Remote symptom monitoring (RSM) during treatment for metastatic prostate cancer (mPC) in older men: Feasibility and efficacy.
Bibliographic record
Abstract
12056 Background: Emerging data support multiple benefits of RSM during chemotherapy to improve outcomes. These studies do not focus on older adults and do not include non-chemotherapy strategies. mPC represents a major burden in older men. Although both chemotherapy and androgen receptor axis-targeted therapies (ARATs) prolong survival, toxicities are substantial and increased in older men. Understanding the feasibility of RSM and key symptoms experienced by men with mPC on treatment is crucial to designing appropriate supportive care interventions. We aimed to assess RSM feasibility and understand key symptoms during treatment with chemotherapy or an ARAT among older men. Methods: Older adults aged 65+ starting chemotherapy, an ARAT, or Radium-223 for mPC were enrolled in a prospective observational multicentre study. Participants completed the Edmonton Symptom Assessment Scale (ESAS) on weekdays online or by phone. Weekly detailed questionnaires assessed mood, anxiety, fatigue, insomnia, and pain. Notifications were sent to the clinical oncology team with severe symptoms (ESAS 7 or higher). Study duration was the first treatment cycle (̃3-4 weeks). Feasibility data were analyzed descriptively. Linear mixed effects models examined symptoms over time and by cohort. Clinician responses were assessed descriptively. Results: A total of 90 men were included (mean age 76.5y, 48% ARAT, 38% chemotherapy, and 14% Radium-223, 42% frail by Vulnerable Elders Survey-13 cutoff of 3+). Approximately half the patients preferred phone-based RSM. Patients provided RSM responses in 1,874 of approximately 2,000 (94%) instances. In the combined cohort, the most common symptoms of moderate to severe intensity (ESAS 4 or higher) occurring at least once were poor well-being (66%), fatigue (62%), reduced appetite (56%), insomnia (54%), and pain (46%). Symptom patterns were similar between chemotherapy and ARAT groups. Moderate to severe symptoms were more common and lasted longer among frail than non-frail men. Symptoms tended to remain stable or improve over the course of 3-4 weeks of RSM. 89% of participants were satisfied or very satisfied with RSM, although daily reporting was reported by several as burdensome. 45% had severe symptoms from RSM leading to informing the oncology care team, 79% of whom were followed up by a nurse or physician, and 12% of treatments were modified. Conclusions: RSM is feasible, acceptable to older adults, and identifies clinically relevant symptoms, but accommodation needs to be made for phone and the optimal frequency of RSM needs to be established. Poor well-being, fatigue, reduced appetite, and insomnia occurred in over half of participants. Longer-term follow up will be important.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".