An eHealth System Supporting Palliative Care for Patients With Non-Small Cell Lung Cancer A Randomized Trial

作者：Gustafson David H^*; DuBenske Lori L; Namkoong Kang; Hawkins Robert; Chih Ming Yuan; Atwood Amy K; Johnson Roberta; Bhattacharya Abhik; Carmack Cindy L; Traynor Anne M; Campbell Toby C; Buss Mary K; Govindan Ramaswamy; Schiller Joan H; Cleary James F

来源：Cancer, 2013, 119(9): 1744-1751.

DOI：10.1002/cncr.27939

• lung cancer
• symptom distress
• palliative care
• quality of life
• survival
• eHealth
• communication and information technology

BACKGROUND: In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non-small cell lung cancer (NSCLC). METHODS: In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint-patient symptom distress-was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale. RESULTS: Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm. Significant differences were observed at 4 months (P = .031; Cohen d = .42) and at 6 months (P = .004; d = .61). Similar but marginally significant effects were observed at 2 months (P = .051; d = .39) and at 8 months (P = .061; d = .43). Exploratory analyses indicated that survival curves did not differ significantly between the arms (log-rank P = .172), although a survival difference in an exploratory subgroup analysis suggested an avenue for further study. CONCLUSIONS: The current results indicated that an online support system may reduce patient symptom distress. The effect on survival bears further investigation. Cancer 2013; 119: 1744-51.

• 出版日期2013-5-1