Severe symptom reporting in medical oncology patients at community cancer centers assessed through eSyM.

Abstract

242 Background: Among cancer patients (pts) treated with chemotherapy, electronic patient reported outcome (ePRO)-based symptom management programs at quaternary cancer care institutions have improved outcomes. Uptake of ePRO programs in the real-world setting, where less is known about severe symptom reporting, is often complicated by perceptions of increased workload and erroneous severe symptom reporting. The SIMPRO study group, which includes 6 diverse health systems, are implementing an integrated electronic symptom management (eSyM) program to address these challenges. Methods: SIMPRO sites deployed the Epic-embedded eSyM program for thoracic (THOR), gastrointestinal (GI), and gynecologic (GYN) medical oncology (MO) pts, who received PRO-CTCAE-based questionnaires via the patient portal twice weekly for 6 months after starting a new chemotherapy regimen. Symptoms were scored 0 (none), 1 (mild), 2 (moderate), and 3 (severe) and automatically transmitted to care teams within Epic. The distribution and predictors of severe symptom reporting were assessed using descriptive statistics and logistic regression modeling. Results: From September 2019 – March 2022, 47% of eligible pts (2679/5716) submitted 27,062 questionnaires (median age of 67 years, 55% female, 78% white, 53% married, and 49% retired). 17% of eSyM questionnaires included at least 1 severe symptom (15% for GI, 14% for GYN, and 18% for THOR). Table displays the frequencies of all symptoms reported with fatigue, general pain, and constipation being most common. Among respondents, older, black, and employed pts reported significantly fewer severe symptoms (p < 0.03); cancer type was not associated with a greater likelihood of severe symptom reporting. Conclusions: Only approximately 1 of every 6 eSyM responses included a severe symptom, suggesting that routine monitoring in the real-world could help identify patients experiencing bothersome symptoms with minimal disruption to clinical workload. The mix of symptoms commonly reported as severe are challenging to treat with medications alone, arguing that symptom management strategies should provide multidisciplinary supportive care. Interventions that aide both patients and care teams and are embedded within eSyM or Epic could help address these symptoms without overburdening care teams. Clinical trial information: NCT03850912. [Table: see text]