Imagine a world where cancer patients can manage their symptoms effectively, without the need for frequent hospital visits. This is the vision that inspired a groundbreaking study by researchers at the Mayo Clinic.
The Battle Against Cancer Symptoms
For those living with cancer, symptoms like pain, anxiety, and insomnia can quickly escalate, leading to costly and emotionally draining emergency room visits. But here's where it gets controversial: what if we could prevent these crises before they happen?
The Mayo Clinic researchers set out on a mission to explore the potential of digital check-ins and remote care teams. Their goal? To empower patients to take control of their symptoms and avoid reaching a critical point.
A Simple Yet Ambitious Goal
"Our goal was simple but ambitious," says Dr. Andrea Cheville, lead researcher and professor at the Mayo Clinic Comprehensive Cancer Center. "We wanted to see if automating symptom check-ins and care through electronic health records could improve patients' lives without overburdening oncology teams."
And the results speak for themselves. The study found that this innovative approach not only alleviated symptoms like anxiety and depression but also kept thousands of patients out of the hospital. This is a testament to the power of technology in extending the reach and efficacy of care.
A Personal Story: Becky Johnson's Journey
Becky Johnson, a participant in the Enhanced EHR-Facilitated Cancer Symptom Control Trial (E2C2), experienced the benefits firsthand. Despite the anxiety surrounding her double breast cancer diagnosis at 40, Johnson found solace in the trial's digital surveys and support.
"I was constantly searching for more information online, trying to understand treatments, prognosis, and the experiences of others," Johnson explains. "The steroid medications I took before chemo also disrupted my sleep. It got to a point where my body's norm was to wake up in the middle of the night, affecting my healing process."
As part of the trial, Johnson regularly completed digital surveys about various health aspects. Insomnia quickly became a priority, prompting a call from a nurse who provided counseling and a link to an online class based on cognitive behavioral therapy for better sleep.
"Virtual or phone visits were incredibly convenient and efficient, especially when I didn't have any physical issues," Johnson says. The intervention worked, and her sleep improved.
The Power of Automation
To make these interventions possible, the researchers developed automations within the Plummer Chart, the software system managing patients' electronic health records (EHRs). Between 2019 and 2023, over 50,200 patients across 15 cancer specialties at Mayo Clinic enrolled in the E2C2 trial.
Patients filled out short surveys about pain, fatigue, sleep, anxiety, and other symptoms before clinic visits or monthly between visits. The system automatically categorized their responses, providing self-care tips for moderate symptoms and connecting patients with remote symptom care managers for severe cases.
Behind the scenes, the software acted as an automated traffic controller and safety net. It routed information to patients automatically, allowing care teams to focus on tasks requiring their expertise. For patients, it simplified support access without additional appointments or travel.
Transforming Cancer Care
The trial results were remarkable. Automated surveys and responses within the EHR made care more efficient and improved patients' symptoms. Patients reported reduced anxiety and depression, with modest improvements in other areas. Additionally, patients had 40% to 60% fewer acute care encounters, including emergency visits, hospitalizations, and ICU admissions.
All of this was achieved with just 2-3 full-time care managers and 20% of one physician's time supporting over 50,000 study participants.
The E2C2 trial showcases a revolutionary approach to using digital tools in cancer care. By automating routine monitoring and triaging of patient symptoms and well-being through EHRs, a small care team can effectively support a large patient population.
"The gains we saw are encouraging and point to a scalable way to extend supportive oncology care beyond clinic walls, meeting patients where they are," Dr. Cheville emphasizes. "The next step is ensuring these tools are accessible to healthcare teams, enabling them to efficiently reach every patient in need of supportive care."
The E2C2 trial was funded by the National Institutes of Health, National Cancer Institute (NCI) as part of the Cancer Moonshot℠ initiative. The study was conducted as part of NCI's IMPACT Consortium. For more details, including a complete list of authors, disclosures, and additional funding, refer to the study.
Source: Cheville, A. L., et al. (2025). Electronic health record-facilitated symptom surveillance and collaborative care intervention in oncology (E2C2): a cluster-randomised, population-level, stepped-wedge, pragmatic trial. The Lancet Oncology. DOI: 10.1016/S1470-2045(25)00526-1.
