Patient Reported Outcome Tools Can Help Pharmacists Measure Quality of Life, Improve Symptom Management

Alison M. Palumbo, PharmD, MPH, BCOP, Clinical Oncology Pharmacist, Oregon Health and Science University, Portland, Oregon, discusses innovating tools and means of assessing patient-reported outcome measures at Hematology/Oncology Pharmacy Association (HOPA) Annual Conference from March 29 to April 1, 2023.

PT Staff: What is the significance of quality of life (QoL) as a patient-reported outcome measure (PROM) for patients on oral anti-cancer therapy?

Alison M. Palumbo, PharmD, MPH, BCOP: So quality of life (QoL) is a clinical outcome. patients care about living longer and living better. QoL helps address the living better portion. So if we can better collect information on QoL, then we can hopefully improve patient outcomes.

PT Staff: How frequently are pharmacists included in the analysis of data from patient reported outcome (PRO) tools?

Alison M. Palumbo, PharmD, MPH, BCOP: So that's difficult to say, I think it really depends on the program. There was a study that was recently published that tried to assess how many pharmacists are really involved in electronic patient reported outcomes and think maybe a third of centers are doing it. It really depends on the center. But hopefully, we can start increasing those numbers.

PT Staff: How has your team implemented these (PRO) tools in the clinical setting?

Alison M. Palumbo, PharmD, MPH, BCOP: At our institution, you know, the project that I did was completely new. And who was on the back end was me and my study team. At this time, we haven’t actually implemented anything in our centers that is routinely used in patient care, just in the study setting.

PT Staff: How can pharmacists evaluate data from PRO tools to help patients address and maintain treatment-related toxicities?

Alison M. Palumbo, PharmD, MPH, BCOP: So it really depends on what tool is being used in our study; we use the EORTC QLQ-C 30 tool, and that really evaluates global QoL, functional quality of life, and symptoms. I think where pharmacists can get involved is in symptom management. If you see that there is a decline in QoL regarding a certain symptom, you can certainly intervene, likely through the use of a collaborative care practice agreement.

PT Staff: Could you expand on functional QoL?

Alison M. Palumbo, PharmD, MPH, BCOP: [With] functional quality of life, at least with the EORTC QLQ-C 30 tool, I believe there are 5 domains; there's social function, emotional function, physical function, and perhaps a few others, but it’s really trying to evaluate how are you doing in social relationships? What about physically? Is it difficult for you to move around, etc. That's kind of what the functional aspect is.

PT Staff: You explained that you use the EORTC QLQ-C30 tool- how specifically could a pharmacist use this tool?

Alison M. Palumbo, PharmD, MPH, BCOP: Yeah, so the EORTC QLQ-C 30 30 tool has traditionally been like paper/pen when it's used. And it's just like 30 different questions that address these different domains. What we do in our study that was unique; we actually did it through text message. So this is the first time that it was sent, to my knowledge, via text message. And we ended up using this Research Electronic Data Capture (RED)Cap tool, where we could, in a secure fashion, send patients a text message that would redirect them to take the survey online and then complete all 30 questions—we had to redo the tool so that they could easily take it on their phone. All of this was approved through the ORTC as well with their permission. So I don't know if this specific tool will be used. It's quite a few questions, though patients really didn't seem to mind the number of questions. What I have actually heard, just yesterday, is that through some of our specialty programs (specialty pharmacy programs and oral chemotherapy) there are systems that are used in the electronic medical record that actually send patients survey tools, through the electronic medical records. So that stuff will be in the electronic medical record. I don't know what tool specifically they use, that's something I would have to look into now that I know about it. But that is something that might actually be used going forward.

PT Staff: Often used for clinical trials, what could be the impact of expanding the role of PRO tools to pharmacy care teams in the outpatient setting?

Alison M. Palumbo, PharmD, MPH, BCOP: The use of these tools in the outpatient setting can really be quite broad, depending on how people want to use it. Like I mentioned with specialty pharmacy programs, they're trying to evaluate QoL. They could potentially use these tools to evaluate QoL. And then they could use it for all different kinds of things, so potentially looking at patient’s symptoms. There was a study conducted by like Shannon Hough, PharmD, BCOP (Director, ClinReview & Clinical Content at McKesson/US Oncology) and colleagues at the University of Michigan [who] looked at the use of PRO tools and patients who are at risk of nausea and vomiting, of chemotherapy-induced nausea and vomiting. And it showed that pharmacists can actually help reduce healthcare utilization. I think there's a whole there's a big opportunity here for pharmacists to get involved with PROs and use that to help improve patient’s health.