Digital health coaching program for breast cancer did not improve patient-reported outcomes
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Key takeaways:
- Patients reported improvements in quality of life but worsening financial toxicity.
- Researchers observed nonsignificant improvements in symptom severity, but symptom interference worsened.
A novel digital health coaching program did not improve patient-reported outcomes among individuals with active breast cancer, according to study results presented at San Antonio Breast Cancer Symposium.
Additional research is needed to identify best practices for digital health care interventions, researchers concluded.
Rationale and methods
As web-based health care platforms and mobile phone applications become more widely used, understanding the impact of a digital health coaching program on patient-reported outcomes among women with breast cancer is imperative, according to study background.
“Women with breast cancer on active therapy have many needs. They are often busy people with families and careers. We felt that a digital method of education and support might best aid them with the flexibility needed to fit their schedules,” Loretta Williams, PhD, APRN, associate professor at The University of Texas MD Anderson Cancer Center, told Healio.
“Digital health care has been increasing during the past 20 years or so, and the COVID-19 pandemic accelerated the pace of this increase,” Williams added. “However, there has been little research on best practices for digital health care interventions, especially from the perspective of the patient.”
Williams and colleagues sought to evaluate the effect of a digital health coaching program on patient-reported outcomes, including global health, symptom burden, quality of life, health care utilization and financial toxicity.
The analysis included 254 English-speaking adult women (mean age, 48 years; 74% white) undergoing active treatment for breast cancer.
Researchers randomly assigned 127 women to usual care. They assigned the other 127 to a 6-month digital health coaching program, which included weekly telephone calls from a health adviser; unlimited patient-initiated communication via phone, text or email; and digital delivery of additional health-behavior content.
Investigators used validated measures at baseline, 1 months, 3 months and 6 months to collect patient-reported outcomes. They used summary statistics to describe participant characteristics and linear mixed models to assess the effect of the intervention on outcomes.
Findings
Results showed no significant improvement in physical patient-reported outcome scores at 3 months (mean 37.93 vs. 37.47 ) or 6 months (mean, 36.46 vs. 35.08) among women assigned the digital intervention vs. usual care.
Researchers reported similar results for mental patient-reported outcome scores at 3 months (mean, 34.63 vs. 37.32) and 6 months (mean, 35.26 vs. 36.11).
Williams and colleagues observed nonsignificant improvements in symptom severity and quality of life throughout time for both the intervention and usual care groups. However, results showed worsening symptom interference with usual activities as well as financial toxicity over time for both groups.
Researchers observed fewer emergency room visits among those in the intervention group, but the difference did not reach statistical significance.
“There were several possible reasons for not finding significant results, and the results do not necessarily mean that a digital education and support intervention might not work in other situations,” Williams said. “We may not have designed the intervention to be most effective, as we did not consult with women on active treatment for breast cancer prior to beginning the study or after the study. So, we may not have completely understood their needs and how to best meet them. We may have chosen the wrong measures of change or may have done the measurements at the wrong times to find a change.”
Researchers reported potential reasons for failure to detect a treatment effect for digital health coaching. These included the ineffectiveness of digital health coaching on the selected outcomes, the low strength of the intervention, the variation in uptake of digital health coaching in the intervention group, heterogeneity of the sample and the potential that the study was underpowered due to COVID-19 restrictions that affected enrollment.
“We had planned to enroll about twice as many patients in our study, but the COVID-19 pandemic limited our ability to recruit women within a reasonable period of time,” Williams said. “Had we had more patients, we may have found some differences. It may be that the intervention would be useful for a subset of women. Only slightly more than two-thirds of women getting digital health coaching stayed on the study for the entire time, so this may have caused us not to find significant results.”
Implications
A better understanding of the education and support requirements of women with breast cancer on active treatment is needed, Williams told Healio, including “the optimal way to provide these requirements, and what improvements meeting these requirements optimally will cause for these women.
“We also need to understand if certain subgroups of these women have more needs than others,” she added. “Speaking with groups of women with breast cancer undergoing active treatment and who have participated in the digital intervention to understand their needs and preferences before further studies would be most helpful. Interventions and assessments should be designed based on the results of these discussions.”
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Williams L, et al. Abstract PS02-08. Presented at: San Antonio Breast Cancer Symposium; Dec. 5-9, 2023; San Antonio.
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