Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients
Open accessAbstract
Background: The use of web-based monitoring for lung cancer patients is growing in interest because of promising recent results suggesting improvement in cancer and resource utilization outcomes. It remains an open question whether the overall survival (OS) in these patients could be improved by using a web-mediated follow-up rather than classical scheduled follow-up and imaging. Methods: Advanced-stage lung cancer patients without evidence of disease progression after or during initial treatment were randomly assigned in a multicenter phase III trial to compare a web-mediated follow-up algorithm (experimental arm), based on weekly self-scored patient symptoms, with routine follow-up with CT scans scheduled every three to six months according to the disease stage (control arm). In the experimental arm, an alert email was automatically sent to the oncologist when self-scored symptoms matched predefined criteria. The primary outcome was OS. Results: From June 2014 to January 2016, 133 patients were enrolled and 121 were retained in the intent-to-treat analysis; 12 deemed ineligible after random assignment were not subsequently followed. Most of the patients (95.1%) had stage III or IV disease. The median follow-up was nine months. The median OS was 19.0 months (95% confidence interval [CI] = 12.5 to noncalculable) in the experimental and 12.0 months (95% CI = 8.6 to 16.4) in the control arm (one-sided P = .001) (hazard ratio = 0.32, 95% CI = 0.15 to 0.67, one-sided P = .002). The performance status at first detected relapse was 0 to 1 for 75.9% of the patients in the experimental arm and for 32.5% of those in the control arm (two-sided P < .001). Optimal treatment was initiated in 72.4% of the patients in the experimental arm and in 32.5% of those in the control arm (two-sided P < .001). Conclusions: A web-mediated follow-up algorithm based on self-reported symptoms improved OS due to early relapse detection and better performance status at relapse.
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An app designed to screen patient reported outcomes for signs of disease recurrence to allow for early re-intervention in previously treated lung cancer patients improved median survival compared to optimized standard imaging follow-up (23 months vs 14.8 months; HR 0.62, 95% CI 0.39-0.995, P = 0.048).
“For example, an app designed to screen patient reported outcomes for signs of disease recurrence to allow for early re-intervention in previously treated lung cancer patients improved median survival compared to optimized standard imaging follow-up (23 months in the experimental arm vs 14.8 months in the control arm (HR 0.62, 95% CI 0.39–0.995, P = 0.048)).”
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- Authors
- Denis, F., Lethrosne, C., Pourel, N., Molinier, O., Pointreau, Y., Domont, J., Bourgeois, H., Senellart, H., Trémolières, P., Lizée, T., Bennouna, J., Urban, T., El Khouri, C., Charron, A., Septans, A.-L., Balavoine, M., Landry, S., Solal-Céligny, P., & Letellier, C.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- Les Hôpitaux de Chartres (FR)
- Institut Sainte Catherine (FR)
- Centre Hospitalier du Mans (FR)
- Centre Jean Bernard (FR)
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
- Institut de Cancérologie de l'Ouest (FR)
- Institut de Cancérologie de l’Ouest Paul Papin, Angers, France
- Centre Hospitalier Universitaire d'Angers (FR)
- Institut Catherine de Sienne, Nantes, France
- Institut de Cancérologie de l’Ouest René Gauducheau, St Herblain, France
- CORIA UMR 6614—Normandie Université, CNRS Université et INSA de Rouen, Campus Universitaire du Madrillet, Saint-Etienne du Rouvray, France
- Corresponding author
- Denis, Fabrice
- ORCID
- Venue
- JNCI: Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-04-10
- Volume
- 109
- Issue
- 9
- Pages
- djx029
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- OpenAlex
- W2606041829
- Cited by
- 482
- References
- 23
- Citations by year
- 2026: 36 · 2025: 49 · 2024: 48 · 2023: 62 · 2022: 74 · 2021: 65 · 2020: 60 · 2019: 33 · 2018: 35 · 2017: 17
- FWCI
- 32.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- Bonnie J. Addario Lung Cancer Foundation
- Unicancer
- Duke Cancer Institute
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- lung cancer, self-reported symptoms, routine monitoring, overall survival, early relapse detection, computed tomography, performance status, advanced lung cancer
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Lung Neoplasms, Male, Middle Aged, Neoplasm Staging, Population Surveillance, Prospective Studies, Quality of Life, Time Factors, Chi-Square Distribution, Outcome Assessment, Health Care, Internet, Kaplan-Meier Estimate, Self Report, Diagnostic Self Evaluation
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