@Article{info:doi/10.2196/46128,
author="Gomaa, Sameh
and Posey, James
and Bashir, Babar
and Basu Mallick, Atrayee
and Vanderklok, Eleanor
and Schnoll, Max
and Zhan, Tingting
and Wen, Kuang-Yi",
title="Feasibility of a Text Messaging--Integrated and Chatbot-Interfaced Self-Management Program for Symptom Control in Patients With Gastrointestinal Cancer Undergoing Chemotherapy: Pilot Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="10",
volume="7",
pages="e46128",
keywords="chemotherapy; gastrointestinal cancer; digital health; text messaging; chatbot; side effect management",
abstract="Background: Outpatient chemotherapy often leaves patients to grapple with a range of complex side effects at home. Leveraging tailored evidence-based content to monitor and manage these symptoms remains an untapped potential among patients with gastrointestinal (GI) cancer. Objective: This study aims to bridge the gap in outpatient chemotherapy care by integrating a cutting-edge text messaging system with a chatbot interface. This approach seeks to enable real-time monitoring and proactive management of side effects in patients with GI cancer undergoing intravenous chemotherapy. Methods: Real-Time Chemotherapy-Associated Side Effects Monitoring Supportive System (RT-CAMSS) was developed iteratively, incorporating patient-centered inputs and evidence-based information. It synthesizes chemotherapy knowledge, self-care symptom management skills, emotional support, and healthy lifestyle recommendations. In a single-arm 2-month pilot study, patients with GI cancer undergoing chemotherapy received tailored intervention messages thrice a week and a weekly Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events--based symptom assessment via a chatbot interface. Baseline and postintervention patient surveys and interviews were conducted. Results: Out of 45 eligible patients, 34 were enrolled (76{\%} consent rate). The mean age was 61 (SD 12) years, with 19 (56{\%}) being females and 21 (62{\%}) non-Hispanic White. The most common cancer type was pancreatic (n=18, 53{\%}), followed by colon (n=12, 35{\%}) and stomach (n=4, 12{\%}). In total, 27 (79{\%} retention rate) participants completed the postintervention follow-up. In total, 20 patients texted back at least once to seek additional information, with the keyword ``chemo'' or ``support'' texted the most. Among those who used the chatbot system checker, fatigue emerged as the most frequently reported symptom (n=15), followed by neuropathy (n=7). Adjusted for multiple comparisons, patients engaging with the platform exhibited significantly improved Patient Activation Measure (3.70, 95{\%} CI --6.919 to --0.499; P=.02). Postintervention interviews and satisfaction surveys revealed that participants found the intervention was user-friendly and were provided with valuable information. Conclusions: Capitalizing on mobile technology communication holds tremendous scalability for enhancing health care services. This study presents initial evidence of the engagement and acceptability of RT-CAMSS, warranting further evaluation in a controlled clinical trial setting. ",
issn="2561-326X",
doi="10.2196/46128",
url="https://formative.jmir.org/2023/1/e46128",
url="https://doi.org/10.2196/46128",
url="http://www.ncbi.nlm.nih.gov/pubmed/37948108"
}