JMIR Publications

ABSTRACT

Background:

Regular pulmonary rehabilitation exercises are crucial for patients with lung cancer after surgery. However, poor adherence to outpatient exercises is difficult to address due to inadequate supervision. The integration of remote symptom management via electronic patient-reported outcomes (ePRO) offers a potential solution to improve adherence by enabling more effective monitoring and intervention.

Objective:

This study aims to evaluate the impact of ePRO-based remote symptom management on enhancing adherence to outpatient pulmonary rehabilitation exercises following video-assisted thoracic surgery (VATS) for lung cancer.

Methods:

In this single-center, prospective, randomized controlled trial (RCT), 736 patients undergoing minimally invasive lung resection will be recruited. All patients will use a smartphone app for perioperative management, allowing periodic PRO measurement and recording of exercise participation. Upon discharge, patients will be randomized 1:1 into either an intervention or control group. The intervention group will complete the Perioperative Symptom Assessment for Patients Undergoing Lung Surgery (PSA-Lung) scale on the day of discharge and post-discharge days 3, 7, 14, 21, 28. Alerts will be triggered at the provider side if any of the 5 core symptoms (pain, cough, shortness of breath, sleep disturbance, fatigue) scored ≥4, prompting remote symptom management. The control group will complete the PRO measures without triggering alerts. The primary outcome is rehabilitation exercise adherence rate. Secondary outcomes include post-discharge pulmonary complication rate, 30-day readmission rate, trajectory of symptom severity changes, exercise participation rate, and patient satisfaction.

Results:

The enrollment of study participants started in December 2023 and is expected to end in March 2025. The final comprehensive analysis of the results is planned for May 2025, after all data has been collected and thoroughly reviewed.

Conclusions:

This study is among the first to investigate the feasibility and effectiveness of ePRO-based remote symptom management in enhancing rehabilitation adherence post-VATS for lung cancer. If successful, this approach could significantly influence postoperative care practices and potentially be adopted in similar settings. Clinical Trial: ClinicalTrials.gov NCT05990946; https://classic.clinicaltrials.gov/ct2/show/NCT05990946