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Outcomes for patients post-lung cancer surgery improved with electronic patient-reported outcome-based symptom management compared with usual care.
Lung cancer surgery often results in significant postoperative symptoms for patients. Traditional postoperative care, which tends to be reactive rather than proactive, can be insufficient for managing these symptoms effectively.
“Most patients with lung cancer experience a variety of moderate-to-severe symptoms within the first year postsurgery,” wrote Wei Dai, MD, PhD, and colleagues in a study posted online in the Journal of Clinical Oncology. “However, under the current standard of care, symptom monitoring after discharge is often reactive and inefficient. Electronic patient-reported outcome (ePRO)–based symptom monitoring, allowing for patient-centered, proactive, real-time, and remote symptom management, offers a way to address these challenges.”
ePRO symptom monitoring can provide a proactive, patient-centered, and real-time approach to remote symptom management for patients recovering from lung cancer surgery. Initial results from a randomized trial indicated that intensive ePRO-based symptom management significantly reduced symptom burden within the first month postdischarge compared with usual care. However, a recent multicenter, randomized trial extended these findings to explore the long-term benefits up to 1 year post discharge.
The randomized study included patients from one tertiary cancer hospital and two tertiary general hospitals. The researchers enrolled patients with clinical stage I-IIIA lung cancer, aged 18-75 years, who had not undergone neoadjuvant therapy and were able to use electronic devices for symptom reporting. The study team randomly assigned participants to receive either ePRO-based symptom management or usual care. The ePRO group reported symptoms daily postsurgery, twice weekly for the first month postdischarge, and at 3, 6, 9, and 12 months. The usual care group followed standard postoperative care protocols.
The primary outcome measured was the number of symptom threshold events at 12 months postdischarge.
“The secondary outcomes included the composite physical interference score (average score of general activity, work, and walking), composite affective interference score (average score of mood, relations with others, and enjoyment of life), 16 single symptom item score, and six single functional item score in the MDASI-LC,” study authors wrote.
At 12 months post discharge, the ePRO group of 55 patients reported significantly fewer symptom threshold events compared to the usual care group of 57 patients (median [IQR], 0 [0-0] vs 0 [0-1]; P=0.040). Over the entire 1 to 12 months, the ePRO group also consistently reported lower composite scores for physical interference (estimate, –0.86; 95% CI, –1.32 to –0.39) and affective interference (estimate, –0.70; 95% CI, –1.14 to –0.26) (Table).
The findings indicate that patients in the ePRO group experienced fewer severe symptoms (scores ≥4) in key areas such as pain, fatigue, disturbed sleep, shortness of breath, and coughing. This group also reported better functional outcomes, including less interference with general activities, work, walking, mood, relationships, and enjoyment of life.
The study demonstrates that early intensive ePRO-based symptom management not only reduces symptom burden but also enhances functional status for up to one year after discharge.
These findings support integrating ePRO systems into standard postoperative care for lung cancer surgery patients. Implementing such systems could lead to better long-term outcomes and an improved quality of life for patients recovering from lung cancer surgery.
“Early intensive ePRO-based symptom management after lung cancer surgery reduced symptom burden and improved functional status for up to 1 year postdischarge, supporting its integration into standard care,” concluded the study authors.
