Clinical effects of assessing electronic patient-reported outcomes monitoring symptomatic toxicities during breast cancer therapy: a nationwide and population-based study

Pappot, Helle; Bæksted, Christina; Nissen, Aase; Knoop, Ann; Mitchell, Sandra A.; Christensen, Jane Hvarregaard; Hjøllund, Niels Henrik; Johansen, Christoffer

doi:10.1007/s12282-021-01244-x

Cited by 12 publications

(4 citation statements)

References 16 publications

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“…More studies are needed on patients’ perceived circumstances linked to their routine cancer treatment, including chemotherapy, surgery, and radiation therapy. Alongside the traditional clinical reports, transparency on patient-reported outcomes (PROs) is required to enhance the quality of care [ 20 , 21 ]. Close monitoring patient’s care pathway appears to be of particular relevance as the option to conduct a risk stratification becomes available.…”

Section: Introductionmentioning

confidence: 99%

Routine cancer treatments and their impact on physical function, symptoms of cancer-related fatigue, anxiety, and depression

Grusdat

Stäuber

Tolkmitt

et al. 2022

Support Care Cancer

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Background and purpose Breast cancer can be a major challenge for affected women. Knowledge of the physical function, symptoms of cancer-related fatigue, anxiety, and depression based on the cancer treatment may help to guide adequate support. Methods For this prospective observational study, we collected data from seventy-nine women with a mean age 54.6 ± 9.5 years prior to the onset of breast cancer treatment (T0) and after (T1/T2). Handgrip strength test (HGS), six-minute walk test (6MWT), the phase angle (PhA), the hospital anxiety and depression scale (HADS), and functional assessment of chronic illness therapy-fatigue (FACIT-F) were used to collect data from four treatment subgroups SC, surgery + chemotherapy; SCR, surgery + chemotherapy + radiation therapy; SR, surgery + radiation therapy; and S, surgery. Results A mixed ANOVA revealed a significant interaction between time and group for PhA, F = 8.55, p < 0.01; HGS, F = 3.59, p < 0.01; 6MWT, F = 4.47, p < 0.01; and FACIT-F, F = 2.77, p < 0.05 with most pronounced deterioration seen in group SCR (PhA 4.8°; HGS 27.5 kg, 6MWT 453.4 m, FACIT-F 33.8 points). HADS data displayed moderate anxiety and depression predominantly after treatment. Conclusion Our study showed that the extent of change in physical function, symptoms of fatigue, anxiety, and depression depends on the treatment conditions. The potentially higher risk of impaired function due to the prevalence of values below a critical threshold requires early initiated multidisciplinary support.

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Section: Introductionmentioning

confidence: 99%

Routine cancer treatments and their impact on physical function, symptoms of cancer-related fatigue, anxiety, and depression

Grusdat

Stäuber

Tolkmitt

et al. 2022

Support Care Cancer

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“…We investigated this by juxtaposing studies that enabled clinician-patient interaction and those that did not. The study by Pappot et al [ 87 ] and Greer et al [ 88 ] are 2 studies that neither include automated alerts in the design of the ePROM intervention nor mandate clinician review of real-time ePROM reports. Both failed to show any improvement in the evaluated outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Although missing values were imputed and sensitivity analysis was performed in the study by Absolom et al [ 78 ], most missing reports were from patients with worse physical well-being. The comparability of baseline characteristics between the arms could not be ascertained in the studies by Mir et al [ 9 ] and Pappot et al [ 87 ] because the former study did not report the general or digital literacy of the participants and the latter reported none of the baseline characteristics. The rigor of program theory 3 may be lessened at the theory level as it was supported by predominantly indirect evidence; however, the triangulation from different sources has provided sufficient rigor.…”

Section: Resultsmentioning

confidence: 99%

Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes

Govindaraj,

Agar,

Currow

et al. 2023

J Med Internet Res

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Background The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. Objective This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. Methods A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. Results Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions—remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. Conclusions The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters.

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“…Alongside the traditional clinical reports, the importance of measuring PRO in patients with breast cancer is required to improve the quality of care [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Cancer treatment regimens and their impact on the patient-reported outcome measures health-related quality of life and perceived cognitive function

Grusdat

Stäuber

Tolkmitt

et al. 2022

J Patient Rep Outcomes

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Background and purpose Breast cancer can be a significant challenge for those affected. Knowledge of physical function, social-emotional challenges, and perceived cognitive function based on the cancer treatment regimens may help to inform adequate support. Methods For this prospective observational pilot study, we collected data of seventy-nine women (mean age 54.6 ± 9.5 years) before (T0) and after (T1) initial breast cancer treatment. Functional Assessment of Cancer Therapy-Breast (FACT-B) and Functional Assessment of Cancer Therapy–Cognitive-Function (FACT-Cog) were used to collect data of four treatment subgroups: SCR = Surgery + Chemotherapy + Radiation Therapy; SC = Surgery + Chemotherapy; SR = Surgery + Radiation Therapy; S = Surgery. A mixed ANOVA and posthoc analysis (Tukey, Games-Howell) were used to detect interactions (group by time) and the main effect. A repeated-measures ANOVA displayed individual group differences (time). Results Significant interaction showed more deterioration was experienced with SC and SCR than SR and S for FACT-B (p < 0.01) and FACT-Cog (p < 0.001). The longitudinal comparison between T0 and T1 indicated a significant group main effect on all subscales (p < 0.001) except for Emotional Well-Being. Significant reductions (p < 0.05) in FACT-B, (− 19%); FACT-Cog, (− 21%) with most pronounced effect in Physical Well-Being (− 30%), Functional Well-Being (− 20%), Breast Cancer Subscale (− 20%), Perceived Cognitive Impairments (− 18%) and Impact of Cognitive Impairments on Quality of Life (− 39%) were detected for SCR. Conclusion Our study showed that the extent of change in health-related quality of life (HRQoL) and perceived cognitive function (PCF) depends on the treatment regimen. Multidisciplinary support initiated early in breast cancer therapy is needed, especially for women undergoing combined cancer treatment. Routine assessment of patient-reported outcomes (PROs) in oncology practice may increase the transparency of patients’ perceived circumstances, leading to personalized and optimized acute and survivorship care.

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Clinical effects of assessing electronic patient-reported outcomes monitoring symptomatic toxicities during breast cancer therapy: a nationwide and population-based study

Cited by 12 publications

References 16 publications

Routine cancer treatments and their impact on physical function, symptoms of cancer-related fatigue, anxiety, and depression

Routine cancer treatments and their impact on physical function, symptoms of cancer-related fatigue, anxiety, and depression

Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes

Cancer treatment regimens and their impact on the patient-reported outcome measures health-related quality of life and perceived cognitive function

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