Scoping review of the assessment and management of chemotherapy-related toxicity to ensure the eSMART intervention is evidence based and reflects current and local practice

Aim of review The primary aim of the multicentre eSMART study (electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology for patients with cancer) is to evaluate the impact of using... [ view full abstract ]

Aim of review
The primary aim of the multicentre eSMART study (electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology for patients with cancer) is to evaluate the impact of using mobile phone based technology to monitor chemotherapy-related toxicities in patients with breast (BC), colorectal (CRC) or haematological (Hodgkin’s (HL) or non-Hodgkin lymphoma (NHL)) cancer. eHealth systems such as ASyMS facilitate the remote monitoring of toxicities thereby enabling the early identification and timely management of toxicities which are or have the potential to become life-threatening. Self-management of mild, non-life threatening toxicities is also facilitated through the provision of self-care advice. To ensure that the eSMART intervention was evidence-based and consistent with international, national and local guidelines, a scoping review was undertaken.

Search and review methodology
The published and grey literature (including clinical site protocols) was reviewed to identify the assessment and management strategies used to address chemotherapy-related toxicities among patients receiving primary chemotherapy for BC, CRC, NHL, and HL. The literature review also sought to identify the self-care behaviours used to address chemotherapy-related toxicities in this context. Finally, consultations were undertaken with clinicians and patients at the respective clinical sites to establish their views on and agreement with the symptom protocols, clinical risk model, daily symptom questionnaire and self-care advice proposed for ASyMS following the literature review.

Findings
Most of the published papers (n=14/27) addressed fatigue although these primarily related to BC. Chemotherapy-induced nausea and vomiting, mucositis, peripheral neuropathy and pain were addressed to varying degrees through primary research papers and/or clinical guidelines, however, there was limited literature on diarrhoea, constipation, or hand-foot syndrome. Only 3 papers addressed self-care. There was a high level of agreement from clinicians and patients with the final recommendations with only minor suggestions made.


Conclusions and implications
There is a need for more research on symptom management for hand-foot syndrome, constipation and diarrhoea. Studies on fatigue in patients with cancers other than BC are also warranted. The evidence base underpinning ASyMS was updated following the published and grey literature review and subsequent feedback from clinicians and patients.