New research examines the cost of app-based symptom monitoring. For patients, the immediate question is how to get help between appointments.
Hot flashes can interrupt sleep. Joint pain can make getting dressed harder. Fatigue may follow you into work or the next day’s errands. For people taking long-term breast cancer medicines, managing side effects can become a daily task.
Endocrine therapy, also called hormone therapy, treats cancers that use hormones to grow. After surgery, treatment may continue for five to ten years to reduce the chance of cancer returning.
A study published November 2 in JAMA Network Open examines whether app-based symptom monitoring could lower costs. It found lower estimated costs in one monitoring group, although savings remain uncertain. For California patients, the immediate question is how to get help when side effects interfere with daily life.
What the app actually did
The THRIVE trial tested an app that sent patients weekly reminders to report symptoms and medication use. Certain responses triggered alerts to the oncology team. The “app-only” group received this monitoring; another group also received personalized text messages.
The comparison group also received support, including symptom screening during visits and the option to call the clinic between appointments. The researchers were testing what monitoring between visits added to that care. The trial took place at clinics serving Tennessee, Mississippi and Arkansas, with enrollment beginning in 2018 and follow-up ending in 2022.
The new economic evaluation analyzed complete data from 214 of 304 randomized participants. Over one year, estimated average costs were about $6,682 in the app-only group and $11,596 with enhanced usual care.
That roughly $4,914 difference came with a 95% uncertainty interval ranging from $14,046 lower to $1,097 higher. Savings were therefore not established with statistical certainty.
These were societal costs, including medical care, patient time, travel and monitoring expenses. They were not a tally of patients’ bills. Costs were expressed in 2021 dollars.
Quality-of-life-based measures were similar, but the study did not establish equal long-term cancer outcomes. Monitoring lasted six months, with one-year follow-up. The estimates excluded broad startup training expenses.
The original trial did not find a statistically significant overall improvement in taking medication as prescribed. It therefore does not establish that app monitoring helps patients complete years of treatment.
Who might be left out?
Participants had to communicate in English and have a mobile device with a data plan and email. Only nine of the original 304 participants identified as Hispanic. The research cannot establish equal benefit for Spanish-speaking patients or people without the required technology.
A clinic’s reporting system needs to work for the person using it. Patients can ask: Can I report symptoms by phone? Can an interpreter join? Who reads my message, and when?
UCLA Health says its patients can request free interpretation in person, by video or by telephone. Patients can contact Language Services at 310-267-8001. Ask your own clinic how to arrange language support when reporting symptoms.
Reader help: Make a plan for side effects
Describe what changed. Write down the symptom, when it started and how it affects your day. Be specific: Are night sweats waking you? Does joint pain make stairs difficult? Tell your oncology team if symptoms make you consider skipping medicine.
Mayo Clinic advises: “Do not stop estrogen blocker therapy without first talking with your care team.” Options may include treating symptoms, switching medicines or adjusting the plan with your clinician.
Ask how quickly someone will respond. UCLA advises patients to expect a portal response within two business days and to call their clinic for urgent issues. For a medical emergency, call 911 or go to the nearest emergency department. Ask your own clinic which number to use during the day and after hours.
Check costs before enrolling in monitoring. Ask whether there are program fees, insurance charges or copayments. At UCLA, most portal messages are not billed, but some medical-advice messages may be. Patient costs vary by coverage. These are UCLA’s general messaging rules, not prices for the study’s intervention.
Ask for support beyond the prescription. City of Hope lists symptom management and help with insurance and financial questions among its breast cancer support services for its patients. Parriva’s guide to medical debt and available help explains where Californians can seek assistance with bills.
Before your next appointment ends, ask who to contact about side effects, what needs urgent attention and how to get help in the language you understand best. You should know the next step if symptoms make taking your medicine difficult.
