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Keywords:

  • lung cancer;
  • symptom distress;
  • palliative care;
  • quality of life;
  • survival;
  • eHealth;
  • communication and information technology

Abstract

BACKGROUND:

In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non–small cell lung cancer (NSCLC).

METHODS:

In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint—patient symptom distress—was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale.

RESULTS:

Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm. Significant differences were observed at 4 months (P = .031; Cohen d = .42) and at 6 months (P = .004; d = .61). Similar but marginally significant effects were observed at 2 months (P = .051; d = .39) and at 8 months (P = .061; d = .43). Exploratory analyses indicated that survival curves did not differ significantly between the arms (log-rank P = .172), although a survival difference in an exploratory subgroup analysis suggested an avenue for further study.

CONCLUSIONS:

The current results indicated that an online support system may reduce patient symptom distress. The effect on survival bears further investigation. Cancer 2013. © 2013 American Cancer Society.