Symptom tracking tool identifies post-discharge complications after debulking surgery
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Key takeaways:
- The tool helped identify post-discharge complications and may reduce admissions.
- The data from use of these digital tools may help normalize the postoperative experience, according to researchers.
A digital tool that tracks patient-reported symptoms helped identify post-discharge complications among women with gynecologic cancer who underwent debulking surgery, according to retrospective study results.
The approach — used in conjunction with a system that alerted surgeons’ offices when symptoms reached specific thresholds — may reduce readmissions, findings presented at Society of Gynecologic Oncology Annual Meeting on Women’s Cancer showed.
“Most importantly, we know that most of our patients have overall mild symptoms after they return home, and that should be emphasized to patients during their preoperative counseling and considered when patients call with symptoms after discharge,” researcher Jacqueline Feinberg, MD, gynecologic oncology fellow at Memorial Sloan Kettering Cancer Center, told Healio. “Secondarily, we found an association between the use of the recovery tracker with improved complication detection and decreased readmission rates, which may give us another tool to help our patients moving forward.”
Background and methodology
Patients are discharged after debulking surgery when they are medically ready; however, a considerable part of their recovery continues once they get home, Feinberg said.
Feinberg and colleagues aimed to provide insights into patient-reported postoperative symptoms after debulking surgery that could be used to improve counseling.
They also assessed whether a symptom tracking tool could detect complications, potentially decreasing unplanned visits or readmissions.
Researchers retrospectively reviewed patients who underwent debulking surgery and had enrolled in the institution’s Recovery Tracker, a digital tool that helps track patient-reported symptoms during the first 10 days they are home after discharge.
Patients report symptoms using a Likert scale of 0 to 5 (0 = no symptoms; 1 = very mild, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe).
Established thresholds for symptom severity and timing result in “red alerts” that trigger responses from the surgeon’s office, according to study background.
Investigators identified 240 patients who underwent debulking surgery between June 2021 and July 2022 and were eligible to participate in Recovery Tracker.
The analysis included 188 patients who enrolled and completed a median six surveys. The majority (88%; n = 165) had ovarian cancer; the remainder had uterine sarcoma or endometrial cancer.
About half (52%) had interval debulking, whereas 43% underwent primary debulking and 5% had debulking for recurrent disease.
During debulking, approximately half of patients had bowel resection (48%) or an upper abdominal procedure (53%), and 16% had chest debulking.
Results
Patients stayed in the hospital for a median 6 days.
Most patients reported minimal symptoms upon discharge home, with average scores in each symptom category being 2 or less.
Sixty percent of patients reported some level of pain — the most common symptom — but less than 10% reported severe pain.
Bowel function represented the second-most common symptom, with 25% reporting diarrhea and less than 10% reporting constipation. Ten percent reported mild nausea and less than 2% reported vomiting.
Forty percent of patients reported reduced eating, but this improved over time, according to investigators.
Less than 10% reported shortness of breath, less than 5% reported difficulty with urination and less than 2% reported fever. Five percent reported walking limitations.
“It is fascinating to see the trajectory of patient-reported symptoms over time, and some of the patterns were certainly surprising,” Feinberg told Healio. “To see that more than 50% of patients have some amount of pain — mostly mild — that persists for more than 10 days, to see that 25% of patients have some diarrhea, and to see that constipation tends to worsen over time will change how we counsel patients on their symptom management at home.”
Feinberg and colleagues compared patients who participated in Recovery Tracker with those who did not. Results showed no significant difference between groups with regard to percentage who developed complications, percentage with grade 3 or higher complications, or percentage who visited urgent care.
Five patients (3%) enrolled in Recovery Tracker required readmission compared with five (10%) of those not enrolled in Recovery Tracker (P = .049).
In the Recovery Tracker group, 42 patients had red alerts triggered and researchers determined 10 (24%) had post-discharge complications. Among the 146 patients without red alerts, 11 (7.5%) had post-discharge complications.
Next steps
“Based on the results of this study, we plan to continue to refine the digital recovery tracker as a patient engagement tool and with its impact on patient outcomes,” Feinberg said. “There is so much room to use digital tools to improve the care we give our patients, and it is exceedingly important to study the impact of these tools as they continue to grow in popularity.”
Using digital tools to track patient-reported symptoms is one way to stay engaged with patients after they are discharged from the hospital, Feinberg added.
“The data from our use of it can help to normalize the postoperative experience,” she said. “We hope to continue to grow these systems to improve complication detection, decrease hospital readmissions and, hopefully, ultimately decrease complication severity.”
Perspective
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Maurie Markman, MD
The majority of clinician and media attention at Society of Gynecologic Oncology Annual Meeting on Women’s Cancer focused on suggested advances in therapeutics, either relatively new antineoplastic agents or additional uses of existing strategies. However, one of the most clinically relevant abstracts presented at the meeting had nothing to do with treatment, yet could be among the presentations that had the greatest impact on cancer management.
In a retrospective review of 240 patients who underwent cytoreductive surgery at Memorial Sloan Kettering Cancer Center and participated in the institution’s Recovery Tracker, Feinberg and colleagues demonstrated substantial clinical utility of this rather simple, yet near-real-time monitoring strategy.
Recognizing this was a nonrandomized retrospective chart review, it is not possible to draw definitive conclusions. However, the potential of this tool or similar approaches is clear.
Patients with prospectively defined concerning or severe symptoms (“red flags”) can be identified, with necessary interventions undertaken relatively quickly before symptoms worsen, potentially avoiding costly ER visits, hospitalizations or, in the most serious situations, deaths. Further, the information generated in a large patient population can be utilized to counsel future patients regarding the symptoms they are most likely (or unlikely) to experience.
Finally, unexpected observations related to patient-reported outcomes may lead to changes in the approach to disease management, including information provided to patients at the time of hospital discharge.
Despite unequivocal evidence of the benefits of such digital technology, the question remains as to the financial viability of such efforts. How will a provider or practice be compensated for the time (monitoring and potentially responding) and cost of the required technology? Hopefully, future approaches to value-based care will carefully consider this concern and develop robust approaches to strongly encourage such initiatives.
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Feinberg J, et al. Patient-reported symptoms after debulking surgery and associations with urgent care visits, readmissions and complications. Presented at: Society of Gynecologic Oncology Annual Meeting on Women’s Cancer; March 25-28, 2023; Tampa, Florida.
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