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Table 1 Details of included studies including critical appraisal scores

From: Using technology to deliver cancer follow-up: a systematic review

Study and location Patient population Intervention Control Length of follow up Study outcomes Results Critical appraisal score
Beaver et al., 2009 Manchester, UK [11] 374 breast cancer patients Telephone follow up by specialist nurses Usual hospital care 24 months (mean) Psychological morbidity Equivalence trial - : no difference between the two groups Study Quality – 8/10
Participant’s needs for information External validity – 2/3
Participant’s satisfaction Internal Validity (bias) – 6/7
Clinical Investigations ordered Internal Validity (selection bias) – 6/6
Time to detection of recurrent disease Power – 1/1 (Total – 23/27)
Beaver et al., 2009 (Economic evaluation) Manchester, UK [25] 374 breast cancer patients Cost minimization analysis of RCT above - 24 months (mean) Primary: NHS resource use Telephone follow-up more costly (mean difference £55 but telephone patients had lower personal costs (mean difference £47) No score as cost analysis
Secondary: patient, carer and productivity courses
Davison and Degner, 2002 Vancouver, Canada [15] 749 breast cancer patients Computer programme providing information and assisting decision making Standard care only- asked about decision making before clinic appointment One clinic visit Involvement in decision making Women in the intervention group reporting playing a more passive role. Study Quality – 6/10
Patient satisfaction Patient satisfaction was high in both groups External validity – 2/3
Internal Validity (bias) – 5/7
Internal Validity (selection bias) – 4/6
Power – 0/1 (Total – 17/27)
Harrison et al., 2011 Sydney, Australia [21] 75 patients with colorectal cancer 5 telephone calls from a specialist colorectal nurse in 6 months after discharge Standard care 6 months Unmet supportive care needs No difference between the groups for unmet needs and health service utilization Study Quality – 8/10
Health service utilization Quality of life scores higher in the intervention group at 6 months External validity – 2/3
Quality of life Internal Validity (bias) – 5/7
Internal Validity (selection bias) – 6/6
Power – 0/1 (Total – 21/27)
Hegel et al., 2010 New Hampshire, USA [16] 31 Breast cancer patients 6 weekly session of telephone delivered problem solving occupational therapy Usual care 12 weeks Primary outcome: feasibility of conducting the trial Overall positive outcomes Study Quality – 8/10
Secondary outcomes: functional, quality of life and emotional status External validity – 3/3
Internal Validity (bias) – 5/7
Internal Validity (selection bias) – 6/6
Power – 0/1 (Total – 20/20)
Kearney et al., 2008 Stirling, Scotland [12] 112 cancer patients Mobile phone-based remote monitoring during chemotherapy Standard care 16 weeks Chemotherapy related morbidity – 6 common symptoms, nausea, vomiting, fatigue, mucositis, hand-foot syndrome and diarrhoea Higher reports of fatigue in the control group and lower reports of hand-foot syndrome in the control group Study Quality – 8/10
External validity – 1/3
Internal Validity (bias) – 5/7
Internal Validity (selection bias) – 6/6
Power – 0/1 (Total – 20/27)
Kimman et al., 2011 Maastricht, Netherlands [17] 299 women with breast cancer Nurse led telephone follow up or Hospital follow up or hospital follow up plus EGP 18 months Health related quality of life (HRQoL) No difference between the two groups Study Quality – 8/10
Nurse led telephone follow up plus educational group programme (EGP) Secondary measures included role and emotional functioning and feelings of control and anxiety External validity – 2/3
Internal Validity (bias) – 5/7
Internal Validity (selection bias) – 6/6
Power – 1/1 (Total – 22/27)
Kimman et al., 2011 Maastricht, Netherlands [27] 299 women with breast cancer Nurse led telephone follow up or Nurse led telephone follow up plus educational group programme (EGP) Hospital follow up or hospital follow up plus EGP 18 months Quality adjusted life gain (QALYs) Hospital follow-up plus EGP resulted in the highest QALYs but has the highest costs. Next best in terms of costs and QALYs was nurse led telephone follow up plus EGP No score as cost analysis
Incremental cost-effectiveness ratios (ICERs)
Kimman et al., 2010 Maastricht, Netherlands [13] 299 women with breast cancer Nurse led telephone follow up or Hospital follow up or hospital follow up plus EGP 12 months Patient satisfaction Increased patient satisfaction with access to care in telephone follow-up group. No significant influence on general patient satisfaction, technical competence or inter-personal aspects Study Quality – 9/10
Nurse led telephone follow up plus educational group programme (EGP) External validity – 2/3
Internal Validity (bias) – 5/7
Internal Validity (selection bias) – 5/6
Power – 1/1 (Total – 22/27)
Kroenke et al., 2010 Indiana, USA [26] 405 cancer patients Centralized telecare management by a nurse-physican specialist team coupled with home-based symptom monitoring by interactive voice recording or internet Usual care 12 months Depression Pain Improvements in pain and depression for the intervention group Study Quality – 8/10
External validity – 2/3
Internal Validity (bias) 6/7-
Internal Validity (selection bias) – 6/6
Power – 1/1 (Total – 23/27)
Marcus et al., 2009 Colorado, USA [18] 304 breast cancer patients 16 session telephone counselling post treatment Resource directory for breast cancer was given to each patient 18 months Distress No difference for distress and depression Study Quality – 8/10
Depression Need for clinical referral – depression and distress reduced by 50% in the intervention group for dichotomized end points External validity – 2/3
Sexual dysfunction Effects found for personal growth and sexual dysfunction in the intervention group Internal Validity (bias) – 5/7
Personal growth Internal Validity – 5/6 (selection bias)
Power – 0/1 (Total – 20/27)
Matthew et al., 2007 Toronto, Canada [20] 152 prostate cancer patients PDA survey followed by paper Paper followed by PDA survey 30 mins Survey was monitoring health-related quality of life but outcomes looked at assessment of data quality and feasibility Internal consistency similar Study Quality – 8/10
PDA followed by PDA survey. (3 groups) Test re-test reliability confirmed External validity – 3/3
Data from two modalities strongly correlated. Internal Validity (bias) – 5/7
Fewer missed items for the PDA Internal Validity (selection bias) – 5/6
More preferred using the PDA or had no preference. PDA found easy to use Power – 0/1 (Total – 21/27)
Age did not correlate with difficulty using PDA
Sandgren et al., 2003 North Dakota, USA [19] 222 women with breast cancer 6×30 min telephone therapy sessions that involved either cancer education or emotional expressions Standard care 5 months Perceived control Cancer education group reported greater perceived control compared to standard care Study Quality – 7/10
Mood
Quality of life No difference for mood or quality of life External validity – 2/3
Internal Validity (bias) – 5/7
Internal Validity (selection bias) – 6/6
Power – 1/1 (Total – 21/27)
Sikorski et al., 2009 Michigan, USA [22] 486 cancer patients Automated voice response symptom reporting Nurse assisted symptom management via the telephone 6 telephone contacts over 8 weeks Severity of cancer symptom at intake interview and at first intervention contact Patient in the AVR group reported more severe symptoms. There was a variation with age with older patients reporting more severity of symptoms to the nurse Study Quality – 9/10
External validity - 2/3
Internal Validity (bias) – 5/7
Internal Validity (selection bias) – 6/6
Power – 0/1 (Total – 22/27)
Sikorskii et al., 2007 Michigan, USA [23] 435 cancer patients Automated telephone symptom management Nurse-assisted symptom management 10 weeks Severity of cancer symptoms, demographic data and co-morbidities Reduction in symptom severity in both groups. Lung cancer patients with greater symptom severity withdrew from the ATSM group Study Quality – 8/10
External validity – 2/3
Internal Validity (bias) – 5/7
Internal Validity (selection bias) – 6/6
Power – 1/1 (Total – 22/27)
Yun et al. 2012 Seoul, Korea [24] 273 cancer patients Internet based, individually tailored cancer related fatigue education program Usual care 12 weeks Level of fatigue Education group reported a reduction in fatigue, decrease in HADS anxiety score, increase in global QoL score and emotional, cognitive and social functioning of EORTIC QLQ-C30 Study Quality – 8/10
Quality of Life, Anxiety and depression External validity – 1/3
Internal Validity (bias) – 4/7
Internal Validity (selection bias) – 6/6
Power – 1/1 (Total – 20/27)