Advanced Symptom Management System Research Articles

Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART)

ObjectiveTo evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy,...

Advanced Symptom Management System for Patients with Malignant Pleural Mesothelioma (ASyMSmeso): Mixed Methods Study.

BackgroundPatients with malignant pleural mesothelioma (MPM) have a life-limiting illness and short prognosis and experience many debilitating symptoms from early in the illness. Innovations such as remote symptom monitoring are needed to enable patients to maintain wellbeing and manage symptoms in a proactive and timely manner. The Advanced Symptom Management System (ASyMS) has been successfully used to monitor symptoms associated with cancer.ObjectiveThis study aimed to determine the feasibility and acceptability of using an ASyMS adapted for use by patients with MPM, called ASyMSmeso, enabling the remote monitoring of symptoms using a smartphone.MethodsThis was a convergent mixed methods study using patient-reported outcome measures (PROMs) at key time points over a period of 2-3 months with 18 patients. The Sheffield Profile for Assessment and Referral for Care (SPARC), Technology Acceptance Model (TAM) measure for eHealth, and Lung Cancer Symptom Scale-Mesothelioma (LCSS-Meso) were the PROMs used in the study. Patients were also asked to complete a daily symptom questionnaire on a smartphone throughout the study. At the end of the study, semistructured interviews with 11 health professionals, 8 patients, and 3 carers were conducted to collect their experience with using ASyMSmeso.ResultsEighteen patients with MPM agreed to participate in the study (33.3% response rate). The completion rates of study PROMs were high (97.2%-100%), and completion rates of the daily symptom questionnaire were also high, at 88.5%. There were no significant changes in quality of life, as measured by LCSS-Meso. There were statistically significant improvements in the SPARC psychological need domain (P=.049) and in the “Usefulness” domain of the TAM (P=.022). End-of-study interviews identified that both patients and clinicians found the system quick and easy to use. For patients, in particular, the system provided reassurance about symptom experience and the feeling of being listened to. The clinicians largely viewed the system as feasible and acceptable, and areas that were mentioned included the early management of symptoms and connectivity between patients and clinicians, leading to enhanced communication.ConclusionsThis study demonstrates that remote monitoring and management of symptoms of people with MPM using a mobile phone are feasible and acceptable. The evidence supports future trials using remote symptom monitoring to support patients with MPM at home.

Feasibility randomised controlled trial of remote symptom chemotherapy toxicity monitoring using the Canadian adapted Advanced Symptom Management System (ASyMS-Can): a study protocol

IntroductionTechnology is emerging as a solution to develop home-based, proactive ‘real-time’ symptom monitoring and management in cancer care. The Advanced Symptom Monitoring and Management System—Canada (ASyMS-Can) is a remote phone-based...

Adaptation and Implementation of a Mobile Phone-Based Remote Symptom Monitoring System for People With Cancer in Europe.

BackgroundThere has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings.ObjectiveThis study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone–based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care.MethodsThere were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center.ResultsThe ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT.ConclusionsAdapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries.

Usability Evaluation of a Mobile Phone-Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study.

BackgroundAs most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients with cancer, using patient-reported outcomes questionnaires and a clinician alerting system.ObjectiveThis study aims to evaluate the usability of the ASyMS, a mobile phone–based technology, from the perspective of Canadian patients with cancer receiving chemotherapy to identify existing design, functionality, and usability issues and elicit their views, experiences, and satisfaction with the ASyMS.MethodsWe used a mixed-method approach to data collection with user-based testing, a think-aloud technique, semistructured interviews, and short answer questionnaires with a purposive sample of 10 patients with cancer. Participants attended usability testing sessions at the Centre for Global eHealth Innovation, University Health Network, and performed specific tasks on the ASyMS device. The test was videorecorded and each task was timed during the test. After the usability sessions, participants completed a posttest questionnaire and participated in a semistructured qualitative interview. A thematic analysis was used to code and categorize the identified issues into themes that summarized the type and frequency of occurrence.ResultsThe thematic analysis generated 3 overarching themes as follows: ASyMS user-friendliness; usefulness of ASyMS (content quality and richness); and intention to use. Results from the posttest questionnaire indicated that 80% (8/10) of participants had great motivation to use the ASyMS, 70% (7/10) had positive perceptions of the successful use of the ASyMS, and all (10/10, 100%) had a positive attitude toward using the ASyMS in the future. Most identified design and functionality issues were related to the navigation of the ASyMS device and a desire for a more attractive design with advanced functionality and features. The main general design recommendations were as follows: enhance the readability of the screen; implement advance options (eg, search option); and support better navigation.ConclusionsThe ASyMS has shown positive perceptions of patients in usability testing and qualitative interviews. An evaluation of the effects of the ASyMS on symptom outcomes in a clinical trial is needed.

Remote monitoring systems in the cancer setting: eSMART: Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology for patients with cancer

Remote monitoring systems in the cancer setting: eSMART: Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology for patients with cancer

The eSMART study protocol: a randomised controlled trial to evaluate electronic symptom management using the advanced symptom management system (ASyMS) remote technology for patients with cancer

IntroductionWhile some evidence exists that real-time remote symptom monitoring devices can decrease morbidity and prevent unplanned admissions in oncology patients, overall, these studies have significant methodological weaknesses. The electronic Symptom...

NU03.03 eHealth and Remote Patient Monitoring and Supportive Care in Thoracic Oncology

Lung cancer is the commonest cancer worldwide with 1.6 million people diagnosed each year. People with lung cancer experience a high level of supportive care needs and many of these needs are unmet. Systematic supportive care is therefore vital in this patient group. Patient Reported Outcome Measures (PROMs) can be used to identify the supportive care needs of people with lung cancer and the collection of PROMs data is reported to have a number of positive effects on patient outcomes. Enhancing the utility of PROMs within clinical practice is the use of health technologies that have the ability to collect PROM data remotely from patients in their own homes and send this information in ‘real time’ immediately to relevant health/social care professionals for subsequent intervention. The Advanced Symptom Management System is one of the most evolved remote patient monitoring systems in cancer care. This presentation will initially focus on remote patient monitoring within the context of lung cancer before considering the implications for the future and the ultimate vision of connected health for all. Technology, connected health, lung cancer, supportive care

The assessment and management of chemotherapy-related toxicities in patients with breast cancer, colorectal cancer, and Hodgkin's and non-Hodgkin's lymphomas: A scoping review.

The purpose of the eSMART (Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology) study is to evaluate the use of mobile phone technology to manage chemotherapy-related toxicities (CRTs) in people with breast cancer (BC), colorectal cancer (CRC), Hodgkin's lymphoma (HL), and non-Hodgkin lymphoma (NHL)) across multiple European sites. One key objective was to review the published and grey literature on assessment and management of CRTs among patients receiving primary chemotherapy for BC, CRC, HL, and NHL to ensure that ASyMS remained evidence-based and reflected current and local practice. Three electronic databases were searched for English papers, with abstracts available from 01/01/2004-05/04/2014. For the grey literature, relevant clinical practice guidelines (CPGs)/evidence-based resources (EBRs) from the main international cancer organisations were reviewed as were symptom management (SM) protocols from the sites. After full-text screening, 27 publications were included. The majority (n=14) addressed fatigue and focused on BC patients. Relevant CPGs/EBRs were found for fatigue (n=4), nausea/vomiting (n=5), mucositis (n=4), peripheral neuropathy (n=3), diarrhoea (n=2), constipation (n=2), febrile neutropenia/infection (n=7), palmar plantar erythrodysesthesia (PPE) (n=1), and pain (n=4). SM protocols were provided by >40% of the clinical sites. A need exists for empirical research on SM for PPE, diarrhoea, and constipation. Research is needed on the efficacy of self-care strategies in patients with BC, CRC, HL, and NHL. In general, consistency exists across CPGs/EBRs and local guidelines on the assessment and management of common CRTs.

Enabling symptom self-management via use of an electronic patient-reported outcomes (ePRO) system to increase self-efficacy of patients with cancer receiving active chemotherapy treatment

Enabling symptom self-management via use of an electronic patient-reported outcomes (ePRO) system to increase self-efficacy of patients with cancer receiving active chemotherapy treatment

Real-time management of chemotherapy toxicity using the Advanced Symptom Management System (ASyMS)

This paper describes an ongoing study of the Advanced Symptom Management System (ASyMS) for patients receiving chemotherapy for breast or colorectal cancer. We begin by detailing the ASyMS work to date, providing an overview of research conducted in the field over the last ten years. The current study, ASyMS-III, is then presented, highlighting the study methodology, multi-site involvement, the outcomes being measured, and discussion of the tool. The paper concludes with reflections on the progress of the ASyMS-III study to date, and discusses potential directions for future research.

4180 ORAL Using Mobile Phone Technology to Assess Symptoms in Patients Receiving Palliative Care – The Advanced Symptom Management System (ASyMS®-P)

4180 ORAL Using Mobile Phone Technology to Assess Symptoms in Patients Receiving Palliative Care – The Advanced Symptom Management System (ASyMS®-P)

Working in collaboration with young people and health professionals. A staged approach to the implementation of a randomised controlled trial

ASyMS© is an Advanced Symptom Management System utilising mobile phone technology to monitor chemotherapy-related symptoms and promote self-care. It was first developed with an adult cancer population and is now being evaluated with young people through an iterative development process. ASyMS© involves patients recording and sending symptom reports to the hospital and receiving tailored self-care advice. Health professionals are alerted when severe symptoms are reported. Three phases of the ASyMS©-YG (young people) study are complete. Phase 1 involved young people identifying the symptoms to be assessed. Phase 2 involved young people testing the symptom report system, and ascertaining young people’s, parents’ and professionals’ perceptions of ASyMS©-YG. This paper reports on Phase 3, in which the system was developed further in preparation for a randomised controlled trial (RCT). Health professionals devised an alert system based on risk modelling side-effect severity, and young people and professionals developed self-care advice. A pilot study was conducted to test the alert system and study design in readiness for a definitive RCT. The contribution young people and professionals have made to this project is invaluable in evaluating the practical effectiveness of ASyMS©-YG and ensuring the intervention is acceptable and works in everyday practice.

Utilization of the Medical Research Council Evaluation Framework in the Development of Technology for Symptom Management

Technology is becoming an important medium for supporting patients in health care. However, successful application depends on user acceptability. The Advanced Symptom Management System (ASyMS) involves patients reporting cancer chemotherapy-related symptoms using mobile phone technology. The aim of this article was to report a study of how young people were involved in the development of ASyMS using the Medical Research Council framework for evaluating complex interventions. A convenience sample of young people aged 13 to 18 years undergoing cancer chemotherapy were recruited from 2 principal cancer treatment centers in London. In phase 1, young people selected 5 symptoms from an adapted version of the Memorial Symptom Assessment Scale that were most important to them. In phase 2, young people completed the ASyMS-YG PDA (personal digital assistant) questionnaire daily on days 1 to 14 of a cycle of chemotherapy and pre/post-use questionnaires. In phase 1, 5 young people chose diarrhea, nausea, vomiting, constipation, and weight loss as the most important symptoms. In phase 2, 25 young people reported positively to using PDA technology, found ASyMS-YG simple and easy to complete, and liked that they were monitored at home. In addition to the 5 core symptoms, the ASyMS-YG reports showed the number (n = 37) of other symptoms young people experienced. This early development work indicates the acceptability of ASyMS-YG and has informed an exploratory trial (phase 3) and randomized controlled trial (stage 4). This study reaffirms the importance of promoting communication between young people and health professionals.

Involving health professionals in the development of an advanced symptom management system for young people: The ASyMS ©-YG study

Purpose of the study ASyMS © is an advanced symptom management system utilising mobile phone technology for patients to report cancer chemotherapy-related symptoms. The aim of this paper is to present health professionals involvement in the development of ASyMS © for use with young people (YG) and evaluate their perceptions of the system. Stage 1 Health professionals reviewed the symptoms chosen by young people to be included on the personal digital assistant questionnaire to confirm they would have universal relevance. These included: mouth sores, nausea, diarrhoea, vomiting and weight loss. Stage 2 Health professionals completed a questionnaire prior to the study commencing, which suggested they felt ASyMS ©-YG would give young people control and facilitate timely interventions when symptoms occur. Post-study perceptions were sought through semi-structured interviews and consultation sessions with 23 health professionals. These showed two over-arching themes: young people's symptoms and perceptions of ASyMS ©-YG; and six sub-themes: increased control for young people; enhances communication between young people and health professionals; and helps with professional early intervention; increased support for young people; improve knowledge and understanding; technology appealing to young people. Conclusions This early development work indicates that ASyMS ©-YG is acceptable to health professionals and their perceptions of the system were overall very positive. Health professionals will continue to be involved in the study through developing self-care guidelines and alert system, which will be tested in an exploratory trial (stage 3) and randomised controlled trial (stage 4) in the future.

Patients' perceptions and experiences of using a mobile phone-based advanced symptom management system (ASyMS©) to monitor and manage chemotherapy related toxicity

Chemotherapy forms a core component of treatment for the majority patients with cancer. Recent changes in cancer services mean patients frequently receive such treatment as outpatients and are often required to manage side effects at home without direct support from oncology health professionals. Information technology continues to develop to support patients in the community; this study evaluated the impact of a mobile phone-based advanced symptom management system (ASyMS) on chemotherapy related toxicity in patients with lung, breast or colorectal cancer. One hundred and twelve patients were randomized from seven clinical sites across the UK; 56 patients used the mobile phone to record their symptoms, sending their reports directly to the nurses at their clinical site; 56 control group patients received standard care. Health professionals were alerted about any severe or life-threatening symptoms through the development of a chemotherapy symptom risk model. Patients' perceptions of ASyMS were evaluated pre and post participation. Patients reported many benefits of using ASyMS including improved communication with health professionals, improvements in the management of their symptoms, and feeling reassured their symptoms were being monitored while at home. ASyMS has the potential to positively impact on the management of symptoms in patients receiving chemotherapy treatment.

Evaluation of a mobile phone-based, advanced symptom management system (ASyMS©) in the management of chemotherapy-related toxicity

To evaluate the impact of a mobile phone-based, remote monitoring, advanced symptom management system (ASyMS) on the incidence, severity and distress of six chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand-foot syndrome and diarrhoea) in patients with lung, breast or colorectal cancer. A two group (intervention and control) by five time points (baseline, pre-cycle 2, pre-cycle 3, pre-cycle 4 and pre-cycle 5) randomised controlled trial. Seven clinical sites in the UK; five specialist cancer centres and two local district hospitals. One hundred and twelve people with breast, lung or colorectal cancer receiving outpatient chemotherapy. A mobile phone-based, remote monitoring, advanced symptom management system (ASyMS). Chemotherapy-related morbidity of six common chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand-foot syndrome and diarrhoea). There were significantly higher reports of fatigue in the control group compared to the intervention group (odds ratio = 2.29, 95%CI = 1.04 to 5.05, P = 0.040) and reports of hand-foot syndrome were on average lower in the control group (odds ratio control/intervention = 0.39, 95%CI = 0.17 to 0.92, P = 0.031). The study demonstrates that ASyMS can support the management of symptoms in patients with lung, breast and colorectal cancer receiving chemotherapy.

Perceptions of the use of a remote monitoring system in patients receiving palliative care at home

In remote communities, where frequent face-to-face contact with health professionals may be difficult, the ongoing review and management of symptoms--a fundamental part of good palliative care--can be difficult to achieve. Telecare and other developments in information technology are increasingly being sought as a means of addressing shifting population demographics and rising demands on stretched health services, and may help in providing a system which allows patients to report their symptoms as they are happening. This may be one way of enhancing symptom management and improving quality of care at the end of life. A study testing the feasibility of using mobile phone-based technology (Advanced Symptom Management System in Palliative Care (ASyMSp)) to monitor and manage symptoms reported by patients being cared for at home in the advanced stages of their illness was carried out in two rural communities in the north of Scotland. The results of this study show that the system was usable and acceptable to patients and the health professionals who cared for them.

Nurse's perceptions and experiences of using of a mobile-phone-based Advanced Symptom Management System (ASyMS ©) to monitor and manage chemotherapy-related toxicity

Many people diagnosed with cancer will receive chemotherapy as a core component of their care. Recent changes in the delivery of cancer services mean that patients frequently receive care on an out-patient basis and are therefore often required to manage related side effects at home without direct support from oncology health professionals. The use of information and communications technology may be seen as a means of supporting patients receiving chemotherapy in the home care setting. This mixed methods study, reports on the perceptions of nurses (n=35) who participated in a randomised controlled trial of a mobile phone based, Advanced Symptom Management System (ASyMS), in the management of chemotherapy-related toxicity in patients with breast, lung and colorectal cancer. Nurses' perceptions of ASyMS were evaluated at the start and the end of the study. Overall, they could see the benefits of ASyMS in the remote monitoring of chemotherapy toxicity and its role in facilitating early intervention and subsequent management, demonstrating the potential utility of the system within clinical practice.

8069 ORAL A randomised controlled trial of a remote monitoring, mobile phone based, advanced symptom management system in patients with colorectal, lung and breast cancer receiving chemotherapy

8069 ORAL A randomised controlled trial of a remote monitoring, mobile phone based, advanced symptom management system in patients with colorectal, lung and breast cancer receiving chemotherapy