Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial (original) (raw)
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JAMA
IMPORTANCE Electronic systems that facilitate patient-reported outcome (PRO) surveys for patients with cancer may detect symptoms early and prompt clinicians to intervene. OBJECTIVE To evaluate whether electronic symptom monitoring during cancer treatment confers benefits on quality-of-life outcomes. DESIGN, SETTING, AND PARTICIPANTS Report of secondary outcomes from the PROTECT (Alliance AFT-39) cluster randomized trial in 52 US community oncology practices randomized to electronic symptom monitoring with PRO surveys or usual care. Between October 2017 and March 2020, 1191 adults being treated for metastatic cancer were enrolled, with last follow-up on May 17, 2021. INTERVENTIONS In the PRO group, participants (n = 593) were asked to complete weekly surveys via an internet-based or automated telephone system for up to 1 year. Severe or worsening symptoms triggered care team alerts. The control group (n = 598) received usual care. MAIN OUTCOMES AND MEASURES The 3 prespecified secondary outcomes were physical function, symptom control, and health-related quality of life (HRQOL) at 3 months, measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30; range, 0-100 points; minimum clinically important difference [MCID], 2-7 for physical function; no MCID defined for symptom control or HRQOL). Results on the primary outcome, overall survival, are not yet available. RESULTS Among 52 practices, 1191 patients were included (mean age, 62.2 years; 694 [58.3%] women); 1066 (89.5%) completed 3-month follow-up. Compared with usual care, mean changes on the QLQ-C30 from baseline to 3 months were significantly improved in the PRO group for physical function
Cancers
Background: To describe the benefit of patient-reported symptom monitoring on clinical, other patient-reported, and economic outcomes. Methods: We conducted a systematic literature review using Medline/PubMed, limited to original articles published between 2011 and 2021 in English and Spanish, and focused on the benefit of patient-reported symptom monitoring on cancer patients. Results: We identified 16 reports that deal with the benefit of patient-reported symptom monitoring (collected mostly electronically) on different outcomes. Five studies showed that patient-reported symptom surveillance led to significantly improved survival compared with usual care—mainly through better symptom control, early detection of tumor recurrence, and extended chemotherapy use. Additionally, three evaluations demonstrated an improvement in Health-Related Quality of Life (HRQoL) associated with this monitoring strategy, specifically by reducing symptom severity. Additionally, six studies observed tha...
Oncology Nursing Forum, 2004
➤ Although cancer symptoms and quality-of-life issues are of the highest priority to oncology nurse clinicians, little time is available in most clinical settings for comprehensive screening and assessment of problematic areas. ➤ Advances in computer and Internet technologies have made electronic assessment a feasible and attractive method of gathering patient-reported information in busy clinical settings. ➤ Patient-generated symptom and quality-of-life assessment is feasible in an ambulatory setting with patients with various levels of education and prior computer use. pain specialist, social worker, nutritionist) for further evaluation. Such system enhancement could greatly facilitate oncology nurses' coordination role in caring for complex patients with cancer. Purpose/Objectives: To develop and test an innovative computerized symptom and quality-of-life (QOL) assessment for patients with cancer who are evaluated for and treated with radiation therapy. Design: Descriptive, longitudinal prototype development and crosssectional clinical data. Setting: Department of radiation oncology in an urban, academic medical center. Sample: 101 outpatients who were evaluated for radiation therapy, able to communicate in English (or through one of many interpreters available at the University of Washington), and competent to understand the study information and give informed consent. Six clinicians caring for the patients in the sample were enrolled. Methods: Iterative prototype development was conducted using a standing focus group of clinicians. The software was developed based on survey markup language and implemented in a wireless, Web-based format. Patient participants completed the computerized assessment prior to consultation with the radiation physician. Graphical output pages with flagged areas of symptom distress or troublesome QOL issues were made available to consulting physicians and nurses. Main Research Variables: Pain intensity, symptoms, QOL, and demographics. Instruments: Computerized versions of a 0-10 Pain Intensity Numerical Scale (PINS), Symptom Distress Scale, and Short Form-8. Findings: Focus group recommendations included clinician priorities of brevity, flexibility, and simplicity for both input interface and output and that the assessment output contain color graphic display. Patient participants included 45 women and 56 men with a mean age of 52.7 years (SD = 13.8). Fewer than half of the participants (40%) reported using a computer on a regular basis (weekly or daily). Completion time averaged 7.8 minutes (SD = 3.7). Moderate to high levels of distress were reported more often for fatigue, pain, and emotional issues than for other symptoms or concerns. Conclusions: Computerized assessment of cancer symptoms and QOL is technically possible and feasible in an ambulatory cancer clinic. A wireless, Web-based system facilitates access to results and data entry and retrieval. The symptom and QOL profiles of these patients new to radiation therapy were comparable to other samples of outpatients with cancer. Implications for Nursing: The ability to capture an easily interpreted illustration of a patient's symptom and QOL experience in less than 10 minutes is a potentially useful adjunct to traditional face-to-face interviewing. Ultimately, electronic patient-generated data could produce automated "red flags" directed to the most appropriate clinicians (e.g., nurse,
BMC cancer, 2014
The electronic self report assessment - cancer (ESRA-C), has been shown to reduce symptom distress during cancer therapy The purpose of this analysis was to evaluate aspects of how the ESRA-C intervention may have resulted in lower symptom distress (SD). Patients at two cancer centers were randomized to ESRA-C assessment only (control) or the Web-based ESRA-C intervention delivered to patients' homes or to a tablet in clinic. The intervention allowed patients to self-monitor symptom and quality of life (SxQOL) between visits, receive self-care education and coaching to report SxQOL to clinicians. Summaries of assessments were delivered to clinicians in both groups. Audio-recordings of clinic visits made 6 weeks after treatment initiation were coded for discussions of 26 SxQOL issues, focusing on patients'/caregivers' coached verbal reports of SxQOL severity, pattern, alleviating/aggravating factors and requests for help. Among issues identified as problematic, two measur...
2018
Background: ASyMS is a mobile‐phone based remote‐monitoring and alert system that enables real‐time monitoring of patients' chemotherapy (CT)–related symptoms. Aims: eSMART aims to evaluate the short‐ and long‐term impact of ASyMS, compared with standard care, on patient reported outcomes and the delivery of care. Additionally, eSMART includes economic evaluation and the development of predictive risk models for experiencing CT‐related symptoms to enable personalised and anticipatory care. Methods: Patients newly diagnosed with breast, haematological, or colorectal cancer and scheduled to receive at least 3 cycles of chemotherapy are recruited across 5 countries and 13 clinical sites. A total of 1108 patients will be randomised to either ASyMS or standard care. Patient demographic and clinical data are collected at baseline, and standardised PROMS are completed at baseline, during 6 cycles of chemotherapy and every 3 months for up to 12 months. The primary outcome measure is the...
Current Oncology
Electronic patient-reported outcome (ePRO) applications promise great added value for improving symptom management and health-related quality of life. The aim of this narrative review is to describe the collection and use of ePROs for cancer survivorship care, with an emphasis on ePRO-symptom monitoring. It offers many different perspectives from research settings, while current implementation in routine care is ongoing. ePRO collection optimizes survivorship care by providing insight into the patients’ well-being and prioritizing their unmet needs during the whole trajectory from diagnosis to end-of-life. ePRO-symptom monitoring can contribute to timely health risk detection and subsequently allow earlier intervention. Detection is optimized by automatically generated alerts that vary from simple to complex and multilayered. Using ePRO-symptoms during in-hospital consultation enhances the patients’ conversation with the health care provider before making informed decisions about tr...
Journal of Cancer Policy, 2018
Background: A recent study reported that inclusion of a patient-reported outcome (PRO) tool for symptom monitoring during routine cancer treatment for patients with advanced or metastatic disease leads to improved health-related quality of life, decrease in emergency room visits and hospitalization, and improvement in overall survival. Whether the implementation of such a tool would be cost-effective remains uncertain. Objectives and decision problem: The purpose of the present study is to evaluate the cost-effectiveness of a patientreported outcome tool for symptom monitoring in patients undergoing treatment for advanced or metastatic cancer in Alberta compared to standard of care symptom monitoring from the perspective of the public payer in Alberta. Methods: A Markov model incorporating two health states (alive and dead) was used to calculate the incremental cost-effectiveness ratio of a web-based PRO tool for symptom monitoring compared to standard of care over a lifetime horizon. Clinical data was informed from the results of a North American randomized study of a similar web-based PRO tool for patients with metastatic cancer. Cost data was collected from provincial sources and prior Canadian publications. One-way sensitivity and probabilistic sensitivity analyses were performed to evaluate uncertainty in the model. A budget impact was performed to determine overall cost of implementation in the first three years. Results: In the base-case analysis, the PRO tool provided 2.
Psycho-Oncology, 2017
Objectives: The purpose of this study was to explore clinician experiences with cancer symptom and quality of life (SQL) management from diagnosis throughout therapy in the ambulatory setting, plus identify preferences for a future SQL decision support system. Methods: Eligible clinicians worked in ambulatory cancer care with responsibility for direct patient care. Focus groups (FG) were conducted to discuss symptom management throughout the treatment experience and features desired in a future decision support system. Each group was audio-recorded, transcribed, de-identified, and entered into NVivo 9™ for analysis. Open and axial coding was completed, grouping common concepts into nodes; large constructs among the nodes were identified and main messages were synthesized. Results: 118 clinicians were contacted by email resulting in a final sample of 51 attending one of nine FG. Clinicians described a standard face-to-face approach to assessment of SQL, before and throughout therapy. Preparing patients for expected symptoms and approaches to management included paper-based patient education materials and referrals. Communicating with patients between visits was covered in detail, notably use of telephone and email. Future system features desired by the clinicians included an electronic, web-based system with real time, trended data, reasonable alerts and tailored information for patients. Conclusions: Cancer care specialists reported strategies to assess and manage cancer SQL in ambulatory care including patient-report outcome measures, contact communication modes, face-to-face interviews and paper-based patient education materials. Future system features desired by clinicians included an electronic, Web-based system with real time, trended data, reasonable alerts and tailored information for patients.