The Advanced Symptom Management System for patients with malignant pleural mesothelioma (ASyMSmeso): a feasibility study

Background: Patients with malignant pleural mesothelioma (MPM) have a life limiting illness and a short prognosis and experience many debilitating symptoms from early on in the illness. Innovations such as remote symptom monitoring are needed to enable patients to maintain wellbeing and to manage symptoms in a proactive and timely manner. The Advanced Symptom Management System (ASyMS) has been successfully used to monitor symptoms associated with cancer. Objective: To determine the feasibility and acceptability of using an Advanced Symptom Management System (ASyMS) adapted for use by patients with malignant pleural mesothelioma and called: ASyMSmeso enabling the remote monitoring of symptoms using a smartphone. Methods: This was a mixed methods study using Patient Reported Outcome Measures (PROMs) at key time points over a period of 2-3 months with 18 patients. The Sheffield Profile for Assessment and Referral for Care (SPARC); Technology Acceptance Model Measure for e-health (TAM); and the Lung Cancer Symptom Scale-Mesothelioma (LCSS-meso) were the PROMs used in the study. Patients were also asked to complete a daily symptom questionnaire on a smartphone throughout the study. At the end of the study semi-structured interviews with 11 health professionals, 8 patients and 3 carers about their experience of using ASyMSmeso were conducted. Results: Eighteen patients with MPM agreed to participate in the study (33.3% response rate). The completion rates of study PROMs were high (97.2%-100%) and for completion of the daily symptom questionnaire were also high at 88.5% There were no significant changes in quality of life, as measured by LCSS-meso. There were statistically significant improvements from the SPARC domain: psychological need (P=0.049), and in the “Usefulness” domain of the Technology Acceptance Model (P=0.022). End of study interviews identified that both patients and clinicians found the system quick and easy to use. For patients in particular the system provided reassurance about symptom experience and the feeling of being listened to. The clinicians largely viewed the system as feasible and acceptable and areas that were mentioned included the early management of symptoms, connectivity between patients and clinicians leading to enhanced communication. Conclusions: This study demonstrates that remote monitoring and management of symptoms of people with MPM using a mobile phone is feasible and acceptable. The evidence supports future trials using remote symptom monitoring to support patients with MPM at home.