JMIR Publications

ABSTRACT

Background:

Chemotherapy treatments are typically administered in the outpatient setting. Patients are expected to monitor and manage a range of diverse and complicated side effects, which often occur at home well after leaving outpatient infusion facilities. The potential of patient symptoms being monitored with tailored evidence-based educational and supportive content during chemotherapy among GI cancer patients is still unexploited.

Objective:

The overall goal of this study is to address the gap in the continuity of care during outpatient chemotherapy through the integration of an innovative text messaging system with a Chatbot interface in the real-time monitoring and proactive management of side effects among gastrointestinal (GI) cancer patients undergoing intravenous (IV) chemotherapy.

Methods:

Real-time chemotherapy-associated side effects monitoring supportive system (RT-CAMSS) was iteratively developed with patient-centered inputs and evidence-based and theory-guided information to integrate chemotherapy knowledge, self-care symptom management skills, emotional support, doctor-patient communication, and nutritional and physical activity suggestions. We conducted a single-arm 2-month pilot study in which GI patients undergoing chemotherapy received two intervention text messages per week and a weekly CTCAE-based symptom assessment delivered through a Chatbot interface with tailored feedback. Baseline and post-intervention patient-reported outcome follow-up surveys were collected.

Results:

45 eligible patients were approached, 34 consented and enrolled (76% consenting rate). The mean age was 61 (±12). 56% were females and 61.8% were non-Hispanic White. The most frequent cancer type was pancreatic cancer (53%), followed by colon cancer (35%), and stomach cancer (12%). 27 participants completed the post-intervention follow-up (79% retention rate). Twenty-seven patients used the Chatbot system checker at least once during the 2-month intervention. Fatigue was reported the most regardless of severity (N=15), followed by neuropathy (N=7) and altered taste (N=5) were reported the most. After adjusting for multiple comparisons, patients who texted back the platform had significantly improved patient activated measure 3.70 (-6.919,-0.499) P=0.025. Post-intervention open-ended interviews and satisfaction surveys found that participants perceived the intervention as easy to use with helpful information.

Conclusions:

Conclusions:

Communication via mobile technologies is highly scalable for improving health services. The study provides preliminary evidence of engagement and acceptability of RT-CAMSS, which should be evaluated in a controlled clinical trial in the future.