Electronic PRO symptom monitoring benefits revealed
medwireNews: Using an electronic patient-reported outcomes (PROs) system improves overall survival (OS) and offers other clinical benefits for patients undergoing chemotherapy for metastatic solid tumors, research suggests.
“This approach should be considered for inclusion in standard symptom management as a component of quality care,” presenting author Ethan Basch, from the University of North Carolina in Chapel Hill, USA, said at the 2017 annual meeting of the American Society of Clinical Oncology in Chicago, Illinois, USA.
The study was published simultaneously in JAMA.
In all, 766 patients with advanced breast, lung, genitourinary, or gynecologic tumors, attending Memorial Sloan Kettering Cancer Center in New York, USA, participated in the study comparing a web-based system for patients to report symptoms with usual care. The age range of the patients was wide (26–91 years), 22% did not complete their high school education, and 30% had no prior computer experience.
The intervention consisted of weekly email prompts for patients to self-report the severity of 12 common symptoms, such as pain and dyspnea, while at home, as well as the opportunity to report symptoms during visits to their oncologist. The patients’ clinical nurses were informed by email of any symptom changes, allowing early detection of any deterioration.
Over a median 7 years of follow-up, OS was a median of 31.2 months in the 441 patients in the intervention group versus 26.0 months for the 325 patients who received standard monitoring of their symptoms with their clinicians. After adjusting for multiple confounding factors, the hazard ratio was a significant 0.83 in favor of the electronic PRO system.
The patients using the PRO system were also 7% less likely to visit the emergency room over the first 5 years of follow-up.
“Proactive monitoring prompts clinicians to intervene early, before symptoms worsen and cause serious downstream complications,” he said.
Basch noted that patients reported symptoms 73% of the time when prompted and that nurses took action on receiving email alerts 77% of the time, by instigating counseling or supportive care, or by referring patients for imaging, chemotherapy dose adjustment, or emergency room care.
In addition, Basch pointed out the significantly improved physical functioning and self-care in the intervention group, which the researchers believe may also have contributed to the OS gain, adding that results demonstrating improved quality of life with the electronic system were reported previously in the Journal of Clinical Oncology.
Furthermore, patients who reported their symptoms systematically used chemotherapy for 8.2 months compared with just 6.3 months for those receiving standard care, a significant difference. The authors suggest that the self-monitoring may have improved control of side effects, allowing longer and more intensive treatment.
Speaking at a press conference, Basch told medwireNews that it has been hypothesized that heightened awareness of cancer symptoms might generate anxiety, but that the team had not found evidence of this phenomenon.
“We’ve done quite a bit of debriefing interviews with patients who are participating in these studies and we’ve found […] that patients feel more connected to their care team, they feel more activated, they feel more in control,” he said. “And so, if anything, I would conjecture that might reduce anxiety.”
Basch said that people with anxiety showed an improvement as they participated in the program, but observed “that may be more because their provider becomes aware of their anxiety and depression and intervenes to treat that.”
Basch concluded that the team are now testing the next generation of symptom monitoring systems to ease patient communication with care teams and expanding the research to a national study to determine how best to integrate the tools into oncology practice and cancer drug development.
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