The effect of digital health technologies on managing symptoms across pediatric cancer continuum:A systematic review

Objective:Pediatric cancer patients endure multiple symptoms during treatment and also in survivorship.Digital health technologies provide an innovative way to support their symptom management.This review aimed to examine the effect of digital health technologies on managing symptoms among across pediatric cancer continuum.Methods:A systematic literature search of six English and three Chinese electronic databases was combined with hand searching,to identify eligible research studies from database establishment to November 30,2019.Two reviewers carried out data selection,data extraction,and quality appraisal independently.A narrative approach was taken to summarize data.Results:Four randomized control trials,two quasi-experiments,and five one group pre-posttest designed studies,were included in the review with a total of 425 participants.The methodological quality of the studies was generally fair.Seven symptoms(anxiety,depression,pain,anger,fatigue,fear,distress)and seven digital health technologies(visual reality,website,humanoid robot,app,wearable devices,short messages and videoconference)were reported in the included studies.Conclusions:Current evidence supports the effect of digital health technologies is generally mixed and inconclusive.There is a trend of positive effects found in the interventions that feature digital health technologies’interactive function.This review highlights the need for further investigation with rigorous research designs and the consideration of influencing factors from the symptoms,participants,and context levels to inform a better digital health implementation.

Feasibility and reliability of the revised Edmonton Symptom Assessment System(ESAS-r)in Egyptian patients with advanced cancer:A single institutional experience

Objective This study aims to test the acceptance, feasibility, and usefulness of the Arabic version of the revised Edmonton Symptom AssesSment System （ESAS-r） among Egyptian patients with advanced cancer and to compare the rates of symptoms documented by patients and physicians. Methods Between August 2014 and February 2015, a total of 140 patients at Ain Shams University Hospitals in Cairo, Egypt received the Arabic version of the ESAS-r. For each patient, the ESAS-r was completed twice, first by the treating physician （as part of the basic assessment） and a second time by the patient, with a maximum of 2 hours between the two assessments. An additional survey was included to assess patients＇ acceptance of the survey and their preferences. Results Out of 140 enrolled patients in the study, 11 patients refused to complete the questionnaire, and 10 patients were excluded due to incomplete records in their medical records. Complete data was retrieved for 119 patients who were included for further analyses. The 78 （65%） patients declared that the test was clear and easy to complete. They were able to answer the test without help. Collectively, tiredness and sense of well-being were the most commonly encountered symptoms in ratings obtained by both patients and physicians. Tiredness was the only symptom showing a significant difference between the two rating methods, patient-rated scores being higher （P = 0.032）. Cronbach＇s alpha showed that both tests com- pleted by the physician and the patients were internally consistent： the physician-rated test had a coefficient of 0.877, and the patient-rated test had a coefficient of 0.863. All ESAS scores had good internal consis- tency, with a Cmnbach＇s alpha coefficient of 0.88. The internal consistency remained high after removal of individual symptom scores, with Cronbach＇s alpha coefficients ranging from 0.823 to 0.902, indicating that no individual question had undue influence on the total ESAS score. Conclusion The ESAS-r was easily understood by and applicable to patients. There was no significant discrepancy in the rates of symptoms reported by the patients and physicians, apart from tiredness. Based on this, the test could be applied on a larger scale with in-home patients. This test can be cost-effective and can decrease the number of hospital visits among advanced cancer patients in need of supportive treat- ment rather than active cancer therapy.

Symptom Assessment and Management in Patients with Lung Cancer Undergoing Conventional or Traditional Chinese Medicine Care

Patients with lung cancer may experience various symptoms as the disease progresses,which may reduce the benefits of cancer treatment,reduce treatment compliance,delay cancer treatment,reduce the quality of life(QoL),and impact survival.This review discusses comprehensive symptom assessment and management,which are crucial for high-quality lung cancer treatment.Traditional Chinese medicine(TCM)is important in relieving cancer-related symptoms in patients with lung cancer.Including patient-reported outcomes(PROs)in clinical trials and practice can provide a better assessment of symptom burden and the effectiveness of symptom management.Patient-centered care with TCM in lung cancer patients may include six steps:Symptom screening,etiology investigation,comprehensive assessment,integrative management,reassessment,and regular symptom follow-up monitoring.PRO measures can be used to evaluate symptom intensity,the degree to which symptoms interfere with activities of daily living,and the QoL.Clearly defined and reliable PRO measures can enhance patient satisfaction and improve symptom control.Quantitative PRO measures developed from the TCM perspective should be considered one of the important outcome measurements in TCM care.A multidisciplinary collaborative symptom management model,including TCM and conventional therapy,will be the future goal for treating patients with lung cancer.

Effect of modified Sanhuang Xiexin Tang plus additional herbs combined with ＂standard triple therapy＂ on Helicobacter pylori eradication

OBJECTIVE： To determine the effectiveness of modified Sanhuang Xiexin Tang （SHXXT） plus additional herbs （MSAH） combined with ＂standard tri- ple therapy＂ for eradication of Helicobacter pylori （H. pylori） and amelioration of related symptoms in comparison with standard triple and standard quadruple therapies. METHODS： From October 2015 to May 2016, we recruited patients with dyspepsia symptoms con- firmed to have H. pylori infection by the ^13C urea breath test in our outpatient clinic. Patients were randomly divided into three treatment groups： Nexium standard triple therapy （group A, EAC）, Nexium standard quadruple therapy （group B, EBAC）, or Nexium standard triple therapy combined with MSAH （group C; EAC＋MSAH）. Comparisons of H. pylori eradication and symptom amelioration rates were made among the three groups at 2 or 6 weeks after group assignment. RESULTS： There was no difference in H. pylori eradication rates between groups B （EBAC） and C （EAC＋ MSAH） （P = 0.486）, and eradication rates in groups B and C were significantly higher than that in group A （EAC） （P Av, e = 0.001; P AvsC= 0.003）. There was no difference in the total symptom score among the groups before treatment. In all groups, the total symptom scores after treatment （2 or 6 weeks after group assignment） were significantly lower than those before treatment （P 〈 0.001 for all）. However, group C （EAC ＋ MSAH） demonstrated superior total symptom scores and symptom amelioration rates than groups A （EAC） and B （EBAC）. Group B also demonstrated better scores and rates than group A. There was no difference in symptom amelioration rates at 2 and 6 weeks within each group. CONCLUSION： There is no difference between MSAH combined with standard triple therapy and standard quadruple therapy containing bismuth with regard to H. pylori eradication rate. However, MSAH combined with standard triple therapy has a higher symptom amelioration rate and therefore appears to be an ideal treatment scheme for H. pyIori eradication.

埃德蒙顿症状评估量表在针灸治疗癌痛患者中的应用:基于肿瘤科住院患者的回顾性分析和一项前瞻性预试验

Background:As pain is the most prominent clinical symptom for cancer patients and closely related to other symptoms,it is necessary to have a comprehensive assessment on promising intervention to improve pain management.Methods:A retrospective study of 489 inpatient cancer patients(1081 visits)was conducted by querying the electronic medical record database to test the reliability and validity of the Edmonton Symptom Assessment System.Data from a pilot prospective randomized controlled study on acupuncture for cancer pain was analyzed to validate the Edmonton Symptom Assessment System(ESAS)as the primary outcome in the integrative oncology research.Results:In the retrospective analysis,scores of the numerical rating scale(NRS)and the ESAS total score were significantly correlated(r=0.15,P=0.02),and the correlation coefficient between NRS and pain sub-scale in ESAS was 0.47(P<0.001).The pilot study showed the proportions of participants experiencing more than a 2-point reduction in NRS at the end of the treatment were 80%(n=12/15)in the acupuncture group and 50%(n=7/14)in the control group,without a significant difference between groups(P=0.13).For the total scores of ESAS,more responders were found in the acupuncture group(n=13/15)compared to that in the control group(n=7/14),with no significant difference between groups(P=0.05).Conclusions:ESAS is suitable for the comprehensive assessment in patients with cancer pain and could be an appropriate outcome measurement in acupuncture research for cancer pain.Trial registration:Registered on 09/07/2018 with ChiCTR1800017023(https://www.chictr/org.cn/edit.aspx?pid=28879&htm=4)