Results Summary

What was the research about?

Surgery can treat many types of cancer. Patients who have cancer surgery often stay in the hospital for one day or less. These patients and their caregivers manage recovery by themselves at home, which can be stressful. Support for managing patient symptoms at home may reduce symptoms and anxiety. It may also prevent unplanned visits to the hospital or emergency room, or ER.

In this study, the research team compared two approaches to help patients manage symptoms at home after cancer surgery. In both, patients entered details about their symptoms and anxiety in an online survey each day for 10 days. Then, for those 10 days, patients received information in one of two ways:

  • Team monitoring. Healthcare providers, such as doctors or nurses, called patients if their symptoms were above a certain level.
  • Enhanced feedback. Patients received a report right after completing the survey. It showed how their symptoms compared with those of other patients who had similar cancer surgery.

All patients received an alert to seek health care if reported symptoms were too severe.

What were the results?

Patients who received enhanced feedback made fewer calls to nurses in the month after surgery than patients who received team monitoring. Also, anxiety decreased faster for patients who received enhanced feedback.

The two approaches didn’t differ in:

  • The number of patients who went to the ER or returned to the hospital in the month after surgery
  • The number of patients who received referrals to manage pain in the month after surgery
  • Adverse events from surgery, such as infection
  • Patients’ confidence in managing their health two months after surgery
  • Caregiver burden two months after surgery

Who was in the study?

The study included 2,624 patients receiving cancer surgery at an outpatient surgery center in New York City and their caregivers. Patients had surgery for breast, reproductive, urinary, or head and neck cancer. Of these patients, 81 percent were White, 6 percent were African American, 6 percent were Asian, and 3 percent were another race; 7 percent were Hispanic. The average age was 54, and 72 percent were women.

What did the research team do?

The research team assigned patients by chance to receive team monitoring or enhanced feedback. The team reviewed health records to track healthcare use for one month after surgery. The daily online survey had questions about anxiety. Two months after surgery, patients completed surveys about their confidence in managing their health. Caregivers also filled out a survey about burden.

Patients, caregivers, providers, researchers, and hospital staff helped design and conduct the study.

What were the limits of the study?

Patients at outpatient surgery centers are generally healthier and have less complex follow-up care needs than patients who have cancer surgery in hospital settings. The results may not apply to patients having surgery in hospitals.

Future studies could include patients having surgery in hospital settings.

How can people use the results?

Surgery centers can use the results when considering how to help patients manage their symptoms after cancer surgery.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers questioned how the researchers identified the number of study participants who were included in the planned analyses because it was not clear whether participants were excluded from analyses based on unforeseen factors such as rescinding their consent to participate in the study, participants not going through with the planned surgery, and changes to the study protocol which made some of the participants ineligible for the study.  Over several revisions, the researchers clarified which participants were excluded from the analyses for the reasons stated above, and also clarified that participants who received incorrect feedback or missed other elements of the intervention were not excluded from analyses.
  • The reviewers questioned the researchers’ assertions that their comparison analyses could not have been biased by the removal of participants from the analyses for the reasons stated above.  The reviewers also noted that if participants were randomized to feedback group after the surgery these analysis problems could have been avoided. The researchers explained that the clinicians who determined whether to cancel a surgery or change the surgical procedures did not know to which feedback group participants were randomized, so their decisions could not have been biased based on group assignment.  Further, the researchers explained that study participants had to be randomized before their surgeries because they needed to complete all study recruitment activities in order to complete baseline study questionnaires. The researchers did clarify the number of patients included in the analyses and added language to their limitations section regarding the potential for bias in the results, however small, due to removing some participants from the analyses.
  • The reviewers asked for more detail about the patient and stakeholder engagement activities in this research project. They noted that the report did not describe how patients and other stakeholders contributed to study priorities, the research question or study design and therefore could not be considered “partners” to the investigators.  The researchers assured the reviewers that community members were treated as study partners and this was reflected in the feedback these community members gave the investigators. The researchers expanded their description of patient partners’ participation in study planning and decision making.  

Conflict of Interest Disclosures

Project Information

Brett Simon, MD, PhD, and Andrea Pusic, MD, MS
Larissa Temple, MD
Memorial Sloan Kettering Cancer Center
Ambulatory Cancer Care Electronic Symptom Self-Reporting (ACCESS) for Surgical Patients

Key Dates

December 2016
December 2021

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 20, 2023