A digital symptom monitoring program supported by palliative care nurses helped maintain quality of life and reduce hospitalisations among people with advanced cancer, according to findings from a large randomised clinical trial presented at the 2026 ASCO Annual Meeting and published in JAMA Network Open.
The study evaluated an app-facilitated palliative care intervention that combined weekly symptom reporting, automated self-management guidance and nurse-led follow-up for severe symptoms.
Researchers enrolled 1,214 community-dwelling adults with advanced solid tumours across six palliative care clinics in Hong Kong. All participants had stopped systemic anticancer treatment and were receiving palliative care. Patients were randomised to digital symptom monitoring plus usual care (n=590) or usual care alone (n=624) and followed for 18 weeks.
Health-related quality of life was better maintained in the intervention group.
LISTEN TO DR NIARA OLIVEIRA + DR VIVEK RATHI BUSTING SOME BRCA MYTHS!
EQ-5D-5L utility scores remained relatively stable among patients receiving digital symptom monitoring, increasing from 0.49 at baseline to 0.52 at week 18, compared with a decline from 0.50 to 0.38 in the usual care group. The between-group difference was statistically significant (mean difference in change, -0.15; 95% CI, -0.21 to -0.10; P<0.001).
A similar pattern was observed for self-rated health on the EQ visual analogue scale, with scores remaining more stable in the intervention group than in the control group.
The intervention was also associated with better maintenance of self-efficacy, a measure of patients’ confidence in managing their condition. Self-efficacy scores remained relatively stable over 18 weeks among those using the intervention but declined in patients receiving usual care alone (mean difference, -0.53; 95% CI, -0.78 to -0.27; P<0.001).
While emergency department utilisation and deterioration in performance status did not differ significantly between groups, hospital utilisation outcomes favoured the intervention.
Patients assigned to digital symptom monitoring were less likely to experience worsening unplanned hospitalisations than those receiving usual care (17.2% vs 28.5%; OR 1.59; 95% CI, 1.21-2.10; P=0.001). They also spent fewer days in hospital during follow-up, averaging 3.4 days compared with 7.3 days in the control group.
The digital platform used weekly symptom reporting based on the Integrated Palliative Care Outcome Scale (IPOS). Severe symptoms automatically generated alerts that were reviewed by palliative care nurses, who contacted patients within one working day. Participants also received automated self-management advice tailored to reported symptoms.
Notably, most symptom reports were submitted by caregivers rather than patients themselves. Overall, 67.6% of app users were caregiver proxies, highlighting the important role of caregivers in supporting patients receiving palliative care.
Among intervention participants with evaluable data, 86% submitted regular symptom reports during the study period. Severe symptoms were reported in 36% of submissions, most commonly pain, weakness, poor appetite and drowsiness. Two-thirds of symptom alerts required nurse telephone follow-up.
Overall survival did not differ between study groups.
The investigators said the findings support a shift from episodic symptom management during clinic visits towards proactive identification of deterioration and timely intervention between scheduled encounters.
They concluded that integrating structured digital symptom monitoring with nurse-led follow-up into routine palliative care services may help maintain quality of life while reducing avoidable hospital use among patients with advanced cancer.
Paper: Chan, W-L., 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). Access online here.
