Effectiveness of Internet-based interventions in managing chemotherapy-related symptoms in patients with cancer: a systematic literature review
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The aims of this review were to (1) examine the effectiveness of Internet-based interventions on cancer chemotherapy-related physical symptoms (severity and/or distress) and health-related quality of life (HRQOL) outcomes and (2) identify the design elements and processes for implementing these interventions in oncology practices.
A systematic review was performed. The Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and PsycINFO were searched for studies dating from January 2000 through to October 2016. Based on pre-determined selection criteria, data was extracted from eligible studies. Methodological quality of studies was assessed using an adapted version of the Cochrane Collaboration Back Review Group checklist.
The literature search yielded 1766 studies of which only six RCTs fulfilled the eligibility criteria. Although the content, duration, and frequency of interventions varied considerably across studies, commonly used elements included tailored information, education, self-management support, and communication with clinicians. Five studies measured symptom distress and four of them reported statistically significant differences between study groups. Of the three studies that measured HRQOL, two reported improvement (or no deterioration over time) for the intervention group. However, several methodological issues including high attrition rates, poor adherence to interventions, and use of non-validated measures affect confidence in the strength of evidence.
Despite the evidence in support of using the Internet as a worthwhile tool for effective patient engagement and self-management of chemotherapy-related symptoms outside clinic visits, methodological limitations in the evidence base require further well-planned and quality research.
KeywordsInternet-based intervention Implementation Symptom management Chemotherapy-related toxicity Patient engagement Cancer
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
We have full control of all primary data and agree to allow the journal to review our data if requested.
- 2.Bloechl-Daum B, Deuson RR, Mavros P et al (2006) Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol 24(27):4472–4478. https://doi.org/10.1200/jco.2006.05.6382 CrossRefPubMedGoogle Scholar
- 5.Van Leeuwen FE, Ng AK (2016) Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment. Hematology Am Soc Hematol Educ Program 1:323–330Google Scholar
- 9.Peterson DE, Lalla R (2010) Overview of complications of systemic chemotherapy. In Oral Complications of Cancer and its Management. Oxford University Press, OxfordGoogle Scholar
- 11.Kossert A, Howell D, Friedman A et al (2013) Characterization of symptom and disease self-management in Canadian Cancer Care: illness representations of sentinel disease sites. Ann Behav Med 45(2):S10 A028Google Scholar
- 19.Puts MTE, Tu HA, Tourangeau A et al (2013) Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review. Ann Oncol:1–14Google Scholar
- 26.Agboola SO, Ju W, Elfiky A et al (2015) The effect of technology-based interventions on pain, depression, and quality of life in patients with cancer: a systematic review of randomized controlled trials. J Med Internet Res 17(3):e65. https://doi.org/10.2196/jmir.4009 CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Dy SM, Roy J, Ott GE et al (2011) Tell Us: a web-based tool for improving communication among patients, families, and providers in hospice and palliative care through systematic data specification, collection, and use. J Pain Symptom Manag 42(4):526–534. https://doi.org/10.1016/j.jpainsymman.2010.12.006 CrossRefGoogle Scholar
- 40.Ryhanen AM, Rankinen S, Siekkinen M et al (2013) The impact of an empowering Internet-based Breast Cancer Patient Pathway program on breast cancer patients’ clinical outcomes: a randomised controlled trial. J Clin Nurs 22(7–8):1016–1025. https://doi.org/10.1111/jocn.12007 CrossRefPubMedGoogle Scholar
- 42.Borosund E, Cvancarova M, Moore SM et al (2014) Comparing effects in regular practice of e-communication and web-based self-management support among breast cancer patients: preliminary results from a randomized controlled trial. J Med Internet Res 16(12):e295. https://doi.org/10.2196/jmir.3348 CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Medical Research Council (2000) A framework for the development and evaluation of RCTs for complex interventions to improve health. Medical Research Council, LondonGoogle Scholar
- 46.National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. NIH publication # 09-7473. Published May 29, 2009; Revised Version 4.02 September 15, 2009. Available at http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf. Accessed 15 Sept 2017
- 50.McLean S, Chandler D, Nurmatov U et al (2010) Telehealthcare for asthma. Cochrane Database Syst Rev 10. https://doi.org/10.1002/14651858.CD007717.pub2
- 52.Elbert NJ, van Os-Medendorp H, van Renselaar W et al (2014) Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses. J Med Internet Res 16(4):e110. https://doi.org/10.2196/jmir.2790 CrossRefPubMedPubMedCentralGoogle Scholar
- 55.Schofield P, Chambers S (2015) Effective, clinically feasible and sustainable: key design features of psycho-educational and supportive care interventions to promote individualised self-management in cancer care. Acta Oncol 54(5):805–812. https://doi.org/10.3109/0284186X.2015.1010016 CrossRefPubMedGoogle Scholar
- 58.Ruland CM, Maffei RM, Børøsund E et al (2013) Evaluation of different features of an eHealth application for personalized illness management support: cancer patients’ use and appraisal of usefulness. Int J Med Inform 82(7):593–603. https://doi.org/10.1016/j.ijmedinf.2013.02.007 CrossRefPubMedGoogle Scholar
- 60.Goldzweig LC, Shekelle PG, Towfigh AA et al (2012) Systematic review: secure messaging between providers and patients, and patients’ access to their own medical record. Evid Based Synth Prog 39(1)Google Scholar
- 62.Strecher V (2007) Internet methods for delivering behavioral and health-related interventions (eHealth). Annu Rev Clin Psychol 3:53–76. https://doi.org/10.1146/annurev.clinpsy.3.022806.091428 CrossRefPubMedGoogle Scholar
- 64.Varsi C, Ekstedt M, Gammon D et al (2015) Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 17(11):e262. https://doi.org/10.2196/jmir.5091 PubMedPubMedCentralGoogle Scholar
- 68.Li J, Land L, Ray P (2008) Humanitarian Technology Challenge (HTC)-electronic health records perspective. A Report of Joint Project of IEEE and United Nations Foundation InGoogle Scholar
- 70.Nijland N, van Gemert-Pijnen J, Boer H et al (2008) Evaluation of internet-based technology for supporting self-care: problems encountered by patients and caregivers when using self-care applications. J Med Internet Res 10(2):e13. https://doi.org/10.2196/jmir.957 CrossRefPubMedPubMedCentralGoogle Scholar
- 75.Bennett G, Glasgow R (2009) The delivery of public health interventions via the Internet: actualizing their potential. Annu Rev Public Health 30:273–292. https://doi.org/10.1146/annurev.publhealth.031308.100235 CrossRefPubMedGoogle Scholar
- 76.Rogers E (2003) Diffusion of innovations. Free Press, New YorkGoogle Scholar
- 77.Eysenbach G (2005) The law of attrition. J Med Internet Res 1(e11). https://doi.org/10.2196/jmir.7.1.e11
- 80.Ruland CM, Holte HH, Roislien J et al (2010) Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients’ need for symptom management support: a randomized clinical trial. J Am Med Inform Assoc 17(4):403–410. https://doi.org/10.1136/jamia.2010.005660 CrossRefPubMedPubMedCentralGoogle Scholar