A simple weekly digital questionnaire about symptoms and side effects can significantly improve the quality of life for people with advanced cancer. This is according to a study by the Alliance Foundation Trials (AFT). In particular, patients who traditionally have less easy access to good care, such as those with lower levels of education and Black patients, benefited strikingly from this form of monitoring.
According to the researchers, the study shows that digital symptom monitoring not only strengthens communication between patients and healthcare providers, but can also help to reduce health inequalities.
More physically active
Previous research had already shown that actively tracking side effects during cancer treatment helps patients feel better and remain more physically active. In the new study, the researchers investigated whether these benefits are the same for all patient groups. They used the AFT-39 PRO-TECT study (Patient Reported Outcomes To Enhance Cancer Treatment), in which 1,191 adults with advanced cancer took part. The patients were treated at 52 oncology clinics across the United States.
Half of the participants received standard care. The other half completed a short weekly questionnaire from home about their symptoms and side effects. This could be done via a smartphone or computer, or by telephone using an automated voice system. This ensured that limited internet access did not pose a barrier.
Whenever patients reported that their symptoms were severe or had worsened, a notification was automatically sent to a nurse on the treatment team, enabling a swift response. “By providing patients with a simple way to report health issues during their treatment, we were able to circumvent communication barriers and potential biases in healthcare,” says Allison Deal, senior biostatistician at the UNC Lineberger Comprehensive Cancer Centre and co-author of the study. “This enabled healthcare providers to respond more quickly, which helped to delay emergency visits and improved treatment outcomes.”
Better quality of life
After three months, it emerged that patients who reported their symptoms weekly experienced fewer side effects and were better able to carry out their daily activities than patients who received standard care alone. The greatest benefits were seen among patient groups that typically face the most barriers to healthcare.
For instance, the study found that patients with a lower level of education benefited more than average from the weekly digital check-ins. They received alerts more frequently as their symptoms worsened, enabling healthcare providers to intervene more quickly. This group subsequently reported both better symptom control and improved physical functioning. Women and patients under the age of 65 – groups who often experience more side effects and psychological distress during cancer treatment – also showed clear improvements in quality of life.
Finally, it emerged that symptom control improved more markedly among patients of colour than among white patients, meaning that the difference that existed at the start of the study virtually disappeared. In addition, these participants were more likely to report that the weekly questionnaires gave them greater control over their treatment and improved communication with their healthcare providers.
Reducing health inequalities
According to the researchers, the results show that digital symptom monitoring is much more than a technological innovation. Precisely because patients can easily report their symptoms themselves, a direct line of communication with the treatment team is established. As a result, signs that might otherwise go unnoticed during routine check-ups are less likely to remain hidden. Victoria Blinder, an oncology specialist at Memorial Sloan Kettering Cancer Centre and senior author of the study, points out that new technologies can sometimes actually widen health inequalities because not everyone benefits from them. “In this study, we see the opposite. Remote monitoring bridges a significant communication gap and improves access to care for groups that are traditionally harder to reach.”
The researchers expect that widespread adoption of this type of weekly digital check-in could not only improve the quality of life for cancer patients but also help reduce or delay visits to A&E. They believe this would alleviate both the emotional and financial burden on patients and their loved ones. According to study lead Ethan Basch of the University of North Carolina School of Medicine, large-scale implementation of this accessible technology could be a practical step towards more equitable and patient-centred cancer care. Further studies are needed to determine how the systems perform in even broader patient groups
