Weekly Online Symptoms Survey Linked to Prolonged OS in Lung Cancer

June 7, 2018

Weekly patient symptom self-reports, filed using an online tool, allowed timely detection of lung cancer relapses and prolonged patient survival.

Online patient self-reporting of symptoms appeared to allow more timely detection of lung cancer relapse and was associated with prolonged overall survival, according to findings from a randomized study (abstract 6500) in France. The findings were presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 1–5 in Chicago.

“This was the first [web portal] study with an overall median survival benefit,” said lead study author Fabrice Denis, MD, PhD, of the Jean Bernard Cancer Institute in Le Mans, France.

Relapses can be detected a month or more before symptoms emerge. But up to 90% of lung cancer relapses are symptomatic by the time they are detected, and relapsing patients commonly wait “many weeks” before telling clinicians about new symptoms, Denis said.

Previous research has suggested that web portals might offer an opportunity for patients and oncologists to stay connected, and for more timely detection of lung cancer relapse using patient-reported outcomes.

One such portal used at Denis’s center in France is a web-mediated patient follow-up system called Moovcare™, on which the patient or relative submits weekly reports on 12 symptoms. When cancer relapse or a dangerous medical condition is suggested by changes in the symptoms reports, the system alerts oncology nurses and oncologists, and prompts an oncology nurse to follow up by phone consultation with the patient or caregiver. When relapse is suspected, an early visit (with or without diagnostic imaging) is scheduled.

The research team undertook a randomized phase III multicenter study of the impact of web portal participation on overall survival (OS) among patients with stage II (node-positive) to stage IV small cell lung cancer (SCLC) or non–small-cell lung cancer (NSCLC) and performance scores of 0 to2. Eligibility criteria also included Internet access.

The intent-to-treat (ITT) population for the web portal group was 60 patients, and for the control/standard surveillance group was 61 patients. The two groups were balanced for age, disease stage, maintenance/tyrosine kinase inhibitor therapy status, and lung cancer histology.

Planned follow-up visit schedules were similar in both study groups, but patients randomly assigned to the web portal study group had fewer scheduled CT imaging exams. (For stage II–IIIA patients, CT scans were scheduled at 6, 12, and 24 months, but those in the web portal group did not receive an 18-month CT exam. Stage IIIB–IV patients in the web-portal group had imaging exams at 12 and 24 months rather than the standard every 3 months.)

At a planned interim analysis, participation in the web portal program was associated with superior survival; the median OS was 19 months vs 12 months, and the 1-year OS was 75% vs 49%, with a hazard ratio [HR] for death of 0.325 (95% CI, 0.157–0.672; P = .0025), Denis reported.

The final OS analysis, at a median follow-up of 24 months, showed a 16% improved survival rate among patients in the web portal group (HR, 0.594; 95% CI, 0.368–0.959). Predefined subgroup analyses revealed that the web portal’s benefits were particularly strong for men, patients with performance scores of 1–2, patients with stage IIIB/IV disease, and patients with SCLC.

Participation in the web portal group also improved performance status at relapse.

“Earlier and increased supportive care led to improved quality of life,” Denis said.

The study was the “first real personalized follow-up” program for patients with lung cancer and Moovcare™ will soon be made available at pilot sites, Denis said. Larger multicentric international trials are planned for other cancers.

The study was funded by SIVAN Innovation Ltd.