ES02.01 Expanding PROs in Daily Practice

Abstract

Lung cancer remains the leading cause of cancer deaths internationally (1). There have been recent improvements in the early diagnosis of lung cancer, with the implementation of lung cancer screening programs in a number of countries and the addition of targeted therapies, which may improve progression free survival for some patients. However, mortality remains high and people living with a lung cancer diagnosis have some of the highest symptom burden experienced across all cancer diagnoses (1,2). Patient reported outcome measures (PROs) can be defined as “any report on the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else” (3). PROs have been systematically embedded into clinical trials to track side effects and to measure the health related quality of life (HRQOL) of participants. Internationally we are seeing the use of PROs moving into daily clinical practice (4, 5). What are the benefits of using PROs in clinical practice and can they be introduced and embedded into daily practice? PROs can allow patients to highlight to their health care team their current physical and psychosocial issues. In a short clinic appointment with a health care provider the patient may not feel there is time to discuss the most important issues that are affecting them. The health care professional may not ask to right questions to understand the key issues for that person at that time in the context of a short clinic appointment. What is an issue for the patient may not be what the health professional perceives is an issue, leading to barriers in providing truly patient centred care and ensuring shared decision making (6). The utilisation of PROs prior to a clinic appointment can facilitate the therapeutic conversation to ensure the main issues for the patient are addressed at that time. The use of PROs recorded directly into the electronic health record can facilitate communication with the health care team through the receipt of notifications about patient symptoms and function. This can facilitate the management of patient’s symptoms in real time, also allowing for the review longitudinal data about a patients PROs over time (7). An RCT into systematic electronic collection of PROs during chemotherapy treatment with automated health care professional e-alerts found the intervention group had better HRQOL, fewer emergency visits and hospitalisations, as well as improved quality-adjusted survival (8). The European Organisation for Research and the Treatment of Cancer (EORTC) QLQ-C30 and the Functional Assessment of Cancer Therapy (FACT-G) are two of the most commonly used general PROs. Both of these PROs have lung cancer subscales, with questions developed and validated for the lung cancer population. In New South Wales, Australia the Edmonton Symptom Assessment Scale (ESAS) and the Hospital Anxiety and Depression Scale (HADS) are being piloted for collection electronically into oncology medical information systems across the state as part of the state-wide collection of PROs in a number of chronic health conditions. Information from these scales will be available for health professionals at the point of care and will also be linked to the NSW Cancer Registry to allow for longitudinal analysis of PROs with specific cancer treatment protocols. The International Consortium for Health Outcomes Measurement (ICHOM) have also developed a lung cancer standard set, using the EORTC QLQ-C30 and EORTC QLQ-LC13 as measures of the degree of health for people with a lung cancer diagnosis (9). With the increasing use of technology, linked e-health records and the understanding of the benefit of the use of PROs in clinical practice cancer centres should be implementing PROs as standard practice in clinical care. This will ensure health care professionals are able to identify and address physical and psychosocial issues for people living with lung cancer at the point of care. 1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International journal of cancer. 2015;136(5):E359-86. 2. Mohan A, Singh P, Singh S, Goyal A, Pathak A, Mohan C, et al. Quality of life in lung cancer patients: impact of baseline clinical profile and respiratory status. Eur J Cancer Care (Engl). 2007;16(3):268-76. 3. U.S. Department of Health and Human Services. Guidance for industry patient-reported outcome measures: Use in medical product development to support labeling claims. Silver Spring, MD: Food and Drug Administration; 2009. 4. Chen J, Ou L, Hollis SJ. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res. 2013;13:211. 5. Girgis A, Durcinoska I, Levesque JV, Gerges M, Sandell T, Arnold A, et al. eHealth System for Collecting and Utilizing Patient Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) Among Cancer Patients: Mixed Methods Approach to Evaluate Feasibility and Acceptability. Journal of Medical Internet Research. 2017;19(10):e330. 6. Büttner M, Zebralla V, Dietz A, Singer S. Quality of Life Measurements: Any Value for Clinical Practice? Current Treatment Options in Oncology. 2017;18(5):30. 7. Basch E. Patient-reported outcomes - Harnessing patients' voices to improve clinical care. New England Journal of Medicine. 2017;372(2):105-8. 8. Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, et al. Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2016;34(6):557-65. 9. International Consortium for Health Outcomes Measurement. Lung cancer data collection reference guide. International Consortium for Health Outcomes Measurement; 2017. Patient Reported Outcome Measures, patient centred care, point of care assessment