Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial

Abstract

BACKGROUND Previous studies using patient-reported outcomes measures (PROMs) to monitor symptoms during and after (lung) cancer treatment used alerts that were sent to the healthcare provider (HCP), while an approach in which patients receive alerts could be more clinically feasible. The primary aim of this study was to compare the effect of weekly PROM symptom monitoring via a reactive approach (patient receives alert) or active approach (HCP receives alert) with care as usual on health-related quality of life (HRQOL) at 15 weeks after start of treatment in lung cancer patients. METHODS SYMPRO-Lung is a multicenter RCT using a stepped wedge design. Stage I-IV lung cancer patients in the reactive and the active group reported PROM symptoms weekly linked to a common alerting algorithm. HRQOL was measured by the EORTC QLQ-C30 at baseline and after 15 weeks. Linear regression analyses and effect size estimates were used to assess mean QLQ-C30 change scores between groups, accounting for confounding. RESULTS Five hundred fifteen patients were included (160 active group, 89 reactive group, 266 control group). No differences in HRQOL were observed between the reactive and active group (Summary Score B0.51, 95%CI-3.22–4.24, ES0.06, Physical functioning B-0.25, 95%CI-5.15-4.64, ES0.02). The combined intervention groups had significantly better mean change scores on the Summary score (B4.85, 95%CI1.96–7.73, ES0.57) and Physical functioning (B7.00, 95%CI2.90–11.09, ES0.71), compared to the control group. CONCLUSIONS Weekly PRO symptom monitoring significantly improves HRQOL in lung cancer patients. The logistically less intensive, reactive approach may be a better fit for implementation. TRIAL REGISTRATION the Netherlands trial register Identifier: NL7897.

The use of electronic Patient Reported Outcomes in follow-up after palliative radiotherapy: A survey study in Belgium

“…With current limitations in staff and resources, a step-by-step implementation, linking (e)PROMs to referral pathways and other tools to support clinical decision-making, and piloting the protocol on a manageable sample of patients using small cycles of change may be the way forward [ 36 , 41 ]. A recent trial assessing the effect of patient-reported symptom monitoring on HRQOL in lung cancer patients, observed that a reactive approach (patient receives alert) and an active approach (health-care provider receives alert) are equally effective on HRQOL [ 42 ]. Because of time demands placed on HCP, a more patient-centered approach, focusing on self-monitoring and self-care can facilitate sustainable implementation of symptom monitoring within daily clinical practice.…”