Electronic symptom reporting reduces ED visits, improves quality of life
Key takeaways:
- A home-based remote monitoring system reduced emergency visits and improved quality of life for people receiving cancer treatment.
- The system is being rolled out at several U.S. practices.
Use of a home-based electronic monitoring system for symptom reporting reduced ED visits among people receiving treatment for metastatic cancer, according to study findings.
Patients who used the system also reported improved quality of life.
“I’ve been practicing oncology for more than 20 years and, throughout that time, I’ve focused on finding ways to improve the patient-centeredness of how we deliver cancer care,” Ethan Basch, MD, MSc, Richard M. Goldberg distinguished professor of medicine and chief of medical oncology at UNC School of Medicine and director of UNC Lineberger Comprehensive Cancer Center’s Cancer Outcomes Research Program, told Healio. “It’s been my mission to try to find ways to improve the patient experience during cancer treatment.”
“There was incredible usage of the symptom monitoring system in this study, with more than 90% of patients logging in to report how they were feeling each week,” he added. “There was a high level of patient engagement and enthusiasm because they felt more connected to their practice and their own care when using the system.”
Background
People with cancer often experience symptoms that affect quality of life, cause functional impairments and, in some cases, require hospitalization. However, many of these symptoms go undetected by the cancer care team, highlighting the need for improved strategies to optimize symptom detection and allow for timely intervention.
“People can experience severe symptoms and side effects between visits at home, but they often don’t know how to deal with them and can be unsure when to call the doctor’s office, even if they are experiencing a lot of suffering or complications,” Basch told Healio. “And during office visits, amidst talking about a host of clinical or logistical issues, we may forget to talk through symptoms, or patients may feel reluctant to bring up symptom or functioning issues, or might just think a symptom is ‘normal’ in their situation.”
Basch and colleagues conducted the randomized PRO-TECT trial to assess the real-world impact of electronic patient-reported outcomes (PRO) symptom monitoring on clinical outcomes.
Researchers enrolled 1,191 patients (median age, 63 years) receiving treatment for metastatic cancer. The most common cancer types in the cohort included thoracic (19.9%), colorectal/anal (16.9%) and breast cancers (16.45).
About one in six (16.9%) study participants had never used the internet.
Researchers randomly assigned 593 patients to the PRO group, which allowed them to report symptoms weekly via a web-based program or automated telephone system. Worsening or severe symptoms triggered electronic alerts to the care team, allowing them to respond to and manage those symptoms almost in real time.
The other 598 study participants received usual care.
OS served as the primary endpoint. Secondary outcomes included ED visits, patient satisfaction, and time to deterioration of physical function, symptoms and health-related quality of life.
Results
Patients assigned to the PRO group completed 91.5% of weekly symptom surveys.
Results showed no statistically significant difference in OS between the PRO group and the control group (HR = 0.99; 95% CI, 0.83-1.17).
However, results showed significantly longer time to first ED visit (HR = 0.84; 95% CI, 0.71-0.98), fewer emergency visits at 12 months (1.02 vs. 1.3; P < .001) and a 6.1% reduction in emergency visits in the PRO group.
Results of other secondary outcomes also favored the PRO group, including time to deterioration of physical function (median, 12.6 months vs. 8.5 months; HR 0.73; P = .002), symptoms (12.7 months vs. 9.9 months; HR = 0.69; P < .001, and health-related quality of life (15.6 months vs. 12.2 months; HR = 0.72; P = .001).
Surveys showed most patients assigned to the PRO group indicated the system improved their discussions with the care team (77%) and made them feel more in control of their care (84%). The vast majority (91.4%) indicated they would recommend it to other patients.
Researchers acknowledged study limitations. For example, it is possible that not all patients experienced benefits, highlighting the need for more research to identify subgroups that could derive particular benefit, according to investigators. Outcome metrics "may not reflect the full spectrum of value to patients," researchers wrote. Also, the fact the trial was partially conducted during the COVID-19 pandemic may have contributed to the lack of survival benefit observed with the PRO system.
Next steps
Efforts are underway to implement the PRO system in 15 large practices and health systems in the United States, as well as two major oncology practice networks, Basch said.
“A question we pose in the paper is, ‘Why didn’t we see a survival benefit here?' There could be multiple potential reasons, but I don’t think it diminishes the meaningfulness of the benefits, because a lot of what we do is treat people for their symptoms, regardless of how impact on survival,” Basch told Healio. “A large nationally funded initiative called OncoPRO, which is in partnership with ASCO and American Cancer Society, is supporting practices all over the country to implement remote symptom monitoring with patient-reported outcomes, based on the results from this trial. ASCO is also developing a guideline on using PROs to monitor symptoms during cancer care.”
For more information:
Ethan Basch, MD, MSc, can be reached at ebasch@med.unc.edu.
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