Remote symptom monitoring (RSM) during treatment for metastatic prostate cancer (mPC) in older men: Feasibility and efficacy.
Authors: Alibhai Shabbir M.H. , Breunis Henriette , Timilshina Narhari , Feng Gregory , Parthipan Milothy , Sudharshan Abirami , Hansen Aaron Richard , Finelli Antonio , Warde Padraig , Tomlinson George , Krzyzanowska Monika K. , Matthew Andrew , Clarke Hance , Santa Mina Daniel , Soto Pérez de Celis Enrique , Puts Martine , Emmenegger Urban 
Published: June 2022

12056

Background: Emerging data support multiple benefits of RSM during chemotherapy to improve outcomes. These studies do not focus on older adults and do not include non-chemotherapy strategies. mPC represents a major burden in older men. Although both chemotherapy and androgen receptor axis-targeted therapies (ARATs) prolong survival, toxicities are substantial and increased in older men. Understanding the feasibility of RSM and key symptoms experienced by men with mPC on treatment is crucial to designing appropriate supportive care interventions. We aimed to assess RSM feasibility and understand key symptoms during treatment with chemotherapy or an ARAT among older men. Methods: Older adults aged 65+ starting chemotherapy, an ARAT, or Radium-223 for mPC were enrolled in a prospective observational multicentre study. Participants completed the Edmonton Symptom Assessment Scale (ESAS) on weekdays online or by phone. Weekly detailed questionnaires assessed mood, anxiety, fatigue, insomnia, and pain. Notifications were sent to the clinical oncology team with severe symptoms (ESAS 7 or higher). Study duration was the first treatment cycle (̃3-4 weeks). Feasibility data were analyzed descriptively. Linear mixed effects models examined symptoms over time and by cohort. Clinician responses were assessed descriptively. Results: A total of 90 men were included (mean age 76.5y, 48% ARAT, 38% chemotherapy, and 14% Radium-223, 42% frail by Vulnerable Elders Survey-13 cutoff of 3+). Approximately half the patients preferred phone-based RSM. Patients provided RSM responses in 1,874 of approximately 2,000 (94%) instances. In the combined cohort, the most common symptoms of moderate to severe intensity (ESAS 4 or higher) occurring at least once were poor well-being (66%), fatigue (62%), reduced appetite (56%), insomnia (54%), and pain (46%). Symptom patterns were similar between chemotherapy and ARAT groups. Moderate to severe symptoms were more common and lasted longer among frail than non-frail men. Symptoms tended to remain stable or improve over the course of 3-4 weeks of RSM. 89% of participants were satisfied or very satisfied with RSM, although daily reporting was reported by several as burdensome. 45% had severe symptoms from RSM leading to informing the oncology care team, 79% of whom were followed up by a nurse or physician, and 12% of treatments were modified. Conclusions: RSM is feasible, acceptable to older adults, and identifies clinically relevant symptoms, but accommodation needs to be made for phone and the optimal frequency of RSM needs to be established. Poor well-being, fatigue, reduced appetite, and insomnia occurred in over half of participants. Longer-term follow up will be important.