Chemotherapy-related neuropathic symptom management: a randomized trial of an automated symptom-monitoring system paired with nurse practitioner follow-up

摘要

Abstract Purpose The purpose of this study was to evaluate a new care model to reduce chemotherapy-induced neuropathic symptoms. Neuropathic symptom usual care was prospectively compared to an automated symptom-monitoring and coaching system, SymptomCare@Home (SCH), which included nurse practitioner follow-up triggered by moderate to severe symptoms. Methods Patients beginning chemotherapy were randomized to usual care (UC) or to the SCH intervention. This sub-analysis included only taxane/platin therapies. Participants called the automated telephone symptom-monitoring system daily to report numbness and tingling. The monitoring system recorded patient-reported neuropathic symptom severity, distress, and activity interference on a 0–10 scale. UC participants were instructed to call their oncologist for symptom management. SCH participants with symptom severity of ≥?4 received automated self-care strategies, and a nurse practitioner (NP) provided guideline-based care. Results There were 252 participants, 78.6% of which were female. Mean age was 55.1?years. Mean follow-up was 90.2?±?39.9?days (81.1?±?40.3 calls). SCH participants had fewer days of moderate (1.8?±?4.0 vs. 8.6?±?17.3, p ? p ?=?0.006). SCH participants had fewer days with moderate and severe symptom-related distress (1.4?±?3.7 vs. 6.9?±?15.0, p ? p ?=?0.001) and trended towards less activity interference (3.3?±?1.9 vs. 3.8?±?2.1, p ?=?0.08). Other neuropathic symptoms were addressed in 5.8–15.4% of SCH follow-up calls. Conclusions The SCH system effectively identified neuropathic symptoms and their severity and, paired with NP follow-up, reduced symptom prevalence, severity, and distress compared to usual care.