, Basch said.
“This finding is promising because it shows that although we already are quite conscientious about symptom management in clinical practice, that by using simple electronic tools we can even do better,” Basch said.
The benefits of self-reporting
The increased engagement self-reporting software provides may help people with cancer live longer.
In Basch’s study, patients with metastatic cancers who were undergoing chemotherapy and used the tool routinely during the study lived an average of five months longer than patients who did not use the tool.
“The possible mechanism for prolonging life in this study is first that people’s physical function and mobility were significantly improved, and we know from prior research that keeping people more active improves longevity,” Basch said. “The second reason is likely the increased duration of life-prolonging chemotherapy. In this study we found that people using the self-reporting tool remained on chemotherapy for two months longer likely because their side effects were better managed.”
Patients who are undergoing cancer treatment, including chemotherapy, often experience severe side effects. These include, but are not limited to, nausea, uncontrolled pain that leads to hospitalization, and vomiting or diarrhea. Often, doctors and nurses aren’t aware of these symptoms, and patients are left to endure them at home.
Last year, Basch released another that found patients who used the tool experienced a better quality of life during their cancer treatments. They had fewer visits to emergency rooms and fewer hospitalizations.
“Doctors are unaware of half their patients' symptoms,” Basch said. “We can’t provide adequate treatment when we don’t know their full experiences.”
The changing face of cancer treatment
Today, many doctors and oncologists rely on patients to self-report their symptoms and side effects of treatments. If something is bothersome or getting worse, patients are encouraged to call their doctors to report the issues. In the time between visits, however, patients may forget an event or downplay its significance.
“In the current system, between visits, the onus is upon the patient to pick up the phone and call the office or send an electronic message to the office when they have problems, and we know that the majority of patients are hesitant to do that much of the time,” Basch said. “By introducing a simple electronic tool, we remove that barrier through systematic, proactive collections and communications of patients’ symptom data. This improves relationships between patients and clinicians because it eases communication and enables focus on those problems that really matter during encounters.”
While exciting and encouraging, there are many steps to implementing a widely used self-reporting tool. Currently, Basch’s findings are being confirmed in a larger clinical trial. This trial uses a more user-friendly interface that’s available on both a web browser and a mobile device.
When the research is in — and if it confirms what Basch originally found — the work of convincing doctors, hospitals, and insurance companies to support this type of intervention begins.
“Now that we’ve demonstrated benefits associated with patient electronic symptom reporting, we’re turning our attention toward implementation, specifically working out how to integrate this approach into clinical care workflow and into electronic health records symptoms,” Basch said.
Beyond cancer treatment
Basch’s initial field of interest is cancer treatment. As an oncologist, he’s seeking ways to help the patients he interacts with every day. However, he knows the possibilities for this type of web-based reporting go beyond cancer treatment.
“This kind of tool has tremendous promise across chronic illnesses that have symptoms, such as heart failure, diabetes, arthritis, and many others,” he said.
For now, Basch and his colleagues will continue to explore the use of this type of software for patients of all kinds, and hope for confirmation of their original findings. When that day comes, Basch will be ready to help doctors and medical professionals of all stripes find helpful, smart ways to implement self-reporting software for their patients.