CANCER：在线支持系统可减轻NSCLC患者忧虑

　　通过与互联网支持比较，美国学者研究了一种在线支持系统（综合性健康增强支持系统[CHESS]）减轻非小细胞肺癌（NSCLC）患者身体症状相关性忧虑的有效性，结果表明，在线支持系统可能会减轻患者身体症状相关性忧虑，但其能否带来生存获益仍需要进一步研究。 

　　该研究纳入285对非正式护理人员和患者，被随机分配到两组，一组接受标准护理和互联网使用的培训与操作（互联网组），另一组接受标准护理和CHESS使用的培训与操作（CHESS组），时间长达25个月。护理人员同意使用CHESS或互联网，并完成了两月一次的调查，患者可自愿完成这些任务。主要终点为患者身体症状相关性忧虑，使用改良的Edmonton身体症状评估量表进行评估，结果由护理人员报告。

　　结果显示，与互联网组相比，CHESS组的护理人员所报告的身体症状相关性忧虑均较低。在4个月（P = 0.031；Cohen d = 0.42）和6个月（P = 0.004；d = 0.61）时，观察到了显著差异。在2个月（P = 0.051；d = 0.39）和8个月（P = 0.061；d = 0.43）时观察到了相似但轻微的显著性差异。尽管一项探索性亚组分析中显示存活差异，需要进一步研究验证，但是，探索分析结果表明两组之间的存活曲线并无显著差异。

An eHealth system supporting palliative care for patients with non-small cell lung cancer: A randomized trial
BACKGROUND
In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non-small cell lung cancer (NSCLC).
METHODS
In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint-patient symptom distress-was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale.
RESULTS
Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm. Significant differences were observed at 4 months (P = .031; Cohen d = .42) and at 6 months (P = .004; d = .61). Similar but marginally significant effects were observed at 2 months (P = .051; d = .39) and at 8 months (P = .061; d = .43). Exploratory analyses indicated that survival curves did not differ significantly between the arms (log-rank P = .172), although a survival difference in an exploratory subgroup analysis suggested an avenue for further study.
CONCLUSIONS
The current results indicated that an online support system may reduce patient symptom distress. The effect on survival bears further investigation.