A Randomized Trial of a Nurse-Led Symptom Monitoring App for Reducing Unplanned Hospital Admissions in Older Adults Receiving Chemotherapy
DOI:
https://doi.org/10.61919/kzk7fj89Keywords:
Older adults; chemotherapy; nurse-led intervention; symptom monitoring; mobile application; PRO-CTCAE; emergency department visits; hospital admissionsAbstract
Background: Older adults receiving chemotherapy are vulnerable to treatment-related toxicities that may progress rapidly when symptoms are reported late, increasing emergency department visits, unplanned hospital admissions, and treatment disruption. Objective: To evaluate whether a nurse-led mobile symptom-monitoring application improves timely symptom reporting, reduces acute healthcare utilization, and enhances chemotherapy completion among older adults undergoing outpatient chemotherapy. Methods: A parallel-group randomized controlled trial was conducted in the Islamabad–Rawalpindi region over five months. Eighty-four adults aged ≥60 years receiving outpatient chemotherapy for solid malignancies were randomized equally to a nurse-led symptom-monitoring intervention or standard oncology care. The intervention group used a PRO-CTCAE-based mobile application for daily symptom reporting, with nurse review, telephone follow-up within 24 hours for moderate-to-severe symptoms, standardized guidance, escalation when required, and weekly virtual check-ins. The control group received routine oncology care without structured digital monitoring. Outcomes included unplanned hospital admissions, emergency department visits, symptom-reporting delay, ESAS symptom burden, and chemotherapy completion over six weeks. Results: Seventy-five participants completed follow-up, including 38 in the intervention group and 37 in the control group. The intervention group had fewer unplanned hospital admissions than controls (1.21 ± 0.74 vs 2.08 ± 0.91, p<0.001) and fewer emergency department visits (0.89 ± 0.63 vs 1.67 ± 0.88, p<0.001). Symptom-reporting delay decreased from 3.6 ± 1.2 to 1.4 ± 0.6 days in the intervention group, compared with 3.5 ± 1.1 to 3.2 ± 1.0 days in controls. ESAS scores improved more substantially in the intervention group, and chemotherapy completion was higher with nurse-led monitoring (86.8% vs 70.3%, p=0.04). Conclusion: Nurse-led digital symptom monitoring improved early symptom communication, reduced acute healthcare utilization, lowered symptom burden, and supported chemotherapy completion among older adults receiving chemotherapy.
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Copyright (c) 2025 Fauzia Latif, Amna Aziz, Zarina Naz, Kashfa Sana (Author)
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