Digital remote monitoring of symptoms can improve outcomes in patients with metastatic cancer receiving oral anticancer drugs, according to research published in Nature Medicine.
The remote monitoring intervention, combined with usual care, reduced the length of hospital stays and the rate of grade 3 or higher adverse events, when compared with usual care alone, in the phase 3 CAPRI trial.
The CAPRI trial (ClinicalTrials.gov Identifier: NCT02828462) included 559 patients with metastatic cancers who were receiving oral anticancer agents. The median age of the patients was 62.0 years (range, 20.0 to 92.0 years), 11.8% had performance status of 2, and 27.8% had received 3 or more prior lines of treatment.
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The participants were randomly assigned 1:1 to an intervention combining a nurse navigator-led follow-up system and a web portal-smartphone application in addition to usual care (CAPRI arm, 272 patients) or to usual symptom monitoring at the discretion of the treating oncologist (control arm, 287 patients) for 6 months.
Patients in the CAPRI arm were able to report different symptoms (such as fever, pain, appetite, weight, and specific criteria depending on their treatment) via a smartphone application or web portal, which generated automatic alerts that were sent to the patients and the nurse navigators.
In contrast, patients in the control arm had in-hospital follow-up visits, typically after 1 month, followed by every 2 to 3 months, but no interaction with the nurse navigators.
The researchers found that the mean relative dose intensity was significantly improved in the CAPRI arm compared with the control arm — 93.4% and 89.4%, respectively (P =.043).
However, there were no significant differences between the arms in objective response rate, progression-free survival, or overall survival.
The incidence of grade 3 or higher adverse events was significantly lower in the CAPRI arm than in the control arm — 27.6% and 36.9%, respectively (P =.02).
There was a significant reduction in the proportion of patients hospitalized in the CAPRI arm compared with the control arm — 22.8% and 31.7%, respectively (P =.02).
The average number of days hospitalized was significantly shorter in the CAPRI arm than in the control arm — 2.82 days and 4.44 days, respectively (P =.02).
Moreover, there was a significant reduction in the number of visits to an emergency department for patients in the CAPRI arm compared with those in the control arm —15.1% and 22.0%, respectively (P =.04).
There was a significant increase in the use of supportive care for patients in the CAPRI arm compared with those in the control arm (P =.04). Specifically, more patients in the CAPRI arm than in the control arm visited nutritionists and dietitians (14.3% vs 8.7%; P =.04) or social workers (21.7% vs 10.8%; P <.01).
In addition, the CAPRI intervention significantly improved the patient experience of care. The mean global Patient Assessment of Chronic Illness Care score was 2.94 in the CAPRI arm and 2.67 in the control arm (P =.01).
“These findings show that patient-centered care through remote monitoring of symptoms and treatment may improve patient outcomes and experience,” the researchers concluded.
Disclosures: This research was partly supported by Novartis and AstraZeneca. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Mir O, Ferrua M, Fourcade A, et al. Digital remote monitoring plus usual care versus usual care in patients treated with oral anticancer agents: the randomized phase 3 CAPRI trial. Nat Med. Published online April 25, 2022. doi:10.1038/s41591-022-01788-1
