Digital monitoring preserves quality of life
In advanced cancer palliative care, an app with nurse follow-up helped maintain quality of life and reduced unplanned hospital use vs usual care.
*Randomized clinical trial; Level 1b.

Citation

Chan W-L, Soong IS, Lim M-Y, et al. Digital self-management of symptoms and quality of life for patients with advanced cancer: A randomized clinical trial. JAMA Network Open. 2026;9(6):e2615509. doi:10.1001/jamanetworkopen.2026.15509

Background

People with advanced cancer often have worsening symptoms between clinic visits, lowering quality of life and increasing unplanned hospital care. Evidence for digital symptom support in community palliative care has been limited.

Patients

1214 community-dwelling adults in Hong Kong with advanced solid cancer who had chosen no further drug cancer treatment, had at least 1 cancer-related symptom, and had smartphone access. Excluded: blood cancers, expected survival under 3 months, inability to consent, or poor functional status (score >3 on the Eastern Cooperative Oncology Group scale).

Intervention

Weekly symptom reporting via the Integrated Palliative Care Outcome Scale, automated self-care guidance, and nurse contact within 1 working day for severe symptom alerts, plus usual care.

Control

Usual outpatient palliative care (scheduled visits and nursing support as needed).

Outcome

Primary: change in health-related quality of life by EuroQol 5-dimension 5-level utility (range −0.865 to 1). Secondary: self-efficacy (6-item scale range 1–10) and acute care use.

Follow-up Period

18 weeks

Results

Outcome Effect vs usual care
EuroQol 5-dimension 5-level utility (primary) Mean difference in change: 0.15 higher (95% CI, 0.10 to 0.21)
EuroQol self-rated health (0–100) Mean difference in change: 6.09 points higher (95% CI, 3.51 to 8.67)
Self-efficacy (1–10) Mean difference in change: 0.53 higher (95% CI, 0.27 to 0.78)
Worsening unplanned hospitalizations (week 18) Absolute risk reduction 11.3% (28.5% to 17.2%); Number needed to treat: 9
Worsening inpatient days (week 18) Absolute risk reduction 15.5% (34.0% to 18.5%); Number needed to treat: 7
Analyses used intention-to-treat with available data among participants alive at follow-up. A prespecified clinically meaningful difference for EuroQol utility was 0.11; the observed between-group difference exceeded this threshold.
Emergency department visits and functional status did not differ clearly between groups.

Limitations

High attrition from death and loss to follow-up limits certainty and may affect who contributed outcomes at 18 weeks. Participants and nurses were not blinded, which may influence self-reported measures. The bundled intervention prevents separating the app’s effect from nurse follow-up, and results may not generalize to settings with less caregiver support or fewer nursing resources.

Funding

Bank of China (Hong Kong) charity program; Hong Kong government research fund.

Clinical Application

Consider adding structured digital symptom reporting with rapid nurse follow-up to community palliative care to help maintain quality of life and reduce unplanned hospitalizations.