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Chemotherapy-related neuropathic symptom management: a randomized trial of an automated symptom-monitoring system paired with nurse practitioner follow-up

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Abstract

Purpose

The purpose of this study was to evaluate a new care model to reduce chemotherapy-induced neuropathic symptoms. Neuropathic symptom usual care was prospectively compared to an automated symptom-monitoring and coaching system, SymptomCare@Home (SCH), which included nurse practitioner follow-up triggered by moderate to severe symptoms.

Methods

Patients beginning chemotherapy were randomized to usual care (UC) or to the SCH intervention. This sub-analysis included only taxane/platin therapies. Participants called the automated telephone symptom-monitoring system daily to report numbness and tingling. The monitoring system recorded patient-reported neuropathic symptom severity, distress, and activity interference on a 0–10 scale. UC participants were instructed to call their oncologist for symptom management. SCH participants with symptom severity of ≥ 4 received automated self-care strategies, and a nurse practitioner (NP) provided guideline-based care.

Results

There were 252 participants, 78.6% of which were female. Mean age was 55.1 years. Mean follow-up was 90.2 ± 39.9 days (81.1 ± 40.3 calls). SCH participants had fewer days of moderate (1.8 ± 4.0 vs. 8.6 ± 17.3, p < 0.001) and severe chemotherapy-induced peripheral neuropathy symptoms (0.3 ± 1.0 vs. 1.1 ± 5.2, p = 0.006). SCH participants had fewer days with moderate and severe symptom-related distress (1.4 ± 3.7 vs. 6.9 ± 15.0, p < 0.001; 0.2 ± 0.9 vs. 1.5 ± 6.1, p = 0.001) and trended towards less activity interference (3.3 ± 1.9 vs. 3.8 ± 2.1, p = 0.08). Other neuropathic symptoms were addressed in 5.8–15.4% of SCH follow-up calls.

Conclusions

The SCH system effectively identified neuropathic symptoms and their severity and, paired with NP follow-up, reduced symptom prevalence, severity, and distress compared to usual care.

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Acknowledgements

Noah Kolb, MD’s, research time was supported by the National Institute of Health KL2TR001065.

Funding

The study was sponsored by the National Institute of Health R01 CA120558 (KM).

Author information

Authors and Affiliations

  1. Department of Neuroscience, University of Vermont Medical Center, 1 South Prospect Street, MS 405AR2, Burlington, VT, 05401, USA

    Noah Allan Kolb

  2. Department of Neurology, University of Utah, Salt Lake City, UT, USA

    Albert Gordon Smith, John Robinson Singleton & Summer Karafiath

  3. College of Nursing, University of Utah, Salt Lake City, UT, USA

    Susan L. Beck & Kathi Mooney

  4. Huntsman Cancer Institute, Salt Lake City, UT, USA

    Susan L. Beck & Kathi Mooney

  5. Clinical Research Center, University of Vermont, Burlington, VT, USA

    Diantha Howard

  6. Department of Medicine, Hematology/Oncology, University of Vermont, Burlington, VT, USA

    Kim Dittus

Authors
  1. Noah Allan Kolb
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  4. Susan L. Beck
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  7. Summer Karafiath
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Contributions

N. Kolb, MD; A.G. Smith, MD; J. R. Singleton, MD; S. L. Beck, PhD, APRN, FAAN, AOCN; D. Howard, MS, MA; K. Dittus, MD, PhD; S. Brown, MD; and K Mooney, PhD, RN, FAAN all affirm responsibility for the following content:

1. Substantial contributions to the conception and design or acquisition of data or analysis and interpretation of the data

2. Drafting the article or revising it critically for important intellectual content

3. Approval of the version to be published and all subsequent versions

Corresponding author

Correspondence to Noah Allan Kolb.

Ethics declarations

The IRB at the University of Utah and Vanderbilt approved the study protocol. All participants signed a written informed consent prior to enrollment and randomization.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

The IRB at the University of Utah and Vanderbilt approved the study protocol. All participants signed a written informed consent prior to enrollment and randomization.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Kolb, N.A., Smith, A.G., Singleton, J.R. et al. Chemotherapy-related neuropathic symptom management: a randomized trial of an automated symptom-monitoring system paired with nurse practitioner follow-up. Support Care Cancer 26, 1607–1615 (2018). https://doi.org/10.1007/s00520-017-3970-7

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  • DOI: https://doi.org/10.1007/s00520-017-3970-7

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