An eHealth system supporting palliative care for patients with non-small cell lung cancer: A randomized trial

David H. Gustafson, Lori L. Dubenske, Kang Namkoong, Robert Hawkins, Ming Yuan Chih, Amy K. Atwood, Roberta Johnson, Abhik Bhattacharya, Cindy L. Carmack, Anne M. Traynor, Toby C. Campbell, Mary K. Buss, Ramaswamy Govindan, Joan H. Schiller, James F. Cleary

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


BACKGROUND: In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non-small cell lung cancer (NSCLC). METHODS: In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint - patient symptom distress - was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale. RESULTS: Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm. Significant differences were observed at 4 months (P =.031; Cohen d =.42) and at 6 months (P =.004; d =.61). Similar but marginally significant effects were observed at 2 months (P =.051; d =.39) and at 8 months (P =.061; d =.43). Exploratory analyses indicated that survival curves did not differ significantly between the arms (log-rank P =.172), although a survival difference in an exploratory subgroup analysis suggested an avenue for further study. CONCLUSIONS: The current results indicated that an online support system may reduce patient symptom distress. The effect on survival bears further investigation.

Original languageEnglish
Pages (from-to)1744-1751
Number of pages8
Issue number9
StatePublished - May 1 2013


  • communication and information technology
  • eHealth
  • lung cancer
  • palliative care
  • quality of life
  • survival
  • symptom distress

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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