Abstract
Electronic patient-reported outcomes (ePROs) may have the potential to improve cancer care delivery by enhancing patient quality of life, reducing acute care visits, and extending overall survival. However, the optimal cadence of ePRO assessments is unknown. To determine patient response preferences and the clinical value associated with a daily cadence for ePROs for patients receiving antineoplastic treatment. This quality improvement study of adult patients undergoing antineoplastic treatment assessed a remote monitoring program using ePROs that was developed to manage cancer therapy-related symptoms. ePRO data submitted between October 16, 2018 to February 29, 2020, from a single regional site within the Memorial Sloan Kettering Cancer Center network were included. Data were analyzed from April 2020 to January 2022. While undergoing active treatment, patients received a daily ePRO assessment that, based on patient responses, generated yellow (moderate) or red (severe) symptom alerts that were sent to clinicians. The main outcomes assessed included patient response rate, symptom alert frequency, and an analysis of the clinical value of daily ePROs. A total of 217 patients (median [range] age, 66 [31-92] years; 103 [47.5%] women and 114 [52.5%] men) initiating antineoplastic therapy at high risk for symptoms were monitored for a median (range) of 91 (2-369) days. Most patients had thoracic (59 patients [27.2%]), head and neck (48 patients [22.1%]), or gastrointestinal (43 patients [19.8%]) malignant neoplasms. Of 14 603 unique symptom assessments completed, 7349 (50.3%) generated red or yellow symptom alerts. Symptoms commonly generating alerts included pain (665 assessments [23.0%]) and functional status (465 assessments [16.1%]). Most assessments (8438 assessments [57.8%]) were completed at home during regular clinic hours (ie, 9 am-5 pm), with higher response rates on weekdays (58.4%; 95% CI, 57.5%-59.5%) than on weekend days (51.3%; 95% CI, 49.5%-53.1%). Importantly, 284 of 630 unique red alerts (45.1%) surfaced without a prior yellow alert for the same symptom within the prior 7 days; symptom severity fluctuated over the course of a week, and symptom assessments generating a red alert were followed by an acute care visit within 7 days 8.7% of the time compared with 2.9% for assessments without a red alert. These findings suggest that daily ePRO assessments were associated with increased insight into symptom management in patients undergoing antineoplastic treatment and symptom alerts were associated with risk of acute care.
Highlights
A patient-reported outcome describes “the impact of health-related conditions and/or treatments provided by patient self-report without introduction of bias by any third party.”[1,2] Electronic patient reported outcomes can improve cancer care delivery by enhancing quality of life, reducing acute care visits, and improving overall survival.[3-7]
284 of 630 unique red alerts (45.1%) surfaced without a prior yellow alert for the same symptom within the prior 7 days; symptom severity fluctuated over the course of a week, and symptom assessments generating a red alert were followed by an acute care visit within 7 days 8.7% of the time compared with 2.9% for assessments without a red alert
These findings suggest that daily Electronic patient reported outcomes (ePROs) assessments were associated with increased insight into symptom management in patients undergoing antineoplastic treatment and symptom alerts were associated with risk of acute care
Summary
A patient-reported outcome describes “the impact of health-related conditions and/or treatments provided by patient self-report without introduction of bias by any third party.”[1,2] Electronic patient reported outcomes (ePROs) can improve cancer care delivery by enhancing quality of life, reducing acute care visits, and improving overall survival.[3-7]. Incorporation of ePROs in clinical practice is widely viewed as fundamental to improving care delivery for patients with cancer. Enhanced patient-clinician communication is thought to underlie outcome improvements associated with ePRO assessments. To realize this benefit, many institutions are integrating ePROs into clinical workflows, and private companies have emerged to assist with the technology and integration efforts. As oncology practices build these systems, there is a risk for failure if key components of successful ePRO implementation are not identified and incorporated
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