We know that our patients with advanced cancer, after treatment their condition may deteriorate with time gradually. The symptoms always appeared during visits, meaning that it’s between the visits, so in between visits they may come to emergency departments and find for hospitalisation. So because of this we developed an app, it’s called SUPPORT+, to help our patients and caregivers. They can report their symptoms at home every week so our nurses can call the patients and contact the patients and give them timely management.
Could you outline the methodology?
This is a randomised controlled study, multicentre. It was conducted in six palliative care centres in Hong Kong. Patients were recruited in these palliative care centres and then randomised 1:1 to either the usual care arm or the intervention arm. In the intervention arm patients used the SUPPORT+ app and reported symptoms every week using their iPhones. Both the patients or caregivers can use the app to report symptoms.
After reporting symptoms they would receive self-management advice from the app and for severe symptoms the nurses would contact the patients using the app or using the phone to tell them timely management.
What did you find?
The primary endpoint is health-related quality of life. We measured it using the EQ-5D-5L. We found that patients using the app would have much improvement in their HR QoL; the HR QoL is much maintained in the intervention arm. For example, the EQ-5D-5L utility score is maintained but is declined quite significantly in the control arm.
In the secondary endpoints we also checked for the [self advocacy], emergency visits and hospitalisations. In the intervention arm, that is using the app arm, the patients are much more maintained with the [self advocacy], meaning they can have self confidence in taking care of themselves. The hospitalisation episodes and the number of days of in-patient care were also much reduced in the intervention arm, while emergency visits and ECOG performance status were no difference in the two arms.
What impact could these findings have?
It means that patients with a proactive symptom reporting and timely nurse management would improve the patients’ health-related quality of life. Although we may not be able to prolong the survival, especially of patients who decide not for further management, but HR QoL is the most important thing to them and to reduce the burden to the caregivers and reduce the burden to the healthcare system.
