Effects of an Internet Support System to Assist Cancer Patients in Reducing Symptom Distress: A Randomized Controlled Trial RESTORE: an exploratory trial of an online intervention to enhance self-efficacy to manage problems associated with cancer-related fatigue following primary cancer treatment: study protocol for a randomized controlled trial Effects of an online support group for prostate cancer survivors: a randomized trial. Randomized pilot of a self-guided internet coping group for women with early-stage breast cancer Acceptability and Preliminary Feasibility of an Internet/CD-ROM-Based Education and Decision Program for Early-Stage Prostate Cancer Patients: Randomized Pilot Study Psychosexual distress in women with gynecologic cancer: a feasibility study of an online support group. Internet-Based Interactive Support for Cancer Patients: Are Integrated Systems Better? Research paper: Impact on Quality of Life of a Telemedicine System Supporting Head and Neck Cancer Patients: A Controlled Trial During the Postoperative Period at Home Distress and quality of life after autologous stem cell transplantation: a randomized clinical trial to evaluate the outcome of a web-based stepped care intervention Standard versus prosocial online support groups for distressed breast cancer survivors: a randomized controlled trial Evaluation of an internet support group for women with primary breast cancer Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia. Effect of Internet peer-support groups on psychosocial adjustment to cancer: a randomised study A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancer. Web-based tailored education program for disease-free cancer survivors with cancer-related fatigue: a randomized controlled trial. Project onward: an innovative e-health intervention for cancer survivors. Electronic support groups for breast carcinoma Cancer Patient and Survivor Research From the Cancer Information Service Research Consortium: A Preview of Three Large Randomized Trials and Initial Lessons Learned Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial. Development and implementation of an Internet-based survivorship care program for cancer survivors treated with hematopoietic stem cell transplantation
Background : Cancer patients experience many physical and psychosocial problems for which they need support . WebChoice is an Internet-based , interactive health communication application that allows cancer patients to monitor their symptoms and problems , provides individually tailored information and self-management support , e-communication with expert cancer nurses , and an e-forum for group discussion with other patients . Objective : The objective of this study was to examine the effects of WebChoice on symptom distress ( primary outcome ) , depression , self-efficacy , health-related quality of life , and social support ( secondary outcomes ) . Methods : In this 1-year repeated- measures r and omized controlled trial , 325 breast and prostate cancer patients were r and omized into 1 experimental group  with access to WebChoice and 1 control group who received URLs of publicly available cancer Web sites . Results : Group differences on symptom distress were significant only for the global symptom distress index on the Memorial Symptom Assessment Scale ( slope estimate , −0.052 [ 95 % confidence interval , −0.101 to −0.004 ] ; t = 4.42 ; P = .037 ) . There were no significant group differences on secondary outcomes . Additional analyses showed significant within-group improvements in depression in the experimental group only . In the control group , self-efficacy and health-related quality of life deteriorated significantly over time . Conclusion : This r and omized controlled trial is one of the first to evaluate effects of an interactive health communication application to support cancer patients in illness management on symptoms . Although only 1 hypothesis was partially supported , the combined results show a clear trend toward better scores in the intervention group on most outcome measures . Implication s for Practice : If findings can be supported with additional research , WebChoice may become an important tool to support nursing care that can equip cancer patients to better manage their illness Background There are over 25 million people worldwide living with or beyond cancer and this number is increasing . Cancer survivors face a range of problems following primary treatment . One of the most frequently reported and distressing symptoms experienced by cancer survivors is fatigue . There is growing support for survivors who are experiencing problems after cancer treatment to engage in supported self-management . To date there is some evidence of effective interventions to manage fatigue in this population ; however , to our knowledge there are no online re sources that draw on this information to support self-management of fatigue . This paper describes the protocol for an exploratory r and omized controlled trial of an online intervention to support self-management of cancer-related fatigue after primary cancer treatment . Methods / design This is a parallel-group two-armed ( 1:1 ) exploratory r and omized controlled trial including 125 cancer survivors experiencing fatigue ( scoring ≥4 on a unidimensional 11-point numeric rating scale for fatigue intensity ) within five years of primary treatment completion with curative intent . Participants will be recruited from 13 NHS Trusts across the UK and r and omized to either the online intervention ( RESTORE ) , or a leaflet comparator ( Macmillan Cancer Backup , Coping with Fatigue ) . The primary outcome is a change in Perceived Self-Efficacy for Fatigue Self-Management ( as measured by the Perceived Self-Efficacy for Fatigue Self-Management Instrument ) . Secondary outcomes include impact on perception and experience of fatigue ( measured by the Brief Fatigue Inventory ) , and quality of life ( measured by the Functional Assessment of Cancer Therapy - General and the Personal Wellbeing Index ) . Outcome measures will be collected at baseline , 6 weeks ( completion of intervention ) , and 3 months . Process evaluation ( including telephone interviews with recruiting staff and participants ) will determine acceptability of the intervention and trial processes . Discussion Data from this trial will be used to refine the intervention and contribute to the design of an effectiveness trial . This intervention will be exp and ed to address other cancer-related problems important to cancer survivors following primary cancer treatment . Trial registration IS RCT This longitudinal study evaluated the effect a prostate cancer-specific online support group had for self-assessed quality of life .  Participants ( N = 40 ) were r and omly assigned to an online support group or the control group . Data consisted of four previously vali date d quality -of-life measurements . Analysis determined that over time , quality of life improved for those in the online group and decreased for those in the control group , but returned to baseline at eight weeks . Providing support using online methods is effective ; the length of time this intervention should be provided to patients will require further research Background : Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments . Purpose : The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided , Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer . Methods : Sixty-two women completed baseline evaluations and were r and omized into either a small online coping group or a waiting-list control condition . Results : No main effects for treatment were observed at the 12-week follow up . However , there was a significant interaction between baseline self-reported health status and treatment , such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition . Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety , greater cognitive processing , and lower expression of health-related concerns . Conclusions : These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups Background Prostate cancer is the most common cancer affecting men in the United States . Management options for localized disease exist , yet an evidence -based criterion st and ard for treatment still has to emerge . Although 5-year survival rates approach 98 % , all treatment options carry the possibility for significant side effects , such as erectile dysfunction and urinary incontinence . It is therefore recommended that patients be actively involved in the treatment decision process . We have developed an Internet/CD-ROM-based multimedia Prostate Interactive Educational System ( PIES ) to enhance patients ’ treatment decision making . PIES virtually mirrors a health center to provide patients with information about prostate cancer and its treatment through an intuitive interface , using videos , animations , graphics , and texts . Objectives ( 1 ) To examine the acceptability and feasibility of the PIES intervention and to report preliminary outcomes of the program in a pilot trial among patients with a new prostate cancer diagnosis , and ( 2 ) to explore the potential impact of tailoring PIES treatment information to participants ’ information-seeking styles on study outcomes . Methods Participants ( n = 72 ) were patients with newly diagnosed localized prostate cancer who had not made a treatment decision . Patients were r and omly assigned to 3 experimental conditions : ( 1 ) control condition ( providing information through st and ard National Cancer Institute brochures ; 26 % ) , and PIES ( 2 ) with tailoring ( 43 % ) and ( 3 ) without tailoring to a patient ’s information-seeking style ( 31 % ) . Question naires were administrated before ( t1 ) and immediately after the intervention ( t2 ) . Measurements include evaluation and acceptability of the PIES intervention , monitoring/blunting information-seeking style , psychological distress , and decision-related variables ( eg , decisional confidence , feeling informed about prostate cancer and treatment , and treatment preference ) . Results The PIES program was well accepted by patients and did not interfere with the clinical routine . About 79 % of eligible patients ( 72/91 ) completed the pre- and post-PIES intervention assessment s. Patients in the PIES groups compared with those in the control condition were significantly more likely to report higher levels of confidence in their treatment choices , higher levels of helpfulness of the information they received in making a treatment decision , and that the information they received was emotionally reassuring . Patients in the PIES groups compared with those in the control condition were significantly less likely to need more information about treatment options , were less anxious about their treatment choices , and thought the information they received was clear ( P < .05 ) . Tailoring PIES information to information-seeking style was not related to decision-making variables . Conclusions This pilot study confirms that the implementation of PIES within a clinical practice is feasible and acceptable to patients with a recent diagnosis of prostate cancer . PIES improved key decision-making process variables and reduced the emotional impact of a difficult medical decision OBJECTIVES The psychosexual concerns of gynecologic cancer patients are often unaddressed and there are limited re sources available for women to deal with this highly sensitive topic . This feasibility study examines the participation rates and preliminary outcomes for an online support group design ed specifically for women who are sexually distressed subsequent to gynecologic cancer treatment METHODS A 12-week online intervention was developed to address the psychosexual impact of gynecologic cancer . This intervention included a professionally moderated , asynchronous discussion forum as well as the provision of psycho-educational material s addressing the psychosexual impact of gynecologic cancer . Each week , a new topic was introduced and relevant material was posted on the website . Women were encouraged to share their experiences related to the topic . Twenty-seven , sexually distressed , remitted gynecologic cancer patients were r and omly assigned to immediate treatment or a waitlist control condition . Participants completed question naires at baseline , 4-month and 8-month follow-ups assessing sexual distress as the primary outcome as well as anxiety , depression , and illness intrusiveness . RESULTS Participation rates differed between the two groups , with greater participation occurring in the second group . Exit interviews indicated that the majority of the participants were satisfied with the intervention . Intent-to-treat analyses suggest a small effect for reduction in sexual distress CONCLUSIONS This feasibility study suggests that women find this intervention acceptable . Further research is required to determine efficacy To compare the benefits of the Internet generally versus a focused system of services , 257 breast cancer patients were r and omly assigned to a control group , access to the Internet with links to high- quality breast cancer sites , or access to an eHealth system ( Comprehensive Health Enhancement Support System , CHESS ) that integrated information , support , and decision and analysis tools . The intervention lasted 5 months , and self-report data on quality of life , health-care competence , and social support were collected at pretest and at 2- , 4- , and 9-month posttests . CHESS subjects logged on more overall than Internet subjects and accessed more health re sources , but the latter used non health-related sites more . Subjects with access to the Internet alone experienced no better outcomes than controls at any of the 3 time points , compared to pretest levels . Subjects with CHESS experienced greater social support during the intervention period and had higher scores on all 3 outcomes at 9 months , 4 months after the intervention ended . CHESS subjects also scored higher than those with Internet access during the intervention period but not significantly after the intervention ended . Thus , CHESS ( with one simple interface and integrated information , communication , and skills services ) helped newly diagnosed breast cancer patients even after computers were removed . In contrast , patients received little benefit from Internet access , despite having links to a variety of high- quality sites OBJECTIVES Telemedicine applications carry the potential to enhance the quality of life of patients , but studies evaluating telemedicine applications are still scarce . The evidence regarding the effectiveness of telemedicine is limited and not yet conclusive . This study investigated whether telemedicine could be beneficial to the quality of life of cancer patients . DESIGN AND MEASUREMENTS Between 1999 and 2002 , we conducted a prospect i ve controlled trial evaluating the effects of a telemedicine application on the quality of life of patients with cancer involving the head and neck , using quality of life question naires that covered 22 quality of life parameters . All patients had undergone surgery for head and neck cancer at the Erasmus MC , a tertiary university hospital in The Netherl and s. Patients in the intervention group were given access to an electronic health information support system for a period of six weeks , starting at discharge from the hospital . RESULTS In total , we included 145 patients in the control group and 39 in the intervention group . At 6 weeks , the end of the intervention , the intervention group had significantly improved QoL in 5 of the 22 studied parameters . Only one of these five quality of life parameters remained significantly different at 12 weeks . CONCLUSIONS This study adds to the sparse evidence that telemedicine may be beneficial for the quality of life of cancer patients Background Psychological distress ( i.e. depression and anxiety ) is a strong predictor of functional status and other aspects of quality of life in autologous stem cell transplantation following high-dose chemotherapy . Treatment of psychological distress is hypothesized to result in improvement of functional status and other aspects of quality of life . The aim is to evaluate the outcome of stepped care for psychological distress on functional status and other aspects of quality of life in patients with hematological malignancy treated with autologous stem cell transplantation . Methods / Design The study is design ed as a r and omized clinical trial with 2 treatment arms : a stepped care intervention program versus care as usual .  Patients are r and omized immediately pre transplant .  Stepped care and care as usual are initiated after a 6 weeks buffer period . Outcome is evaluated at 13 , 30 , and 42 weeks post transplant . In the experimental group , the first step includes an Internet-based self-help program . If psychological distress persists after the self-help intervention , the second step of the program is executed , i.e. a diagnostic evaluation and a st and ardized interview , yielding a problem analysis . Based on this information , a contract is made with the patient and treatment is provided consisting of individual face-to-face counseling , medication , or referral to other services . Care as usual comprises an interview with the patient , on ad hoc basis ; emotional support and advice , on ad hoc basis ; if urgent problems emerge , the patient is referred to other services . Primary outcome variables are psychological distress and functional status . Data are analyzed according to the intention to treat-principle . Discussion This study has several innovative characteristics . First , the outcome of the intervention for psychological distress in patients with hematological malignancy treated with autologous stem cell transplantation is evaluated in a r and omized controlled study . Second , the impact of the intervention on functional status is evaluated : it is hypothesized that reduction of psychological distress results in improved functional status . Furthermore , the intervention concerns an Internet-based treatment in the first step . Finally , the intervention is characterized by an emphasis on self-management , efficiency , and a multi-disciplinary approach with nurses taking up a central role . Trial Registration Background The Internet can increase access to psychosocial care for breast cancer survivors through online support groups . This study will test a novel prosocial online group that emphasizes both opportunities for getting and giving help . Based on the helper therapy principle , it is hypothesized that the addition of structured helping opportunities and coaching on how to help others online will increase the psychological benefits of a st and ard online group . Methods / Design A two-armed r and omized controlled trial with pretest and posttest . Non-metastatic breast cancer survivors with elevated psychological distress will be r and omized to either a st and ard facilitated online group or to a prosocial facilitated online group , which combines online exchanges of support with structured helping opportunities ( blogging , breast cancer outreach ) and coaching on how best to give support to others . Vali date d and reliable measures will be administered to women approximately one month before and after the interventions . Self-esteem , positive affect , and sense of belonging will be tested as potential mediators of the primary outcomes of depressive/anxious symptoms and sense of purpose in life . Discussion This study will test an innovative approach to maximizing the psychological benefits of cancer online support groups . The theory-based prosocial online support group intervention model is sustainable , because it can be implemented by private non-profit or other organizations , such as cancer centers , which mostly offer face-to-face support groups with limited patient reach . Trial Registration Clinical Trials.gov : Women with breast carcinoma commonly experience psychologic distress following their diagnosis . Women who participate in breast cancer support groups have reported significant reduction in their psychologic distress and pain and improvement in the quality of their lives .  Web‐based breast cancer social support groups are widely used , but little is known of their effectiveness . Preliminary evidence suggests that women benefit from their participation in web‐based support groups OBJECTIVE Insomnia is a common complaint among cancer survivors . Fortunately , cognitive-behavioral therapy for insomnia ( CBT-I ) has been shown to be an effective treatment in this population . However , it is rarely implemented given its limited availability . To address this barrier , we examined the ability of an easily accessible online CBT-I program to improve insomnia symptoms in cancer survivors . METHODS Twenty-eight cancer survivors with insomnia were r and omly assigned to either an Internet insomnia intervention ( n = 14 ) or to a waitlist control group ( n = 14 ) . The online program , Sleep Healthy Using The Internet , delivers the primary components of CBT-I ( sleep restriction , stimulus control , cognitive restructuring , sleep hygiene , and relapse prevention ) . Pre- and post- assessment data were collected via online question naires and daily sleep diaries . RESULTS Participants in the Internet group showed significant improvements at post- assessment compared with those in the control group in overall insomnia severity ( F(1,26 ) = 22.8 ; p<0.001 ) , sleep efficiency ( F(1,24 ) = 11.45 ; P = 0.002 ) , sleep onset latency ( F(1,24 ) = 5.18 ; P = 0.03 ) , soundness of sleep ( F(1,24 ) = 9.34 ; P = 0.005 ) , restored feeling upon awakening ( F(1,24 ) = 11.95 ; P = 0.002 ) , and general fatigue ( F(1,26 ) = 13.88 ; P = 0.001 ) . Although other group × time interactions were not significant , overall adjusted effect sizes for all sleep variables as well as for fatigue , depression , anxiety , and quality of life ranged from small to large . CONCLUSIONS CBT-I delivered through an interactive , individually tailored Internet intervention may be a viable treatment option for cancer survivors experiencing insomnia Background : We conducted a r and omised study to investigate whether providing a self-guided Internet support group to cancer patients affected mood disturbance and adjustment to cancer . Methods : Baseline and 1- , 6- and 12-month assessment s were conducted from 2004 to 2006 at a national rehabilitation centre in Denmark . A total of 58 rehabilitation course weeks including 921 survivors of various cancers were r and omly assigned to a control or an intervention group by cluster r and omisation . The intervention was a lecture on the use of the Internet for support and information followed by participation in an Internet support group . Outcome measures included self-reported mood disturbance , adjustment to cancer and self-rated health . Differences in scores were compared between the control group and the intervention group . Results : The effect of the intervention on mood disturbance and adjustment to cancer showed a transient difference at the 6-month follow-up , where the intervention group reported less reduction in anxious preoccupation ( P=0.04 ) , helplessness ( P=0.002 ) , confusion ( P=0.001 ) and depression ( P=0.04 ) . Otherwise no significant effects were observed . Conclusion : We conclude that use of Internet-based support groups in cancer patients still needs to confirm long-lasting psychological effects OBJECTIVE Peer-to-peer interactions are associated with enhanced psychosocial adjustment among women with breast cancer . Millions of women with cancer and others with various health conditions use the Internet to establish peer relationships , usually without professional moderation . This paper reports findings from the first r and omized , controlled study of the benefits of these types of Internet-based peer interactions . METHODS This pilot study involved seventy-eight women who were recently diagnosed with breast cancer . Participants were r and omly assigned to either an Internet peer support condition or Internet-based educational control condition . Data were gathered at baseline and 4- and 12-months . Primary outcomes of interest were psychological distress and quality of life . RESULTS Contrary to hypotheses , participants in the Internet peer support condition tended to do worse over time on primary outcome measures . There were no differences between groups on secondary outcomes of perceived social support , self-efficacy , or hope . Paradoxically , many women in the Internet peer support condition actively participated and reported high levels of satisfaction , suggesting some self-perceived benefits . CONCLUSIONS These results suggest that Internet based peer-to-peer interactions may not necessarily be universally beneficial despite the positive experiences reported by many participants . Further research is needed to underst and the magnitude of this effect with a larger sample . Moreover , these results raise questions about the need to underst and the comparative effectiveness of Internet-based communications by group structure ( i.e. , unstructured/structured ; unmoderated/moderated ) and the effect of content ( i.e. , expression of fear/anxiety , insightful disclosures , etc . ) on outcomes PURPOSE To determine whether an Internet-based tailored education program is effective for disease-free cancer survivors with cancer-related fatigue ( CRF ) . PATIENTS AND METHODS We r and omly assigned patients who had completed primary cancer treatment within the past 24 months in any of four Korean hospitals and had reported moderate to severe fatigue for at least 1 week to participate in a 12-week , Internet-based , individually tailored CRF education program or to receive routine care .  We based the program on the CRF guidelines of the National Comprehensive Cancer Network ( NCCN ) and incorporated the transtheoretic model ( TTM ) . At baseline and 12 weeks , we used the Brief Fatigue Inventory ( BFI ) and Fatigue Severity Scale ( FSS ) as primary outcomes and the Hospital Anxiety and Depression Scale ( HADS ) and European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ( EORTC QLQ-C30 ) for secondary outcomes . RESULTS We recruited 273 participants and r and omly assigned 136 to the intervention group . Compared with the control group , the intervention group had an improvement in fatigue as shown by a significantly greater decrease in BFI global score ( -0.66 points ; 95 % CI -1.04 to -0.27 ) and FSS total score ( -0.49 ; 95 % CI , -0.78 to -0.21 ) . In secondary outcomes , the intervention group experienced a significantly greater decrease in HADS anxiety score ( -0.90 ; 95 % CI , -1.51 to -0.29 ) as well as global quality of life ( 5.22 ; 95 % CI , 0.93 to 9.50 ) and several functioning scores of the EORTC QLQ-C30 . CONCLUSION An Internet-based education program based on NCCN guidelines and TTM may help patients manage CRF OBJECTIVE This study examined the feasibility and acceptability of an Individual Internet Intervention ( III ) embedded and integrated into an Internet Support Group ( ISG ) with the ultimate goal of enhancing adherence and learning , compared with an individual internet invention alone . METHOD Thirty-one posttreatment cancer survivors were r and omized in groups of seven to nine to either the 8-week III + ISG intervention or the 8-week III condition . Seventeen participants met the Hospital Anxiety and Depression Scale ( HADS ) criteria for depressive symptoms ( HADS ≥ 8) . RESULTS Among all participants , the mean number of logins over 8 weeks was 20.8 ± 17.7 logins for the III + ISG compared with 12.5 ± 12.5 in III-only ( p = 0.15 ) . Two participants in the III + ISG dropped out , compared with five in III ( p = 0.39 ) . Among the 17 participants with depressive symptoms at baseline , both the Onward and the III-only condition showed large reductions in the depression scale of HADS ( d = 1.27 and 0.89 , respectively ) . Improvement over time and time x treatment effects only reached trend significance levels ( ps = 0.07 & 0.12 ) as this pilot was not powered to detect these differences . CONCLUSION Both the III + ISG and III-only demonstrated pre-post reductions in depressive symptoms and high rates of utilization compared with other web-based treatments for depression . Although it is premature to make any determination as to the efficacy of the interventions tested in this feasibility study , these results indicate that pursuing the III + ISG model , as well as st and ard IIIs , may be fruitful areas of future research A recent Pew Charitable Trust study found that 52,000,000 individuals used the Internet to obtain health/medical information . Clinical trials of face‐to‐face breast carcinoma support groups show evidence of 1 ) improvement in quality of life , 2 ) reduction of psychologic symptoms , 3 ) improvement in coping responses , and 4 ) a reduction in pain . To the authors ' knowledge , a few studies published to date have investigated Internet‐delivered electronic support groups ( ESGs ) for cancer . The most sophisticated is the Comprehensive Health Enhancement Support System ( CHESS ) program , which provides integrated information , referral , and a newsgroup‐based social support program . However , to the authors ' knowledge , no studies published to date have examined the impact of a breast carcinoma ESG in a clinical trial The authors describe 3 large r and omized trials from the Cancer Information Service Research Consortium . Three web-based multimedia programs are being tested to help newly diagnosed prostate ( Project 1 ) and breast cancer patients ( Project 2 ) make informed treatment decisions and breast cancer patients prepare for life after treatment ( Project 3 ) . Project 3 also tests a telephone callback intervention delivered by a cancer information specialist . All participants receive st and ard print material specific to each project . Preliminary results from the 2-month follow-up interviews are reported for the initial wave of enrolled participants , most of whom were recruited from the Cancer Information Service ( 1 - 800 - 4-CANCER ) telephone information program ( Project 1 : n = 208 ; Project 2 : n = 340 ; Project 3 : n = 792 ) .  Self-reported use of the multimedia program  was 51 % , 52 % , and 67 % for Projects 1 , 2 , and 3 , respectively . Self-reported use of the print material s ( read all , most , or some ) was 90 % , 85 % , and 83 % for Projects 1 , 2 , and 3 , respectively . The  callback intervention  was completed by 92 % of Project 3 participants . Among those using the Cancer Information Service Research Consortium interventions , perceived usefulness and benefit was high , and more than 90 % reported that they would recommend them to other cancer patients . The authors present 5 initial lessons learned that may help inform future cancer communications research PURPOSE Patients receiving cancer-related thoracotomy  are highly symptomatic in the first weeks after surgery . This study examined whether at-home symptom monitoring plus feedback to clinicians about severe symptoms contributes to more effective postoperative symptom control . PATIENTS AND METHODS We enrolled 100 patients receiving thoracotomy for lung cancer or lung metastasis in a two-arm r and omized controlled trial ; 79 patients completed the study . After hospital discharge , patients rated symptoms twice weekly for 4 weeks via automated telephone calls . For intervention group patients , an e-mail alert was forwarded to the patient 's clinical team for response if any of a subset of symptoms ( pain , disturbed sleep , distress , shortness of breath , or constipation ) reached a predetermined severity threshold . No alerts were generated for controls . Group differences in symptom threshold events were examined by generalized estimating equation modeling . RESULTS The intervention group experienced greater reduction in symptom threshold events than did controls ( 19 % v 8 % , respectively ) and a more rapid decline in symptom threshold events . The difference in average reduction in symptom interference between groups was -0.36 ( SE , 0.078 ; P = .02 ) . Clinicians responded to 84 % of e-mail alerts . Both groups reported equally high satisfaction with the automated system and with postoperative symptom control . CONCLUSION Frequent symptom monitoring with alerts to clinicians when symptoms became moderate or severe reduced symptom severity during the 4 weeks after thoracic surgery . Methods of automated symptom monitoring and triage may improve symptom control after major cancer surgery . These results should be confirmed in a larger study Introduction The Internet provides a widely accessible modality for meeting survivorship care needs of cancer survivors . In this paper , we describe the development and implementation of an Internet site design ed as a base from which to conduct a r and omized controlled trial to meet psycho-educational needs of hematopoietic stem cell transplantation ( HSCT ) survivors . Methods A cross-disciplinary team design ed , wrote content , and programmed an Internet site for online study registration , consent , assessment , and study implementation . All survivors who were 3–18 years after HSCT for hematologic malignancy and treated at one transplant center were approached by mail for participation . All study activities could be conducted without study staff contact . However , participants had options for phone or email contact with study staff as desired . Results Of 1,775 participants approached for the study , 775 ( 58 % of those eligible ) consented and completed baseline assessment . Mean age was 51.7 ( SD , 12.5 ; age range , 18–79 years ) , with 56 % male . Fifty-seven percent required staff contact one or more times ; a majority were for minor technical issues or delays in completion of enrollment or baseline assessment . Discussion s/ conclusions This study demonstrated the potential for providing Internet-based survivorship care to long-term survivors of HSCT . Although building a survivorship Internet site requires a team with diverse expertise , once built , these re sources can be implemented rapidly with large numbers of survivors . Implication s for cancer survivorsWhile Internet-based services will not meet all the needs of cancer survivors , this methodology represents an important modality for augmenting onsite clinical services as a method for meeting psycho-educational , information , and re source needs of cancer survivors
OBJECTIVE This review examines the evidence -based literature surrounding the use of online re sources for adult cancer patients .
The focus is online re sources that connect patients with their healthcare clinician and with supportive and educational re sources , their efficacy and the outcome measures used to assess them .