Completion of electronic patient reported outcome measures among diverse cancer patients treated in an integrated health system.

Abstract

e24035 Background: Patient reported outcome measures (PROMs) are derived entirely from patients’ perspectives and complementary to traditional clinical assessment. Use of PROMs as a symptom communication tool has been demonstrated to improve quality of life, decrease health care utilization, and improve overall survival in clinical trial settings. However, clinical trial enrollment is known to be biased, often excluding those with the most difficulty accessing care. Henry Ford Cancer Institute has implemented a PROMs platform integrated with routine clinical care throughout the vertically integrated health system for all cancer disease sites. The purpose of this study is to compare patient characteristics in those responding to and those without response to PROMs to understand potential disparities. Methods: All patients with a diagnosis of cancer and a visit with an oncologic provider were offered an opportunity to complete PROMs between September 16, 2020 to July 19, 2021. Domain-specific National Institute of Health’s computer adaptive technology Patients-Reported Outcomes Measurement Information System (PROMIS) instruments in pain interference, physical function, fatigue, and depression were offered prior to a visit using a patient-facing electronic portal or via iPAD at the time of visit. Patient level demographic, insurance, ZIP code level socioeconomic status and clinical data were compared across PROMs responders and non-responders using multivariable logistic regression. Results: A total of 3,226 patients were included in the study, of whom 1,652 (51.2%) responded to PROMs. The mean age of the patients was 60 years (SD = 13) and 60.5% were females. Most were of white race (68.8%) and were married (56.1%). There was similar distribution of patients with private (43.7%) and Medicare (41.6%) insurance. After adjusting for age, sex, race, marital status, education, income, insurance and stage, patients who were single (aOR = 0.78; 95% CI: 0.65—0.94) or had Medicare insurance (aOR = 0.68; 95% CI: 0.55—0.83) were less likely to respond to the PROMs. Patients diagnosed with early-stage (stages 0,1,2) disease (aOR = 0.79; 95% CI: 0.67—0.93) were less likely to respond to PROMs, but those with unknown stage (aOR = 1.27; 95% CI: 1.04—1.56) were more likely to respond to PROMs compared to those diagnosed with late-stage (stages 3,4) disease. There was no significant association between race and PROMs response. Conclusions: Patients who are single, have Medicare insurance, and early-stage disease are less likely to respond to PROMs. Future implementation efforts need to focus on these populations to ensure equitable availability of PROMs as a tool for symptom communications in patients with cancer.