Cancer patients who used an online system to monitor their symptoms while undergoing chemotherapy had improved symptom control, according to results of a study published in the Journal of Clinical Oncology.

The phase 3, randomized study followed 508 patients at the Leeds Cancer Centre, United Kingdom, over 18 weeks as they began systemic chemotherapy. The patients were diagnosed with colorectal, breast, or gynecologic cancers.

Patients were randomized to 2 groups. The control group received usual care alone, while the intervention group received usual care and used the online system for symptom monitoring — Electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID).

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Patients in eRAPID group used their phones or computers to submit electronic reports of symptom flares to their oncology team, in addition to sending in weekly symptom assessments. Once a report was submitted, patients received real-time education about how to manage mild or moderate symptoms, while severe symptoms would prompt an alert to the medical team via a monitored email.

The degree of symptom control in all patients was evaluated using the Functional Assessment of Cancer Therapy Scale – General Physical Well-Being subscale. This assessment covers common symptoms during chemotherapy and their impact on patient functioning: pain, nausea, lack of energy, time in bed, feeling ill, not meeting family needs, and being bothered by side effects.

Patients in both the eRAPID and control arms completed paper assessments at weeks 6, 12, and 18.

The researchers found that eRAPID participants had improved physical well-being compared with the control group at 6 weeks and 12 weeks (P =.028 and P =.039, respectively) but not at 18 weeks (P =.69).

Patients in the eRAPID group had significantly better self-efficacy scores at 18 weeks, however (P =.0073).

The researchers also noted that a smaller percentage of patients in the eRAPID group experienced clinically significant deterioration at 6 weeks (43% vs 48%) and 12 weeks (47% vs 56%).

No significant differences were seen between the groups when comparing hospital admissions, emergency hotline calls, or chemotherapy delivery.

In a subgroup analysis, the researchers found that the positive effect of eRAPID was limited to patients with nonmetastatic disease. For those with metastatic disease (n = 191), no significant difference in well-being was found between the eRAPID and usual care groups.

However, the researchers noted that their study may have been limited by the relatively small number of patients with metastatic disease and the brevity of the trial. Extended monitoring might have detected symptoms of recurrence that would lead to treatment interventions in the metastatic population.

Other study limitations included possible contamination bias because oncology practitioners followed patients in both arms of the study, potentially influencing their interactions when assessing symptom management.

In addition, the average adherence rate of weekly eRAPID assessment was only 64.6%, although the researchers noted that this rate was similar to those in other online monitoring studies.

“The eRAPID approach offers a model for alternative care delivery during curative chemotherapy,” the researchers concluded.

Disclosures: This research was supported by the National Institute for Health Research

Cancer Research. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Absolom K, Warrington L, Hudson E, et al. Phase III randomized controlled trial of eRAPID: ehealth intervention during chemotherapy. J Clin Oncol. 2021;39(7):734-747. doi:10.1200/JCO.20.02015