Imagine a world where cancer patients can manage their symptoms effectively, without the added stress of frequent hospital visits. This is the vision that inspired a groundbreaking study by researchers at the Mayo Clinic. The results are nothing short of revolutionary.
For individuals battling cancer, symptoms like pain, anxiety, and insomnia can rapidly 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 Enhanced EHR-Facilitated Cancer Symptom Control Trial (E2C2) aimed to do just that. By utilizing digital check-ins and a remote care team, the study sought to empower patients to tackle their symptoms proactively. And the findings were eye-opening.
"Our mission was straightforward yet ambitious," explains Dr. Andrea Cheville, lead researcher and professor at the Mayo Clinic Comprehensive Cancer Center. "We wanted to explore whether automating symptom check-ins and care through electronic health records could enhance patients' well-being without overburdening oncology teams. What we discovered was remarkable - this approach not only alleviated symptoms like anxiety and depression but also kept thousands of patients out of the hospital. It's a testament to the potential of technology to extend the reach and effectiveness of care."
One participant, Becky Johnson, experienced the benefits firsthand. Diagnosed with double breast cancer at 40, Johnson found solace in the E2C2 trial. "I was constantly searching for more information online about treatments, prognosis, and the experiences of others. 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 and not fall back asleep, impacting my healing process," recalls Johnson, program director for the Mayo Clinic School of Health Sciences Sonography Program.
As part of the trial, Johnson regularly completed digital surveys about various health aspects. Insomnia quickly emerged as a priority, prompting a call from a nurse who offered guidance on improving sleep. The nurse also provided Johnson with a link to an online class on cognitive behavioral therapy-based sleep strategies.
"Virtual or phone call visits, especially when I didn't have any physical issues, were incredibly convenient and efficient," says Johnson. The intervention worked, and her sleep quality improved.
To enable such interventions, 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. Like Johnson, they completed short surveys about pain, fatigue, sleep, anxiety, and other symptoms before clinic visits or monthly between visits. The system automatically categorized their responses, with mild scores logged, moderate scores triggering self-care tips, and severe scores prompting contact from a remote symptom care manager - a nurse or social worker who could assist patients remotely.
Behind the scenes, the software acted as an automated traffic controller and safety net. For care teams, it streamlined information flow to patients, allowing them to focus on tasks requiring their expertise. For patients, it simplified support access without additional appointments or travel.
The trial outcomes were impressive. Automated surveys and responses integrated into the EHR enhanced care efficiency and, ultimately, improved patients' symptoms. Patients reported reduced anxiety and depression, with modest improvements in other symptoms. Additionally, patients experienced 40% to 60% fewer acute care encounters, including emergency visits, hospitalizations, and ICU admissions.
All 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 novel approach to digital tools in cancer care. By automating routine patient symptom and well-being monitoring and triaging through electronic health records, a small care team can support a vast patient population.
"The gains we saw are encouraging and suggest a scalable way to extend supportive oncology care beyond clinic walls, reaching patients wherever they are," says Dr. Cheville. "The next step is ensuring these tools are accessible to healthcare teams, empowering them to efficiently reach every patient needing supportive care."
The E2C2 trial was funded by the National Institutes of Health, National Cancer Institute (NCI) as part of the Cancer Moonshot℠. The study was conducted as part of NCI's IMPACT Consortium. For a complete list of authors, disclosures, and additional funding, review 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.
