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Web-Based Cancer Symptom Self-Management System: A Randomized Clinical Trial.
David Cella1, Nicola Lancki2, Maja Kuharic1
1Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Network Open
|May 5, 2025
Summary
Adding a bilingual web-based self-management program to electronic health record (EHR)-integrated patient-reported outcomes (cPRO) did not reduce symptom burden or healthcare resource use (HCRU) in cancer patients. Low engagement suggests a need for improved intervention strategies.
Area of Science:
- Oncology
- Digital Health
- Health Services Research
Background:
- Cancer patients and survivors often experience significant symptom burden, impacting quality of life and increasing healthcare utilization.
- Effective symptom management is crucial for patient-centered cancer care.
Purpose of the Study:
- To assess if a bilingual (English/Spanish) web-based self-management program, added to electronic health record (EHR)-integrated patient-reported outcome (cPRO) assessment, can reduce symptom burden and healthcare resource use (HCRU) in cancer patients.
- To evaluate the effectiveness of enhanced care (EC) versus usual care (UC) in managing cancer symptoms and resource utilization.
Main Methods:
- A patient-level randomized clinical trial involving 1614 adult cancer patients and survivors across 30 clinics.
- Participants received either usual care (UC) with EHR-integrated cPRO or enhanced care (EC) with an added web-based self-management program.
- Outcomes included Patient-Reported Outcomes Measurement Information System measures (anxiety, depression, fatigue, pain, physical function) and HCRU (inpatient visits, ED visits, hospital days) over 12 months.
Main Results:
- No statistically significant differences were observed between the enhanced care (EC) and usual care (UC) groups for any cPRO outcomes over 12 months.
- Healthcare resource utilization (HCRU) also showed no significant differences between the EC and UC groups.
- Website engagement was low, with only 52.1% accessing the program and 47% of those returning, spending a median of 45 seconds per visit.
Conclusions:
- The addition of a bilingual web-based self-management program to EHR-integrated cPRO did not significantly reduce symptom burden or HCRU in this patient population.
- Low engagement with the web-based intervention highlights a critical need for developing strategies to improve participation and tailor digital health tools for maximum benefit.
- Further research is needed to optimize digital interventions for cancer symptom management and reduce healthcare resource use.
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