There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited.
A group of thought researchers randomly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians. Those with home computers received weekly e-mail prompts to report between visits. Treating physicians received symptom printouts at visits, and nurses received e-mail alerts when participants reported severe or worsening symptoms.
The primary outcome was change in health-related quality of life (HRQL) at 6 months compared with baseline, measured by the EuroQol EQ-5D Index. Secondary endpoints included emergency room (ER) visits, hospitalizations, and survival.
The following are some fractions of their Discussion presented on their published paper available on the Journal of Clinical Oncology, official journal of the American Society of Clinical Oncology:
For adults receiving outpatient chemotherapy for advanced cancer at a large specialty cancer center, web-based symptom reporting with automated clinician e-mail alerts resulted in better HRQL, fewer ER visits, fewer hospitalizations, a longer duration of palliative chemotherapy, and superior quality-adjusted survival.
Although the vast majority of patient-reported symptoms were grade 1 or 2 (mild to moderate), more than 1,400 were grade 3 or 4 (severe to disabling). In response to e-mail alerts for severe or worsening symptoms, nurses performed direct interventions primarily composed of telephone counseling, medication changes, and ER or hospital referral. Clinical actions may also have been taken in response to symptom reports delivered to clinicians at each office visit including responses to mild/moderate symptoms, although these were not systematically tracked and may be a useful focus of future research.
Prior studies have explored mechanisms by which patient reporting of symptoms may confer clinical benefits, with findings including increased rates of symptom discussions between patients and clinicians,11,18,19 intensified symptom management by clinicians in response to patient reports,11-13 and improved symptom control when patient reports are shared with clincians.11-14,18 As such, systematic patient reporting appears to enhance clinician awareness and can augment existing mechanisms for symptom management during routine oncology care.
Conversely, when undetected in the absence of patient self-reporting, symptoms may continue to worsen and cause serious complications, lead to hospital visits, limit the ability to safely deliver chemotherapy, and diminish outcomes, as observed in this study.
…Some benefits appeared greater for computer-inexperienced patients, who were overall older, frailer, and more symptomatic than computer-experienced patients. Participants lacking computer experience may have less-developed health communication skills and thereby benefit more from a structured program for eliciting symptoms. Future work is warranted to discern which patient populations may benefit most from this type of health communication intervention.
…In the context of a changing health care delivery system where both population management and patient centeredness are prioritized, symptom self-reporting engages patients as active participants and may improve the experience, efficiency, and outcomes of care. Given the favorable outcomes we have demonstrated with a simple prototype, further work to refine optimal strategies for engaging both patients and clinicians in harnessing technology to improve care should be a priority.
This paper was published on the Journal of Clinical Oncology. To read the full paper, please click here