Facing a cancer diagnosis can be overwhelming, and the symptoms that come with it can sometimes feel like a never-ending battle. But what if there was a way to manage these symptoms effectively, potentially keeping patients out of the emergency room?
For many cancer patients, issues like pain, anxiety, or insomnia can quickly escalate, leading to costly and emotionally draining ER visits. However, a groundbreaking study led by Mayo Clinic researchers offers a promising solution: using digital check-ins and a remote care team to proactively manage symptoms before they become crises.
"Our goal was straightforward, yet ambitious," explains Dr. Andrea Cheville, the study's lead researcher. "We wanted to see if automating symptom checks and care through the electronic health record could improve patients' lives without overburdening oncology teams. We found that this approach not only alleviated symptoms like anxiety and depression but also prevented thousands of patients from needing hospital care. This demonstrates how technology can help us extend the reach and effectiveness of care."
One patient, Becky Johnson, found this approach life-changing. Participating in the Enhanced EHR-Facilitated Cancer Symptom Control Trial (E2C2) helped her sleep better, despite the stress of her double breast cancer diagnosis at age 40 in 2022.
"I was constantly searching for information about treatments, prognoses, and the experiences of others. Plus, the steroid medications I was taking for treatment messed with my sleep. It got to the point where I would wake up in the middle of the night and not be able to fall back asleep, which affected my ability to heal," Johnson recalls, who is a program director for the Mayo Clinic School of Health Sciences Sonography Program.
As part of the trial, Johnson regularly completed digital surveys about her health. Insomnia quickly became a key concern, prompting a phone call from a nurse who offered advice on improving her sleep. The nurse also provided a link to a self-paced online class with cognitive behavioral therapy-based sleep strategies.
"A virtual or phone call visit, especially when I didn't have any physical issues, was so convenient and efficient," Johnson says. The intervention was effective, and her sleep improved.
To make these interventions possible, the researchers developed automations within the Plummer Chart, the software system managing patients' electronic health records (EHRs) and helping Mayo teams coordinate care. Between 2019 and 2023, over 50,200 patients across 15 cancer specialties at Mayo Clinic enrolled in the E2C2 trial. Like Johnson, they completed brief surveys about pain, fatigue, sleep, anxiety, and other symptoms before clinic visits or monthly between visits. The system automatically categorized their responses. Mild scores were simply recorded, moderate scores triggered self-care tips, and severe scores prompted outreach from a remote symptom care manager – a nurse or social worker who could assist patients via phone or video.
Essentially, the software became an automated traffic controller and safety net. It automatically routed information to patients, allowing care teams to focus on their specialized work. For patients, it simplified getting support without extra appointments or travel.
The trial results showed that automated surveys and responses built into the EHR improved care efficiency and, ultimately, patient symptoms.
- Patients reported less anxiety and depression, with moderate improvements in other symptoms.
- Patients had 40% to 60% fewer acute care encounters, including emergency visits, hospitalizations, and ICU admissions.
And this is the part most people miss: All of this was achieved with only 2-3 full-time care managers plus 20% of one physician's time, supporting over 50,000 study participants.
The E2C2 trial highlights a new approach to using digital tools in cancer care. By automating routine monitoring and triaging of patient symptoms and well-being through the EHR, a small care team can support a large patient population.
"The improvements we observed are encouraging and suggest a scalable way to extend supportive oncology care beyond the clinic, meeting patients where they are," Dr. Cheville states. "The next step is to ensure that these tools are available to healthcare teams, enabling them to efficiently reach every patient who needs supportive care."
The E2C2 trial was funded by the National Institutes of Health, National Cancer Institute (NCI) as part of the Cancer Moonshot℠. The study was conducted as part of NCI’s IMPACT Consortium. You can review the study for a complete list of authors, disclosures, and additional funding.
What are your thoughts on using technology to improve cancer care? Do you think this approach could be implemented more widely? Share your opinions in the comments below!
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