- This exploratory analysis of data from a randomized, controlled trial investigated by Massachusetts General Hospital Cancer Center researchers showed how age moderated outcomes of electronic self-reporting of symptoms by patients with metastatic cancer
- Among younger patients (age <70), those assigned to electronic symptom monitoring had a lower risk of emergency room visits and better overall survival than those assigned to usual oncology care alone
- These benefits were not apparent for older patients in the intervention group
- Both older and younger patients in the intervention group experienced better quality of life and reduced risk of hospitalizations than patients in the control group
- Collectively, these findings suggest electronic symptom monitoring may not provide the same benefits for geriatric oncology patients as for younger patients
Many centers now ask patients with cancer to report their symptoms regularly on a tablet computer or other electronic device. Such monitoring is especially promising for older patients, whose cases tend to be complex and leave little time to review symptoms during clinic visits.
Ryan D. Nipp, MD, MPH, oncologist in Gastrointestinal & Geriatric Oncology, Areej R. El-Jawahri, MD, oncologist at the Massachusetts General Hospital Cancer Center, and colleagues recently became the first to report that the outcomes of electronic monitoring of cancer symptoms differ according to patient age. Their findings appear in the Annals of Oncology.
Study Subjects and Methods
The researchers conducted an exploratory analysis of data collected from a randomized, controlled trial published in JAMA. In that trial, 766 consecutive patients initiating chemotherapy for metastatic cancer were randomly assigned to usual oncology care alone or electronic reporting of 12 symptoms on a tablet computer. Participation continued until cancer treatment was stopped, voluntary withdrawal or death.
Younger patients were defined as those <70. There was no significant difference between the enrollment rates of younger patients (median age 58) and older patients (median age 75).
- Younger patients in the intervention group were at lower risk of emergency department visits (HR, 0.74; P = .01) and had longer survival (HR, 0.76; P = .01) than younger patients receiving usual care
- Those benefits were not apparent for older patients in the intervention group
- Both older and younger patients in the intervention group experienced better quality of life and less risk of hospitalization than patients in the control group
Older patients with advanced cancer are as willing as those under 70 to participate in electronic symptom monitoring, but they may not experience the same level of benefit, at least in terms of ED visits and survival. Many factors that influence those outcomes in older adults—such as mobility, cognitive function and the availability of social support—are not comprehensively addressed by symptom monitoring.
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