People with advanced cancer who reported their symptoms weekly through an electronic survey had about a third better physical function and more than 15% better control of their symptoms compared to those who were less frequently assessed by face-to-face clinical visits. , according to the results. of a multistate study conducted at 52 community cancer clinics. The PRO-TECT (Patient Reported Outcomes To Enhance Cancer Treatment) trial was led by researchers at the Lineberger Comprehensive Cancer Center at the University of North Carolina.
The findings were published online June 5, 2022 in the Journal of the American Medical Association and presented simultaneously at the annual meeting of the 2022 American Society of Clinical Oncology in Chicago, providing more in-depth analysis of the findings. data presented during a virtual ASCO. presentation at the November 2021 plenary session.
It is estimated that 50 percent of cancer-related symptoms are not detected or reported. Electronic systems that facilitate patient-reported outcome (PRO) surveys can identify symptoms early and ask physicians to intervene before symptoms become more complicated or complex, thus improving outcomes.
The trial enrolled 1,191 participants. About half (593) were randomly assigned to complete a weekly Internet-based or automated telephone system survey that included questions about common symptoms, performance status, and falls. The other half were assigned to a regular care group, which often meant waiting until their next visit to the clinic scheduled periodically to report any symptoms. The most common symptoms reported in the electronic survey were fatigue, nausea, insomnia, loss of appetite, diarrhea, pain, difficulty breathing and constipation. Alerts were sent to nurses if a patient’s reported symptoms were severe or worsened.
We had a very high engagement with patients and their care teams in this study, with patients completing more than ninety percent of their symptom surveys and nurses frequently contacting patients when symptoms were reported electronically. severe or worsening. This probably reflects how many patients and providers have become accustomed to telehealth and electronic communications. “
Ethan Basch, MD, MSc of UNC Lineberger, lead author of the paper
In particular, about a third of participants, in most rural areas, chose to report their symptoms using an optional automated telephone system instead of the Internet. This may reflect limited broadband access to rural areas or other factors that need to be addressed in future studies to ensure that access to programs like PRO-TECT is truly equitable, said Basch, who is the Distinguished Professor. Richard Goldberg and head of medical oncology at UNC School of Medicine, director of the UNC Lineberger Cancer Outcomes Research Program and chief physician at North Carolina Cancer Hospital.
Patients in the PRO group were significantly more likely to experience clinically significant benefits compared to the control group, including a 35% better ability to function physically, a 16.1% better control of their symptoms, and an overall quality of life. 41% better related to health. . All of these were clinically significant improvements over the current standard of care.
The researchers noted that while the improvements were robust after three months of telehealth reports, the improvements dissipated after a year. Basch suggests that part of the fall could be attributed to patients having solved any need they had, but also possibly due to the declining number of study participants after a year due to the hope of limited lives of people with advanced cancer. Another factor may have been the COVID-19 pandemic; many healthcare teams were scrapped and had to prioritize their time, possibly limiting how much they could proactively participate in PRO-TECT.
“PRO-TECT is a way to bring patients together with their healthcare team and helps identify those at greatest risk,” Basch said. “And because we had the same success in 52 practices in 25 states, it shows that there is widespread acceptance for this type of intervention.”
The next goal of the researcher is to determine the best models for widespread implementation and how to make the intervention more efficient for practices. The impact of PROs on overall survival, as well as the financial capacity of people to pay for care, either in the clinic or through telehealth, are analyzes that researchers are currently conducting and hope to report in a near future.
Source:
UNC Lineberger Comprehensive Cancer Center
Magazine reference:
Basch, E., et al. (2022) Effect of electronic symptom tracking on patient-reported outcomes among patients with metastatic cancer. JAMA. doi.org/10.1001/jama.2022.9265.