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Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial
Dai W, Feng W, Zhang Y, Wang XS, Liu Y, Pompili C, Xu W, Xie S, Wang Y, Liao J, Wei X, Xiang R, Hu B, Tian B, Yang X, Wang X, Xiao P, Lai Q, Wang X, Cao B, Wang Q, Liu F, Liu X, Xie T, Yang X, Zhuang X, Wu Z, Che G, Li Q, Shi Q. Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial. J Clin Oncol. 2022 Jan 7:JCO2101344.
PURPOSE 目的We aimed to evaluate the efficacy and feasibility of patient-reported outcome (PRO)-based symptom management in the early period after lung cancer surgery.
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。
METHODS 方法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.
手术前，临床诊断为肺癌的患者被1:1的比例随机分配，接受基于PRO的术后症状管理或常规护理。所有患者均通过电子PRO系统报告了MD Anderson症状量表-肺癌术前、术后每日和出院后每周两次（长达4周）的症状。在干预组中，治疗外科医生对由五种目标症状评分（在疼痛、疲劳、睡眠不安、呼吸短促和咳嗽评分为0-10分中≥ 4）中的任何一种驱动的超阈值电子警报做出反应。对照组患者接受常规护理，未产生警报。主要结果是出院时症状阈值事件（任何得分≥ 4的目标症状）的数量。按方案进行分析。
RESULTS 结果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.
在166名参与者中，83名被随机分配到每组。出院时，干预组报告的症状阈值事件少于对照组（中位数 [四分位数范围]，0 [0-2]v 2 [0-3]；p=0.007）。出院后4周，干预组和对照组之间的差异仍然存在（中位数 [四分位数范围]，0 [0-0]v 0 [0-1]；p=0.018）。干预组的并发症发生率低于对照组（21.5% v 40.6%；P=0.019）。外科医生平均花费3分钟来管理警报。
CONCLUSION 结论PRO-based symptom management after lung cancer surgery showed lower symptom burden and fewer complications than usual care for up to 4 weeks postdischarge.
与出院后4周的常规护理相比，肺癌手术后基于PRO的症状管理显示出较低的症状负担和较少的并发症。
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