Implementing Patient-Reported Outcomes Systems Improves Overall Survival, Quality of Life

A mainstay of quality cancer care is symptom management because both the disease and its treatments are highly symptomatic, according to Ethan Basch, MD, MSc, a chief of Division Oncology and physician-in-chief at the North Carolina Cancer Hospital, during a session at the virtual Association of Community Cancer Centers 47^th Annual Meeting & Cancer Business Summit.

Basch explained that symptom management is particularly important because providers can miss symptoms patients are experiencing that may emerge later on. The realization of this issue while working as a clinician led Basch to conduct research in which his team asked patients to self-report symptoms simultaneously with clinicians in order to observe its impact on patient outcomes.

His team was able to chart symptom development based on patient’s self-reporting and clinicians’ reports, and the graph showed there was a gap between clinician’s awareness of symptoms and patients self-reported symptoms, as patients were able to report their own symptoms more quickly than the clinicians.

“This is a missed opportunity to catch symptoms early, to intervene, and to improve the patients’ experience and potentially to avoid downstream complications,” Basch said.

One way of approaching the process of allowing patients to self-report their symptoms is through an electronic patient-reported outcomes (ePRO) system, which can automatically send messages back to patients on how to self-manage problems, as well as communicate data to the electronic health record or directly to providers.

For severe or worsening symptoms, an ePRO system can send alerts with real-time messages to providers. Then at an in-person visit, the ePRO system can generate a longitudinal report of this data.

“This information can then be used by the care team to feed back to the patient for managing their symptoms, thereby improving the patient experience and avoiding downstream problems like hospitalization, emergency room visits, or the inability to receive therapy due to limited tolerability,” Basch said.

Additionally, Basch noted during the session that these ePRO systems generally have straightforward patient-facing questionnaires with interfaces for clinicians to visualize this information, which can then be conveyed to patients by web, smartphone, or other mobile device.

In terms of adherence in clinical practice, Basch explained that clinicians can expect patient adherence to completing self-reported questionnaires through these ePRO systems at about 60% to 80%.

In a randomized controlled trial that Basch and his team conducted, they observed that in comparison to usual care, when given access to an ePRO system for self-reporting symptoms, the observed use of ePRO systems drives down emergency room visits by about 7% per year.

“A more striking finding is the impact on survival. It turns out that when patients are asked to self-report on a regular basis, and this is conveyed to providers, when compared to usual care, there is an improvement in overall survival in this particular study by about 5.2 months. This is in a population of patients with multiple different cancer types receiving active chemotherapy for metastatic or advanced disease,” Basch said during the webinar.

Basch additionally explained that there are also observed improvements in quality of life, physical function, and overall patient satisfaction when patients are able to self-report their symptoms.

“This is because proactive monitoring prompts clinicians to intervene early before symptoms cause complications,” Basch said during the webinar. “Second, symptom control enables patients to stay more functional, and we know that staying more functional is a predictor of better outcomes, including survival. Third, it’s because symptom monitoring enables control of chemotherapy [adverse] effects. In fact, in this study and in other studies, patients have been able to stay on chemotherapy longer when using this kind of ePRO intervention.”

REFERENCE

Basch E, Still N, Herzfeld MT, Lempernesse B. The Role of Remote Cancer Symptom Management in an Evolving Reimbursement Landscape. Presented at: Association of Community Cancer Centers 47^th Annual Meeting & Cancer Business Summit; virtual: March 2, 2021.