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Pilot randomized trial of an electronic symptom monitoring and reporting intervention for hospitalized adults undergoing hematopoietic stem cell transplantation

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Abstract

Purpose

Patients undergoing a hematopoietic stem cell transplantation (HCT) have varied symptoms during their hospitalization. This study examined whether daily symptom reporting (with electronic patient-reported outcomes [PROs]) in an inpatient bone marrow transplant clinic reduced symptom burden on post-transplant days +7, +10, and +14.

Methods

A prospective, single-institution 1:1 pilot randomized, two-arm study recruited HCT patients. HCT inpatients (N = 76) reported daily on 16 common symptoms using the PRO version of the Common Terminology for Adverse Events (PRO-CTCAE). Fisher’s exact test was used to examine differences in the proportion of patients reporting individual symptoms. Multivariable linear regression modeling was used to examine group differences in peak symptom burden, while controlling for symptom burden at baseline, age, comorbidity, and transplantation type (autologous or allogeneic).

Results

HCT patients receiving the PRO intervention also experienced lower peak symptom burden (average of 16 symptoms) at days +7, +10, and +14 (10.4 vs 14.5, p = 0.03).

Conclusions

Daily use of electronic symptom reporting to nurses in an inpatient bone marrow transplant clinic reduced peak symptom burden and improved individual symptoms during the 2 weeks post-transplant. A multi-site trial is warranted to demonstrate the generalizability, efficacy, and value of this intervention.

Trial registration

ClinicalTrials.gov identifier: NCT 02574897

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References

  1. Bevans MF, Mitchell SA, Barrett AJ, Bishop M, Childs R, Fowler D, Krumlauf M, Prince P, Shelburne N, Wehrlen L (2011) Function, adjustment, quality of life and symptoms (FAQS) in allogeneic hematopoietic stem cell transplantation (HSCT) survivors: a study protocol. Health Qual Life Outcomes 9:24

    Article  Google Scholar 

  2. Gyurkocza B, Sandmaier BM (2014) Conditioning regimens for hematopoietic cell transplantation: one size does not fit all. Blood 124(3):344–353

    Article  CAS  Google Scholar 

  3. Liang Y, Zhou M, Wang F, Wu Z (2018) Exercise for physical fitness, fatigue and quality of life of patients undergoing hematopoietic stem cell transplantation: a meta-analysis of randomized controlled trials. Jpn J Clin Oncol 48(12):1046–1057

    Article  Google Scholar 

  4. Nakagaki M, Barras M, Curley C, Butler JP, Kennedy GA (2017) A randomized trial of olanzapine versus palonosetron versus infused ondansetron for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients undergoing hematopoietic stem cell transplantation. Support Care Cancer 25(2):607–613

    Article  Google Scholar 

  5. Liu D, Yan C, Xu L, Wang Y, Han W, Zhang X, Liu K, Huang X (2010) Diarrhea during the conditioning regimen is correlated with the occurrence of severe acute graft-versus-host disease through systemic release of inflammatory cytokines. Biol Blood Marrow Transplant 16(11):1567–1575

    Article  Google Scholar 

  6. Bowen JM, Wardill HR (2017) Advances in the understanding and management of mucositis during stem cell transplantation. Curr Opin Support Palliat Care 11(4):341–346

    Article  Google Scholar 

  7. Ma JD, El-Jawahri AR, LeBlanc TW, Roeland EJ (2018) Pain syndromes and management in adult hematopoietic stem cell transplantation. Hematol Oncol Clin North Am 32(3):551–567

    Article  Google Scholar 

  8. Boonstra L, Harden K, Jarvis S, Palmer S, Kavanaugh-Carveth P, Barnett J, Friese C (2011) Sleep disturbance in hospitalized recipients of stem cell transplantation. Clin J Oncol Nurs 15(3):271–276

    Article  Google Scholar 

  9. Wood WA, Deal AM, Abernethy A, Basch E, Battaglini C, Kim YH, Whitley J, Shatten C, Serody J, Shea T, Reeve BB (2013) Feasibility of frequent patient-reported outcome surveillance in patients undergoing hematopoietic cell transplantation. Biol Blood Marrow Transplant 19(3):450–459

    Article  Google Scholar 

  10. Stover A, Irwin DE, Chen RC et al (2015) Integrating patient-reported outcome measures into routine cancer care: cancer patients’ and clinicians’ perceptions of acceptability and value. EGEMS (Washington, DC) 3(1):1169

    Google Scholar 

  11. Green AK, Reeder-Hayes KE, Corty RW, Basch E, Milowsky MI, Dusetzina SB, Bennett AV, Wood WA (2015) The project data sphere initiative: accelerating cancer research by sharing data. Oncologist 20(5):464–e420

    Article  Google Scholar 

  12. McCurdy SR, Kanakry CG, Tsai HL et al (2018) Development of grade II acute graft-versus-host disease is associated with improved survival after myeloablative HLA-matched bone marrow transplantation using single-agent post-transplant cyclophosphamide. Biol Blood Marrow Transplant 24:343–352

    Article  CAS  Google Scholar 

  13. Atilla E, Atilla PA, Bozdag SC, Demirer T (2017) A review of infectious complications after haploidentical hematopoietic stem cell transplantations. Infection. 45(4):403–411

    Article  CAS  Google Scholar 

  14. Bryant AL, Coffman EM, Bullard E, Hirschey R, Bradley J, Stover A, Wood WA, Bennett AV (2018) Experiences of inpatient bone marrow transplantation nurses and providers using electronic symptom reporting. J Oncol Pract 14(8):e496–e504

    Article  Google Scholar 

  15. Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, Schrag D (2017) Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. Jama 318(2):197–198

    Article  Google Scholar 

  16. Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, Rogak L, Bennett AV, Dueck AC, Atkinson TM, Chou JF, Dulko D, Sit L, Barz A, Novotny P, Fruscione M, Sloan JA, Schrag D (2016) Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 34(6):557–565

    Article  CAS  Google Scholar 

  17. Nipp RD, El-Jawahri A, Ruddy M et al (2018) Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer. Ann Oncol

  18. Basch E, Reeve BB, Mitchell SA, Clauser SB, Minasian LM, Dueck AC, Mendoza TR et al (2014) Development of the National Cancer Institute’s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Natl Cancer Inst 106(9). pii: dju244. https://doi.org/10.1093/jnci/dju244

    Article  Google Scholar 

  19. Hay JL, Atkinson TM, Reeve BB, Mitchell SA, Mendoza TR, Willis G, Minasian LM, Clauser SB et al. (2014) Cognitive interviewing of the US National Cancer Institute’s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). Qual Life Res, 23(1):257–269

    Article  Google Scholar 

  20. Dueck AC, Mendoza TR, Mitchell SA, Reeve BB, Castro KM, Rogak LJ, Atkinson TM, Bennett AV, Denicoff AM, O'Mara AM, Li Y, Clauser SB, Bryant DM, Bearden JD 3rd, Gillis TA, Harness JK, Siegel RD, Paul DB, Cleeland CS, Schrag D, Sloan JA, Abernethy AP, Bruner DW, Minasian LM, Basch E, National Cancer Institute PRO-CTCAE Study Group (2015) Validity and reliability of the US National Cancer Institute’s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). JAMA Oncol 1(8):1051–1059

    Article  Google Scholar 

  21. Atkinson TM, Hay JL, Dueck AC, Mitchell SA, Mendoza TR, Rogak LJ, Minasian LM, Basch E (2018) What do "none," "mild," "moderate," "severe," and "very severe" mean to patients with cancer? Content validity of PRO-CTCAE response scales. J Pain Symptom Manag 55(3):e3–e6

    Article  Google Scholar 

  22. Bevans MF, Mitchell SA, Marden S (2008) The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT). Support Care Cancer 16(11):1243–1254

    Article  Google Scholar 

  23. Sorror ML, Maris MB, Storb R et al (2005) Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 106(8):2912–2919

    Article  CAS  Google Scholar 

  24. Esser P, Kuba K, Scherwath A, Johansen C, Schwinn A, Schirmer L, Schulz-Kindermann F, Kruse M, Koch U, Zander AR, Kröger N, Götze H, Mehnert A (2017) Stability and priority of symptoms and symptom clusters among allogeneic HSCT patients within a 5-year longitudinal study. J Pain Symptom Manag 54(4):493–500

    Article  Google Scholar 

  25. Kroemeke A, Sobczyk-Kruszelnicka M, Kwissa-Gajewska Z (2018) Everyday life following hematopoietic stem cell transplantation: decline in physical symptoms within the first month and change-related predictors. Qual Life Res Int J Qual Life Asp Treat Care Rehab 27(1):125–135

    Google Scholar 

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Funding

This study was financially supported by a 5K12CA120780-07 (Bryant), University Cancer Research Fund UL1RR025747 (Bryant and Wood), and T32 NR00709 (Hirschey). The University of North Carolina’s Patient-Reported Outcomes Core is supported in part by the University Cancer Research Fund and the Lineberger Comprehensive Cancer Center core grant (P30-CA-016086).

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Authors and Affiliations

  1. The University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599-7460, USA

    Ashley Leak Bryant & Rachel Hirschey

  2. Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Erin Coffman

  3. Hemophilia and Thrombosis Center, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Brett Phillips

  4. UNC Lineberger Biostatistics Core, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7460, USA

    Xianming Tan

  5. North Carolina Cancer Hospital, UNC Hospitals, Chapel Hill, USA

    Elizabeth Bullard & Joshua Bradley

  6. Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, USA

    Antonia V. Bennett

  7. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Angela M. Stover

  8. School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Lixin Song

  9. Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, USA

    Thomas C Shea & William A. Wood

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  1. Ashley Leak Bryant
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  2. Erin Coffman
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  3. Brett Phillips
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  11. Thomas C Shea
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  12. William A. Wood
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Corresponding author

Correspondence to Ashley Leak Bryant.

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Conflict of interest

Dr. Bill Wood has funding support from Pfizer, Genetech, Koneksa Health, and Best Doctors. I do not have a financial relationship with the organization that sponsored the research.

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Bryant, A.L., Coffman, E., Phillips, B. et al. Pilot randomized trial of an electronic symptom monitoring and reporting intervention for hospitalized adults undergoing hematopoietic stem cell transplantation. Support Care Cancer 28, 1223–1231 (2020). https://doi.org/10.1007/s00520-019-04932-9

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  • DOI: https://doi.org/10.1007/s00520-019-04932-9

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