Background: Cancer therapies predispose survivors to a high symptom burden. This study utilized mobile health (mHealth) technology to assess the feasibility of collecting daily symptoms from adult survivors of childhood cancer to evaluate symptom fluctuation and associations with future health-related quality-of-life (HRQOL). Methods: This prospective study used an mHealth platform to distribute a 20-item cancer-related symptom survey (5 consecutive days each month) and an HRQOL survey (the day after the symptom survey) over 3 consecutive months to participants from the Childhood Cancer Survivor Study. These surveys comprised a PROMIS-29 Profile and Neuro-QOL assessed HRQOL. Daily symptom burden was calculated by summing the severity (mild, moderate, or severe) of 20 symptoms. Univariate linear mixed-effects models were used to analyze total, person-to-person, day-to-day, and month-to-month variability for the burden of 20 individual symptoms. Multivariable linear regression was used to analyze the association between daily symptom burden in the first month and HRQOL in the third month, adjusted for covariates. Results: Out of the 60 survivors invited, 41 participated in this study (68% enrollment rate); 83% reported their symptoms ≥3 times and 95% reported HRQOL in each study week across 3 months. Variability of daily symptom burden differed from person-to-person (74%), day-to-day (18%), and month-to-month (8%). Higher first-month symptom burden was associated with poorer HRQOL related to anxiety (regression coefficient: 6.56; 95% CI: 4.10–9.02), depression (6.32; 95% CI: 3.18–9.47), fatigue (7.93; 95% CI: 5.11–10.80), sleep (6.07; 95% CI: 3.43–8.70), pain (5.16; 95% CI: 2.11–8.22), and cognitive function (–6.89; 95% CI: –10.00 to –3.79) in the third month. Conclusions: Daily assessment revealed fluctuations in symptomology, and higher symptom burden was associated with poorer HRQOL in the future. Utilizing mHealth technology for daily symptom assessment improves our understanding of symptom dynamics and sources of variability.
背景：癌症治疗使幸存者面临较高的症状负担。本研究利用移动健康技术，评估从儿童期癌症成年幸存者中收集每日症状的可行性，以探究症状波动及其与未来健康相关生活质量的关联。方法：这项前瞻性研究通过移动健康平台，对来自儿童癌症幸存者研究的参与者连续三个月发放20项癌症相关症状调查（每月连续5天）及健康相关生活质量调查（症状调查次日）。调查工具包括PROMIS-29量表和神经生活质量量表。每日症状负担通过20种症状的严重程度（轻度、中度或重度）总和计算。采用单变量线性混合效应模型分析20种个体症状负担的总体变异度、人际差异、日间波动和月际变化。通过多变量线性回归分析首月每日症状负担与第三月健康相关生活质量的关联，并对协变量进行校正。结果：在受邀的60名幸存者中，41人参与研究（入组率68%）；83%的参与者在三个月的研究周期内每周至少报告症状3次，95%每周完成健康相关生活质量评估。每日症状负担的变异度呈现人际差异（74%）、日间波动（18%）和月际变化（8%）的特征。较高的首月症状负担与第三月较差的健康相关生活质量显著相关，具体表现为焦虑（回归系数：6.56；95% CI：4.10–9.02）、抑郁（6.32；95% CI：3.18–9.47）、疲劳（7.93；95% CI：5.11–10.80）、睡眠障碍（6.07；95% CI：3.43–8.70）、疼痛（5.16；95% CI：2.11–8.22）及认知功能下降（–6.89；95% CI：–10.00至–3.79）。结论：每日评估揭示了症状学的动态波动特征，较高的症状负担与未来较差的健康相关生活质量存在显著关联。运用移动健康技术进行每日症状监测，有助于深化对症状动态变化规律及变异来源的理解。
肿瘤(癌症)患者之家