我们旨在评估肺癌术后早期基于患者报告结果(PRO)的症状管理的有效性和可行性。

临床诊断为肺癌的患者术前按1:1随机分配，接受术后基于pro的症状管理或常规护理。所有患者通过电子PRO系统在MD Anderson症状清单-肺癌术前、术后每日和出院后每周两次报告症状，持续4周。在干预组中，治疗外科医生根据5个目标症状评分(疼痛、疲劳、睡眠紊乱、呼吸短促和咳嗽评分为4分，评分为0-10分)中的任何一个评分来对超过阈值的电子警报做出反应。对照组患者接受常规护理，未发生警报。主要结局是出院时症状阈值事件(评分为4分的任何目标症状)的数量。进行了协议分析。

在166名参与者中，83人被随机分配到每组。出院时，干预组报告的症状阈值事件比对照组少(中位数[四分位范围]，0 [0-2]v 2 [0-3];P = .007)。在出院后4周，干预组和对照组之间保持了这种差异(中位数[四分位范围]，0 [0-0]v 0 [0-1];P = .018)。干预组并发症发生率低于对照组(21.5% vs 40.6%;P = .019)。外科医生处理一次警报的平均时间为3分钟。肺癌术后基于pro的症状管理在出院后4周内比常规护理症状负担更低，并发症更少。

Abstract

Purpose: We aimed to evaluate the efficacy and feasibility of patient-reported outcome (PRO)-based symptom management in the early period after lung cancer surgery.

Methods: Before surgery, patients with clinically diagnosed lung cancer were randomly assigned 1:1 to receive postoperative PRO-based symptom management or usual care. All patients reported symptoms on MD Anderson Symptom Inventory-Lung Cancer presurgery, daily postsurgery, and twice a week after discharge for up to 4 weeks via an electronic PRO system. In the intervention group, treating surgeons responded to overthreshold electronic alerts driven by any of the five target symptom scores (score ≥ 4 on a 0-10 scale for pain, fatigue, disturbed sleep, shortness of breath, and coughing). The control group patients received usual care and no alerts were generated. The primary outcome was the number of symptom threshold events (any target symptom with a score of ≥ 4) at discharge. Per-protocol analyses were conducted.

Results: Of the 166 participants, 83 were randomly allocated to each group. At discharge, the intervention group reported fewer symptom threshold events than the control group (median [interquartile range], 0 [0-2] v 2 [0-3]; P = .007). At 4 weeks postdischarge, this difference was maintained between the intervention and control groups (median [interquartile range], 0 [0-0] v 0 [0-1]; P = .018). The intervention group had a lower complication rate than the control group (21.5% v 40.6%; P = .019). Surgeons spent a median of 3 minutes managing an alert.

Conclusion: PRO-based symptom management after lung cancer surgery showed lower symptom burden and fewer complications than usual care for up to 4 weeks postdischarge.

原文链接

pubmed.ncbi.nlm.nih.gov/34995100/

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