Telenursing May Lead to Lower Symptom-Related Distress in Lung Cancer

Telenursing (TN) is associated with lower symptom distress compared with a lack of TN support in adults with lung cancer, according to new findings from a review and meta-analysis published in Japan Journal of Nursing Science.

Despite recent advances in lung cancer diagnosis and treatment, it remains the leading cause of cancer deaths worldwide and carries a fairly low 5-year survival rate. Considering the significant toxicity associated with lung cancer treatment, improving quality of life (QOL) for patients with lung cancer is an important goal.

One potential strategy to improve patient QOL between clinic or home care visits is providing additional support via TN. In general, TN is remote nursing care using information and communication technology (ICT) and telecommunication, as well as potentially telemonitoring (TM) of physical and mental health metrics, such as vital signs. This allows for more timely evaluations and increased communication between in-person visits, which may help improve patient QOL.

“TM in combination with home nursing has been used to capture physical changes in people with lung cancer that could not be detected by nurse visits alone and has been useful in alleviating suffering,” the authors wrote. Their review and analysis aimed to provide clarity on the QOL benefits of TN during lung cancer treatment.

Five reports on 4 studies were included in the review, and 3 of the studies were included in the meta-analysis. All of the studies were randomized controlled trials that included 2 arms for intervention and control groups. A total of 508 patients were included in the studies, and the majority of these patients had stage III-IV cancer. Providers taking part in TN interventions, which ranged in frequency from biweekly to twice a week in the studies, included nurses, clinicians, oncologists, oncology fellows, physicians, and physician assistants.

TM via patient-reported outcome (PRO) submission to health care providers was one type of intervention in the 3 studies that were analyzed. After patients submitted PRO symptoms by phone or software application, any responses that met predefined symptom thresholds generated an automated email to health care providers. Initial responses were typically handled by nurses, who could then contact the participant for further symptom assessment. Nursing professionals would provide clinical care when appropriate, counsel and educate patients, schedule visits, and contact oncologists when necessary to address a patient’s symptoms and concerns.

Another type of intervention was a health education program (EP) in the form of a website to inform patients of typical symptoms and management strategies. Question-and-answer opportunities were provided and monitored by a nurse and physician. The contents of the EP overall were revised periodically. Notably, only one study reported routine monitoring of vital signs and other typical measurements, which are often included in TM for patients with noncancer chronic diseases.

The meta-analysis focused on QOL and cancer-related symptoms as main outcomes. The pooled data showed that at 3 months of participation, there was no evidence of an effect on overall QOL between patients participating in TN vs the control groups. However, a pooled analysis of 2 of the studies with sufficient data found that TN led to lower distress related to cancer symptoms in patients who were included in TN.

“It is of noteworthy significance that health care providers can approach adults with lung cancer on a more regular basis using ICT between scheduled clinic visits to monitor and educate them about their symptoms,” the authors wrote.

Providing additional opportunities for education and assessments can help facilitate better treatment, and the use of PROs can help identify symptoms that may otherwise be missed by providers. Discussing symptoms with a provider remotely may also reduce the number of unplanned clinic or hospital visits if the distress surrounding those symptoms is alleviated by TN visits.

Notably, the data pool for the meta-analysis was small and a GRADE analysis of the data quality showed a serious risk of imprecision, bias, and inconsistency in the data. Further research is needed to provide more definitive data on the effects of TN for patients with lung cancer, but the findings of the meta-analysis suggest there is some benefit to remote monitoring in lung cancer care.

Reference

Harada T, Shibuya Y, Kamei T. Effectiveness of telenursing for people with lung cancer at home: a systematic review and meta-analysis. Jpn J Nurs Sci. Published online October 20, 2022. doi:10.1111/jjns.12516