Feasibility and usefulness of symptom monitoring with electronic patient-reported outcomes: an experience at single-center outpatient oncology clinic

Abstract

Purpose: The benefit of patient-reported outcomes (PRO) in routine oncology practice is increasingly recognized. This study aimed to develop a team-based monitoring and intervention system using electronic PRO (ePRO) and to evaluate its impact at an outpatient oncology clinic.

Methods: Patients receiving chemotherapy at our department were eligible for this study. Those who had access to a smartphone or tablet (Bring Your Own Device [BYOD]) and consented participated, and reported 28 symptoms weekly via 3H P-guardian downloaded on their BYOD. E-mail alerts were sent to attending healthcare providers when participants reported at least grade 3 severity for any of nine symptoms (decreased appetite, nausea, vomiting, diarrhea, shortness of breath, pain, insomnia, fatigue, and sadness), which prompted interventions. Comparisons of overall survival (OS), emergency room visits, and hospitalizations were conducted using propensity scores.

Results: Among 203 patients who received chemotherapy from September 2021 to August 2023, 77 participated in ePRO monitoring. The overall response rate was 55% (1991 valid responses out of a total of 3597 expected time points), and the median individual response rate was 66% (range, 0-100%). Of 1991 valid responses, 250 (13%) prompted alerts, and most interventions were initiated by making telephone calls. OS and other clinical outcomes were better in ePRO participants compared with non-participants, but these outcomes did not differ significantly between the ePRO and pre-ePRO eras.

Conclusions: It was feasible to develop a multi-professional team-based monitoring and intervention system using ePRO at a single-center outpatient oncology clinic. Our results indicate that weekly monitoring of ePRO, along with corresponding interventions, may benefit patients receiving chemotherapy.

Keywords: Oncology; Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE); Patient-reported outcome; Survivorship; Symptom monitoring; ePRO.