27th Annual Conference of the International Society for Quality of Life Research

Aims: eRAPID is an online eHealth system for patients to report symptoms during cancer treatment. It provides automated severitydependent advice to patients guiding self-management or medical contact. Patient reports are transferred to the electronic patient records for immediate use in patient care. This trial evaluated the impact of eRAPID on symptom control, clinical care, patient self-efficacy, and quality of life (QOL). Methods: A prospective randomized parallel two-arm trial included colorectal, breast or gynecological patients commencing chemotherapy at a UK cancer center. Participants were randomized to usual care plus eRAPID or usual care (UC). eRAPID patients completed weekly symptom reports for 18 weeks. Primary outcome: symptom control at 18 weeks (Functional-Assessment-Cancer-Therapy-Physical Wellbeing, FACT-PWB). Secondary outcomes: cost-effectiveness, clinical process measures (admissions/ chemotherapy delivery), patient self-efficacy(6-item Self-Efficacy Scale) and global QOL(FACT-G). Multivariable mixed-effects repeated measures models were employed. Clinical relevance of any differences was evaluated with responder analysis. Trial registration-ISRCTN88520246. Results: Between Jan 2015 and June 2018, 508/690 eligible patients (73.6%) consented and were randomized (256 eRAPID:252 UC). No significant effect of eRAPID on FACT-PWB was found at 18 weeks (mean difference 0.20;95% CI -0.81, 1.20; p = 0.699). There was a benefit at 6 and 12 weeks (1.08; 95% CI 0.12, 2.05; p = 0.028 & 1.01; 95% CI 0.05, 1.98; p = 0.039). Responder analysis: eRAPID patients experienced less clinically relevant symptom deterioration at 6 and 12 weeks (deterioration at 12 weeks was 47.5% in eRAPID patients vs 56.3% UC). There were no differences for admissions/chemotherapy delivery. eRAPID patients reported better self-efficacy (p = 0.007) at 18 weeks, and better QOL EQ5D-VAS scores at 12 (p = 0.030) and 18 (p = 0.009) weeks. Intervention fidelity: Patient adherence to weekly symptom reporting varied between 71.8% in week 1 to 58.1% week 18 (average 64.7%). 3314 online reports were completed, median per patient 14.0 (range 0-117); emergency alerts were activated in 29/3314 cases (0.9%), self-management advice 2714/3314 (81.9%). Post hoc analyses showed high patient adherence was associated with clinician's use of the data, high baseline FACT-PWB and older age. High adherence patients had better FACT-PWB scores at 12 weeks. Conclusion: eRAPID improved symptom control early at 6 and 12 weeks during chemotherapy and supported patient self-efficacy, without increasing hospital workload. Engaging both patients and clinicians is important for the intervention success.