Clinical Utility and User Perceptions of a Digital System for Electronic Patient-Reported Symptom Monitoring During Routine Cancer Care: Findings From the PRO-TECT Trial

Abstract

PURPOSE There is increasing interest in implementing digital systems for remote monitoring of patients’ symptoms during routine oncology practice. Information is limited about the clinical utility and user perceptions of these systems. METHODS PRO-TECT is a multicenter trial evaluating implementation of electronic patient-reported outcomes (ePROs) among adults with advanced and metastatic cancers receiving treatment at US community oncology practices (ClinicalTrials.gov identifier: NCT03249090 ). Questions derived from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) are administered weekly by web or automated telephone system, with alerts to nurses for severe or worsening symptoms. To elicit user feedback, surveys were administered to participating patients and clinicians. RESULTS Among 496 patients across 26 practices, the majority found the system and questions easy to understand (95%), easy to use (93%), and relevant to their care (91%). Most patients reported that PRO information was used by their clinicians for care (70%), improved discussions with clinicians (73%), made them feel more in control of their own care (77%), and would recommend the system to other patients (89%). Scores for most patient feedback questions were significantly positively correlated with weekly PRO completion rates in both univariate and multivariable analyses. Among 57 nurses, most reported that PRO information was helpful for clinical documentation (79%), increased efficiency of patient discussions (84%), and was useful for patient care (75%). Among 39 oncologists, most found PRO information useful (91%), with 65% using PROs to guide patient discussions sometimes or often and 65% using PROs to make treatment decisions sometimes or often. CONCLUSION These findings support the clinical utility and value of implementing digital systems for monitoring PROs, including the PRO-CTCAE, in routine cancer care.

The Effect of Collaborative Reviews of Electronic Patient-Reported Outcomes on the Congruence of Patient- and Clinician-Reported Toxicity in Cancer Patients Receiving Systemic Therapy: Prospective, Multicenter, Observational Clinical Trial

“…In one study that administered weekly PRO from the National Cancer Institute’s PRO-CTCAE item library (for symptoms such as pain, nausea, and diarrhea) via mail or telephone and assessed them by using a 5-point ordinal verbal descriptor scale and via PRO questions about physical performance (ECOG) and financial toxicities (The Comprehensive Score for Financial Toxicity [COST-FACIT] questionnaire), it was found that most patients agreed that weekly reporting was a favored frequency for ePRO questionnaire administration in the context of advanced and metastatic cancer treatment [ 22 ]. However, during a more complex or intensive treatment phase, a more frequent (even daily) assessment of more than 8 symptoms might be well regarded and positively associated with an increased use of educational materials about home symptom management.…”

How Should Oncologists Choose an Electronic Patient-Reported Outcome System for Remote Monitoring of Patients With Cancer?

“…As early supportive care improves survival in oncology, the solution should contain algorithms to detect symptoms that make a patient eligible for early supportive care [ 3 , 5 , 6 , 18 ].…”

“…The solution should allow for follow-up of the patient to detect complications or symptomatic relapse early, which improves clinical utility and patient outcomes [ 3 , 7 ].…”

Sensible Introduction of MR-Guided Radiotherapy: A Warm Plea for the RCT

“…Also, in terms of "traditional" outcomes, like measured toxicity, instead of the doctor taking a snap-shot at the outpatient clinic, we believe that toxicity and functioning are better assessed by the patients themselves at multiple time points during follow-up. Fortunately, multiple technological solutions (including established cloud-based solutions, apps, and websites) and tools (such as the validated PRO-CTCAE, EORTC QLQ-C30, and other questionnaires) are readily available (29)(30)(31)(32). As MRgRT study designs are considered, strong consideration should be given to PRO-based endpoints as either primary or complementary objectives.…”