A targeted literature review on the impact of tailored interventions on patient outcomes in oncology
Graham Ferrier, Aleksandra Filipovic, Harpreet Wasan, Alessandra di Pietro, Deepali Mittal, Geetanjali Kamath, Saifuddin Kharawala & Faisal Mehmud
Abstract
Non-pharmacological approaches to managing symptoms and side effects of cancer treatments are not always aligned with true needs and characteristics of patients. Without proactive patient-tailored interventions to anticipate, prevent, and manage side effects, risk of patients experiencing treatment interruption or discontinuation increases. A targeted literature review identified published studies evaluating the impact of tailored (customized based on individual patient characteristics) non-pharmacological interventions on patient outcomes in oncology versus routine care (usual clinical practice), enhanced care (support beyond routine care, including additional patient education, psychological support, and medication tracking), or uniform engagement (non-tailored support offered in a uniform manner). Thirty completed clinical studies were included. Approximately 50% of interventions across studies were remote health education/self-management programs, and the remaining provided clinical follow-up for symptom management. All types of tailored intervention led to positive patient outcomes versus routine care. Significant improvements were seen in favor of self-efficacy for self-management (patient’s belief in their ability to manage own symptoms and treatment; p < 0.05) and symptom burden (overall as well as specific symptoms including anxiety, nausea, vomiting; all p < 0.05), although there were inconsistent effects on health-related quality of life (HRQoL), healthcare resource utilization (HCRU), and adherence. Compared with enhanced care, most studies showed no consistent improvement for tailored interventions in symptom burden, self-efficacy, HRQoL, HCRU or adherence, although benefits were slightly more common in larger/longer studies. Tailored interventions were not consistently better than uniform engagement in improving outcomes, although the number of studies was limited, with small sample sizes/short follow-ups. In summary, tailored interventions showed positive benefits versus routine or enhanced care (the latter only in larger and longer studies). No consistent benefit was observed compared with uniform engagement. Clinical outcomes were most sensitive to type of intervention. Tools to both enhance and measure the process should be routinely incorporated in clinical trials.
