Evidence map›Paper›PMID 34880055›Full record

Trial reportBMJ (Clinical research ed.)2021

Remote, proactive, telephone based management of toxicity in outpatients during adjuvant or neoadjuvant chemotherapy for early stage breast cancer: pragmatic, cluster randomised trial.

Monika K Krzyzanowska, Jim A Julian, Chu-Shu Gu, Melanie Powis, Qing Li, Katherine Enright, Doris Howell, Craig C Earle, Sonal Gandhi, Sara Rask and 19 more

Registry-linked trialOpen access · hybridAbstract readMulticenter StudyPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02485678 (A Pragmatic Cluster-Randomized Trial of Ambulatory Toxicity Management in Patients Receiving Adjuvant or Neo-adjuvant Chemotherapy for Early Stage Breast Cancer), which is not on this map. Cited by 24 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 1 pooled it
2.9field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02485678 nacompletednot on this map

A Pragmatic Cluster-Randomized Trial of Ambulatory Toxicity Management in Patients Receiving Adjuvant or Neo-adjuvant Chemotherapy for Early Stage Breast Cancer (AToM)

TypeinterventionalSponsorOntario Clinical Oncology Group (OCOG)Ran2016 to 2020Enrolled1,460ConditionsEarly Stage Breast CancerArmsProactive Telephone Toxicity Management, Control Arm, PRO Sub-Study
3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 1 synthesis or guideline pooled it, 47 citations in OpenAlex.

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  4. Nurse-led remote symptom management for chemotherapy toxicity and quality of life in lymphoma: a quasi-experimental study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors at 20 institutions in 2 countries.

Monika K KrzyzanowskaPrincess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada monika.krzyzanowska@uhn.ca.ORCID 0000-0001-5533-7418
Jim A JulianOntario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada.
Chu-Shu GuOntario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada.
Melanie PowisPrincess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Qing LiInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Katherine EnrightTrillium Health Partners, Credit Valley Hospital, Mississauga, ON, Canada.
Doris HowellPrincess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Craig C EarleInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Sonal GandhiSunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Sara RaskSimcoe Muskoka Regional Cancer Program, Royal Victoria Hospital, Barrier, ON, Canada.
Christine Brezden-MasleySt Michael's Hospital, Unity Health, Toronto, ON, Canada.
Susan DentOttawa Hospital Cancer Centre, Ottawa, ON, Canada.
Leena HajraMarkham Stouffville Hospital, Markham, ON, Canada.
Orit FreemanDurham Regional Cancer Centre, Oshawa, ON, Canada.
Silvana SpadaforaAlgoma District Cancer Programme, Sault Area Hospital, Sault Ste Marie, ON, Canada.
Caroline HammWindsor Regional Hospital, Windsor, ON, Canada.
Nadia CalifarettiGrand River Hospital's Regional Cancer Centre, Kitchener, ON, Canada.
Maureen TrudeauSunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Mark N LevineOntario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada.
Eitan AmirPrincess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Louise BordeleauJuravinski Cancer Centre, Hamilton, ON, Canada.
James A ChiarottoScarborough Health Network, Toronto, ON, Canada.
Christine ElserPrincess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Juhi HusainBrampton Civic Hospital, Brampton, ON, Canada.
Nicole LaferriereRegional Cancer Centre Northwest, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada.
Yasmin RahimStronach Regional Cancer Centre, Newmarket, ON, Canada.
Andrew G RobinsonKingston General Hospital, Kingston, ON, Canada.
Ted VandenbergLawson Health Research Institute, London, ON, Canada.
Eva GrunfeldOntario Institute for Cancer Research, Toronto, ON, Canada.
University Health Network · CAJuravinski Cancer Centre · CAOntario Clinical Oncology Group · CAOntario Institute for Cancer Research · CASunnybrook Health Science Centre · CABrampton Civic Hospital · CAGrand River Hospital · CAInstitute for Clinical Evaluative Sciences · CAKingston General Hospital · CALawson Health Research Institute · CAMarkham Stouffville Hospital · CAOttawa Hospital · CARegional Municipality of Durham · CARoyal Victoria Regional Health Centre · CASault Area Hospital · CASt. Michael's Hospital · CAThe Scarborough Hospital · CAThunder Bay Regional Health Sciences Centre · CATrillium Health Centre · CAWindsor Regional Hospital · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the effectiveness of remote proactive management of toxicities during chemotherapy for early stage breast cancer.

designPragmatic, cluster randomised trial.

setting20 cancer centres in Ontario, Canada, allocated by covariate constrained randomisation to remote management of toxicities or routine care.

participantsAll patients starting adjuvant or neoadjuvant chemotherapy for early stage breast cancer at each centre. 25 patients from each centre completed patient reported outcome questionnaires.

interventionsProactive, standardised, nurse led telephone management of common toxicities at two time points after each chemotherapy cycle.

main outcome measuresThe primary outcome, cluster level mean number of visits to the emergency department or admissions to hospital per patient during the whole course of chemotherapy treatment, was evaluated with routinely available administrative healthcare data. Secondary patient reported outcomes included toxicity, self-efficacy, and quality of life.

resultsBaseline characteristics of participants were similar in the intervention (n=944) and control arms (n=1214); 22% were older than 65 years. Penetration (that is, the percentage of patients who received the intervention at each centre) was 50-86%. Mean number of visits to the emergency department or admissions to hospital per patient was 0.91 (standard deviation 0.28) in the intervention arm and 0.94 (0.40) in the control arm (P=0.94); 47% (1014 of 2158 patients) had at least one visit to the emergency department or a hospital admission during chemotherapy. Among 580 participants who completed the patient reported outcome questionnaires, at least one grade 3 toxicity was reported by 48% (134 of 278 patients) in the intervention arm and by 58% (163 of 283) in the control arm. No differences in self-efficacy, anxiety, or depression were found. Compared with baseline, the functional assessment of cancer therapy trial outcome index decreased by 6.1 and 9.0 points in the intervention and control participants, respectively.

conclusionsProactive, telephone based management of toxicities during chemotherapy did not result in fewer visits to the emergency department or hospital admissions. With the rapid rise in remote care because of the covid-19 pandemic, identifying scalable strategies for remote management of patients during cancer treatment is particularly relevant.

trial registrationClinicalTrials.gov NCT02485678.

Indexed as

OutpatientsTelemedicineTelephoneAdultAgedAged, 80 and overAntineoplastic Combined Chemotherapy ProtocolsBreast NeoplasmsChemotherapy, AdjuvantCOVID-19Drug-Related Side Effects and Adverse ReactionsEmergency Service, HospitalFemaleHumansMiddle AgedMonitoring, Ambulatory

Identifiers

PMID34880055
PMCPMC8652580
OpenAlexW4200140927

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.