Digital Self-Management of Symptoms and Quality of Life for Patients With Advanced Cancer: A Randomized Clinical Trial.

IMPORTANCE

Patients with advanced cancer experience substantial symptom burden that impairs health-related quality of life (HRQOL) and contributes to emergency department (ED) visits and hospitalizations. Evidence for application (app)-facilitated palliative care interventions remains limited.

OBJECTIVE

To evaluate whether an app-facilitated palliative care intervention integrating digital symptom monitoring with nurse-led clinical follow-up can improve outcomes among patients with advanced cancer.

DESIGN, SETTING, AND

PARTICIPANTS

This multicenter randomized clinical trial was conducted at 6 palliative care clinics in Hong Kong from January 25, 2023, to February 5, 2025. Community-dwelling adults with advanced solid cancer who were no longer receiving systemic anticancer treatment were randomized 1:1 to digital symptom monitoring plus usual care or usual care alone and followed up for 18 weeks.

INTERVENTION: Digital symptom monitoring combined weekly symptom reporting using the Integrated Palliative Care Outcome Scale, automated self-management guidance, and nurse-led follow-up for severe symptom alerts.

MAIN OUTCOMES AND MEASURES: The primary outcome was change in HRQOL as measured by EuroQol 5-dimension 5-level (EQ-5D-5L) assessment. Secondary outcomes included self-efficacy (6-item Self-Efficacy for Managing Chronic Disease Scale), Eastern Cooperative Oncology Group performance status (ECOG PS), ED visits, and hospitalizations.

RESULTS

Among 1214 randomized participants (590 to digital symptom monitoring and 624 to usual care; median age, 78 [range, 31-103] years; 617 [50.8%] male), including 821 caregivers (67.6%) as application users, HRQOL was better maintained with digital symptom monitoring at week 18. Mean changes from baseline favored the intervention compared with usual care for EQ-5D-5L utility (0.49 to 0.52 vs 0.50 to 0.38; mean difference in change, -0.15 [95% CI, -0.21 to -0.10]; P < .001) and EQ-5D visual analogue scale (63.16 to 65.72 vs 63.87 to 59.69; mean difference, -6.09 [95% CI, -8.67 to -3.51] points; P < .001). Self-efficacy was better maintained with the digital symptom monitoring intervention (5.29 to 5.34 vs 5.43 to 4.87; mean difference, -0.53 [95% CI, -0.78 to -0.27]; P < .001). Deterioration in ECOG PS (44 of 367 [12.0%] vs 66 of 379 [17.4%]; odds ratio [OR], 1.22 [95% CI, 0.83-1.79]; P = .31) and ED utilization (74 of 367 [20.2%] vs 97 of 379 [25.6%]; OR, 1.27 [95% CI, 0.97-1.67]; P = .09) were similar between groups. Hospitalization outcomes favored digital symptom monitoring, including fewer participants with worsening unplanned hospitalization episodes (63 of 367 [17.2%] vs 108 of 379 [28.5%]; OR, 1.59 [95% CI, 1.21-2.10]; P = .001) and fewer inpatient days during follow-up (mean [SD], 3.4 [8.9] vs 7.3 [15.5]).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of patients with advanced cancer, an app-facilitated palliative care intervention helped maintain HRQOL and self-efficacy and reduced acute care use compared with usual care.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07475312.