Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer

Abstract

IMPORTANCE Electronic systems that facilitate patient-reported outcome (PRO) surveys for patients with cancer may detect symptoms early and prompt clinicians to intervene. OBJECTIVE To evaluate whether electronic symptom monitoring during cancer treatment confers benefits on quality-of-life outcomes. DESIGN, SETTING, AND PARTICIPANTS Report of secondary outcomes from the PRO-TECT (Alliance AFT-39) cluster randomized trial in 52 US community oncology practices randomized to electronic symptom monitoring with PRO surveys or usual care. Between October 2017 and March 2020, 1191 adults being treated for metastatic cancer were enrolled, with last follow-up on May 17, 2021. INTERVENTIONSIn the PRO group, participants (n = 593) were asked to complete weekly surveys via an internet-based or automated telephone system for up to 1 year. Severe or worsening symptoms triggered care team alerts. The control group (n = 598) received usual care. MAIN OUTCOMES AND MEASURESThe 3 prespecified secondary outcomes were physical function, symptom control, and health-related quality of life (HRQOL) at 3 months, measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30; range, 0-100 points; minimum clinically important difference [MCID], 2-7 for physical function; no MCID defined for symptom control or HRQOL). Results on the primary outcome, overall survival, are not yet available. RESULTS Among 52 practices, 1191 patients were included (mean age, 62.2 years; 694 [58.3%] women); 1066 (89.5%) completed 3-month follow-up. Compared with usual care, mean changes on the QLQ-C30 from baseline to 3 months were significantly improved in the PRO group for physical function (PRO, from 74.27 to 75.81 points; control, from 73.54 to 72.61 points; mean difference, 2.47 [95% CI,]; P = .02), symptom control (PRO, from 77.67 to 80.03 points; control, from 76.75 to 76.55 points; mean difference, 2.56 [95% CI, 0.95-4.17]; P = .002), and HRQOL (PRO, from 78.11 to 80.03 points; control, from 77.00 to 76.50 points; mean difference, 2.43 [95% CI, 0.90-3.96]; P = .002). Patients in the PRO group had significantly greater odds of experiencing clinically meaningful benefits vs usual care for physical function (7.7% more with improvements of Ն5 points and 6.1% fewer with worsening of Ն5 points; odds ratio [OR], 1.35 [95% CI, 1.08-1.70];

Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician

“…The PRO-TECT randomized trial enrolled 1191 patients to either weekly internet or automated telephone surveys regarding symptoms which triggered automatic alerts to their oncology providers. Three-month follow-up surveys showed an improvement in physician function, symptom control and quality of life in the survey group [56].…”

Effects of a Geriatric Assessment Intervention on Patient-Reported Symptomatic Toxicity in Older Adults With Advanced Cancer

“…20,[51][52][53] The efficacy of weekly electronic PRO monitoring for adults with metastatic cancer receiving treatment (including symptoms with alerts to clinicians for severe or worsening symptoms) on improving symptoms has recently been reported. 54 A similar symptom-specific intervention that integrates GA could be evaluated for older patients with aging-related conditions. Further research is needed to assess the feasibility of digital methods for capture of PRO data from older adults with advanced cancer and aging-related conditions.…”

The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

“…In conclusion, the available evidence was insufficient to draw firm conclusions that PRO monitoring could extend survival. Further evidence is expected to emerge from PRO-TECT, a large randomized cluster study that is currently underway in 52 community oncology practices in the United States of America on 1191 subjects with metastatic cancer [ 43 ]. The results regarding overall survival as the primary outcome are not yet available.…”