29 July 2021

Remote 24-hour monitoring for cancer patients who are receiving chemotherapy can improve their quality of life, a new international study published last week suggests.

The study, eSMART, represents the largest trial to date of remote monitoring of symptoms during chemotherapy for cancers. The research team, led by the University of Strathclyde, Scotland, say it provides a safe, secure, and “real time” system that optimises symptom management and enables patients to stay at home.

Previous research on remote monitoring during chemotherapy has shown benefits, but was largely based on short trials from a single site or country.

To address the gap, the team of international researchers evaluated the effects of remote monitoring of chemotherapy-related side effects on symptom burden, supportive care needs, anxiety, work limitations, and quality of life.

Their findings, published in The BMJ, are based on 829 adult patients aged 18 years and over, who were diagnosed with breast cancer, colorectal cancer, Hodgkin’s lymphoma, or non-Hodgkin’s lymphoma. They were all receiving chemotherapy at 12 cancer centres in Austria, Greece, Norway, the Republic of Ireland and the UK.

The cohort was randomly selected to receive either 24-hour symptom monitoring via the Advanced Symptom Management System (ASyMS) or standard care at their cancer centre over six cycles of chemotherapy.

The intervention patients in the ASyMS group completed a daily symptom questionnaire on a handheld device, which generated alerts to hospital clinicians if action was needed. Patients also received self-care advice on how to manage their symptoms.

The research group found the symptom burden in the intervention group remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle one onwards.

The intervention group also experienced significant reductions in psychological and physical symptoms, as well as the level of distress associated with each symptom. Their health-related quality of life scores were also higher across all cycles, and average scores for anxiety were lower.

Measures of cancer patients’ confidence and ability to engage in their care were also higher in the intervention group, and most supportive care needs were lower.

The researchers concede that because most participants had breast cancer and were female, a larger study is needed for patients with other types of cancer. However, they add that their findings suggest that an evidence-based remote monitoring intervention, such as ASyMS, has the potential to be included in routine care for cancer patients.


Maguire R, McCann L, Kotronoulas G, Kearney N, Ream E, Armes J, Patiraki E, Furlong E, Fox P, Gaiger A, McCrone P, Berg G, Miaskowkski C, Cardone A, Orr D, Flowerday A, Katsaragakis S, Darley A, Lubowitzki S, Harris J, Skene S, Miller M, Moore M, Lewis L, DeSouza N, Donnan PT. (2021) “Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART).” BMJ, doi: 10.1136/bmj.n1647

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