Pilot study of a text messaging-integrated and Chatbot-interfaced self-management program for symptom control in GI cancer patients undergoing chemotherapy.

BACKGROUND Chemotherapy treatments are typically administered in the outpatient setting. Patients are expected to monitor and manage a range of diverse and complicated side effects, which often occur at home well after leaving outpatient infusion facilities. The potential of patient symptoms being monitored with tailored evidence-based educational and supportive content during chemotherapy among GI cancer patients is still unexploited. OBJECTIVE The overall goal of this study is to address the gap in the continuity of care during outpatient chemotherapy through the integration of an innovative text messaging system with a Chatbot interface in the real-time monitoring and proactive management of side effects among gastrointestinal (GI) cancer patients undergoing intravenous (IV) chemotherapy. METHODS Real-time chemotherapy-associated side effects monitoring supportive system (RT-CAMSS) was iteratively developed with patient-centered inputs and evidence-based and theory-guided information to integrate chemotherapy knowledge, self-care symptom management skills, emotional support, doctor-patient communication, and nutritional and physical activity suggestions. We conducted a single-arm 2-month pilot study in which GI patients undergoing chemotherapy received two intervention text messages per week and a weekly CTCAE-based symptom assessment delivered through a Chatbot interface with tailored feedback. Baseline and post-intervention patient-reported outcome follow-up surveys were collected. RESULTS 45 eligible patients were approached, 34 consented and enrolled (76% consenting rate). The mean age was 61 (±12). 56% were females and 61.8% were non-Hispanic White. The most frequent cancer type was pancreatic cancer (53%), followed by colon cancer (35%), and stomach cancer (12%). 27 participants completed the post-intervention follow-up (79% retention rate). Twenty-seven patients used the Chatbot system checker at least once during the 2-month intervention. Fatigue was reported the most regardless of severity (N=15), followed by neuropathy (N=7) and altered taste (N=5) were reported the most. After adjusting for multiple comparisons, patients who texted back the platform had significantly improved patient activated measure 3.70 (-6.919,-0.499) P=0.025. Post-intervention open-ended interviews and satisfaction surveys found that participants perceived the intervention as easy to use with helpful information. CONCLUSIONS Conclusions: Communication via mobile technologies is highly scalable for improving health services. The study provides preliminary evidence of engagement and acceptability of RT-CAMSS, which should be evaluated in a controlled clinical trial in the future.