Routine review of patient-reported outcome data influences radiotherapy care: IMPROVE study results

Khinh Ranh Voong; Siyao Li; Chen Hu; Ori Shokek; Russell K Hales; Jeffrey Meyer; Stephen Greco; Todd McNutt; Colin Hill; Kathryn Lowe; James Huang; Jean Wright; Amol Narang; Aditya Halthore; Andrea Brown; Shing Lee; Claire Snyder

doi:10.1016/j.radonc.2024.110688

Routine review of patient-reported outcome data influences radiotherapy care: IMPROVE study results

Radiother Oncol. 2024 Dec 18:203:110688. doi: 10.1016/j.radonc.2024.110688. Online ahead of print.

Authors

Khinh Ranh Voong¹, Siyao Li², Chen Hu³, Ori Shokek⁴, Russell K Hales⁵, Jeffrey Meyer⁵, Stephen Greco⁵, Todd McNutt⁵, Colin Hill⁵, Kathryn Lowe⁵, James Huang⁵, Jean Wright⁵, Amol Narang⁵, Aditya Halthore⁵, Andrea Brown⁵, Shing Lee⁶, Claire Snyder⁷

Affiliations

¹ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, United States. Electronic address: kvoong1@jh.edu.
² Division of Quantitative Sciences, Department of Oncology, Johns Hopkins University School of Medicine Baltimore, MD, United States. Electronic address: sli258@jhmi.edu.
³ Division of Quantitative Sciences, Department of Oncology, Johns Hopkins University School of Medicine Baltimore, MD, United States. Electronic address: huc@jhu.edu.
⁴ Welllspan Health, York, PA, United States.
⁵ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, United States.
⁶ Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, United States.
⁷ Departments of Medicine, Oncology, and Health Policy & Management, Johns Hopkins Schools of Medicine and Public Health, Baltimore, MD, United States.

PMID: 39706343
DOI: 10.1016/j.radonc.2024.110688

Abstract

Background: Radiation oncologists closely monitor patients during weekly on-treatment visits (OTVs). This study examines whether routine patient-reported outcome measures (PROMs) during OTVs change physicians' perceptions of treatment-toxicity and inform symptom-management.

Patient and methods: IMPROVE is a single-arm prospective multicenter trial, conducted from 2020 to 2023. Patients with locally-advanced or oligometastatic thoracic or gastrointestinal cancers receiving definitive-intent radiation, with or without chemotherapy, and their physicians enrolled. Patients completed a 14-question disease-specific PROM in clinic prior to OTVs. Physicians rated their patient's global toxicity-burden based on clinical data/assessments, then re-rated their patient's toxicity-burden and reported management-changes after PROM review. At radiotherapy end, physicians completed a Feedback Form. PROMs and outcome-data collection used electronic or paper forms. We report any change in physician-assessed burden-score and symptom-management due to PROMs.

Results: The 100 patients enrolled (49 academic, 51 community-based) were 70 years old (median), 51% female, 81% Caucasian, 95% ECOG 0-1, and 94% received concurrent chemotherapy. The median radiation dose was 60 Gy, delivered over 6 weeks. PROMs were available for review for 607/629 (97%) OTVs: full 433/629 (69%), partial 174/629 (28%). For 75/100 patients (75%; 95% CI:65%-83%), PROM review resulted in any change in physician-reported burden-score, and for 50/100 patients (50%; 95% CI:40%-60%) any change in patients' on-treatment management. Rates of burden-score and management-changes were similar between academic and community-based practices (78% vs. 73%; 53% vs. 47%, respectively). For 78/100 patients with Feedback Forms, physicians agreed/strongly agreed that PROMs improved patients' quality-of-care (91%).

Conclusions: PROM review changes radiation oncologists' on-treatment toxicity assessment in 75% and care delivery in 50% of their patients.

Keywords: Cancer care; Patient-reported outcome measures; Radiation oncology; Radiotherapy; Symptom management; Toxicity.