Going beyond (electronic) patient-reported outcomes: harnessing the benefits of smart technology and ecological momentary assessment in cancer survivorship research

Thong, Melissa S. Y.; Chan, Raymond Javan; Hurk, Corina van den; Fessele, Kristen L; Tan, Winston; Poprawski, Dagmara; Fernández-Ortega, Paz; Paterson, Catherine; Fitch, Margaret I.

doi:10.1007/s00520-020-05648-x

Cited by 23 publications

(19 citation statements)

References 36 publications

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“…Another timing topic is to visualize in detail a patient’s problem over the course of the day to discover patterns as a basis for intervention. In this so-called Ecological Momentary Assessment, the patient reports on his or her problems several times a day for a few weeks [ 26 , 27 ]. This is, for example, performed by automatic timing-based triggering following persistent high scores on an ePRO-symptom such as pain or fatigue [ 28 ].…”

Section: Epro Methodology and Implementationmentioning

confidence: 99%

A Narrative Review on the Collection and Use of Electronic Patient-Reported Outcomes in Cancer Survivorship Care with Emphasis on Symptom Monitoring

et al. 2022

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Electronic patient-reported outcome (ePRO) applications promise great added value for improving symptom management and health-related quality of life. The aim of this narrative review is to describe the collection and use of ePROs for cancer survivorship care, with an emphasis on ePRO-symptom monitoring. It offers many different perspectives from research settings, while current implementation in routine care is ongoing. ePRO collection optimizes survivorship care by providing insight into the patients’ well-being and prioritizing their unmet needs during the whole trajectory from diagnosis to end-of-life. ePRO-symptom monitoring can contribute to timely health risk detection and subsequently allow earlier intervention. Detection is optimized by automatically generated alerts that vary from simple to complex and multilayered. Using ePRO-symptoms during in-hospital consultation enhances the patients’ conversation with the health care provider before making informed decisions about treatments, other interventions, or self-management. ePRO(-symptoms) entail specific implementation issues and complementary ethics considerations. The latter is due to privacy concerns, digital divide, and scarcity of adequately representative data for particular groups of patients.

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Section: Epro Methodology and Implementationmentioning

confidence: 99%

A Narrative Review on the Collection and Use of Electronic Patient-Reported Outcomes in Cancer Survivorship Care with Emphasis on Symptom Monitoring

et al. 2022

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“…SCT also describes self‐efficacy as a construct that responds to moment‐to‐moment changes in psychophysiological states, highlighting the importance of treating these constructs as dynamic rather than stable across time 19 . Ecological momentary assessment (EMA) methods involving repeated sampling of participants' behavior and cognitions as they go about their daily lives, have been identified as a useful and efficacious methodology for the examination of real‐time experiences and behaviors among cancer patients and survivors 24,25 . These real‐time measurements alongside continuous assessment of physical activity via accelerometry may offer insights into the relation between SCT and physical activity during chemotherapy at a more granular level (e.g., twice per day) that could inform development of physical activity interventions during treatment to maintain or increase physical activity that are, for example, timed and tailored based on this type of granular evidence.…”

Section: Introductionmentioning

confidence: 99%

“…19 Ecological momentary assessment (EMA) methods involving repeated sampling of participants' behavior and cognitions as they go about their daily lives, have been identified as a useful and efficacious methodology for the examination of real-time experiences and behaviors among cancer patients and survivors. 24,25 These real-time measurements alongside continuous assessment of physical activity via accelerometry may offer insights into the relation between SCT and physical activity during chemotherapy at a more granular level (e.g., twice per day) that could inform development of physical activity interventions during treatment to maintain or increase physical activity that are, for example, timed and tailored based on this type of granular evidence. To date, no studies have used EMA to assess SCT constructs and physical activity during chemotherapy for breast cancer 24 nor assessed previous-day SCT constructs in relation to next-day physical activity.…”

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confidence: 99%

Social cognitive variables and physical activity during chemotherapy for breast cancer: An intensive longitudinal examination

et al. 2021

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Objective: Although physical activity is associated with better health outcomes in breast cancer survivors (BCS), activity often declines during cancer treatment. Social cognitive theory (SCT) constructs have been associated with physical activity in post-treatment BCS, but little is known about the relation between these constructs and physical activity during chemotherapy. Methods: BCS (n = 67; M age = 48.6 [SD = 10.3]) undergoing chemotherapy wore accelerometers and completed prompts in the morning and at night assessing sameday and next-day exercise self-efficacy, physical and psychological outcome expectations, and goal-setting for 10 consecutive days (3 days pre-, day of, and 6 days post-chemotherapy dose) at three time points (beginning, middle, and end of chemotherapy). Separate mixed models assessed between-and within-person associations of each of the SCT constructs associations with same-and next-day moderate to vigorous physical activity (MVPA) and light physical activity (LPA), independently. Results: Within-person differences in all SCT variables were statistically significantly related to same-day MVPA (p's < 0.001) and LPA (p's < 0.001). Every onepoint increase in SCT construct related to an increase in MVPA ranging from (a) 3.70 (self-efficacy) to 8.02 (physical outcome expectations) minute increase in MVPA and (b) 12.72 (self-efficacy) to 20.38 (physical outcome expectations) increase in LPA that day. No same-day between-person effects nor any next-day effects were significant. Conclusion: MVPA and LPA were related to same-day within-person differences in SCT variables. Interventions targeted at increasing or mitigating chemotherapyrelated declines in daily within-person changes in SCT constructs could help to increase physical activity among BCS during chemotherapy.

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“…In summary, we demonstrated that a shared monitoring and review process to assess symptoms between patients and physicians has the potential to improve the quality of future patient self-reporting. Our study indicated that the integration of ePRO into oncological clinical research and continuous clinical practice should leverage monitoring of side effects and symptom management [ 28 , 29 ] using the rapidly developing digital mobile and sensor technologies, which can provide more objective measures and facilitate the active and passive collection of detailed, personalized data.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Collaborative Reviews of Electronic Patient-Reported Outcomes on the Congruence of Patient- and Clinician-Reported Toxicity in Cancer Patients Receiving Systemic Therapy: Prospective, Multicenter, Observational Clinical Trial

Trojan¹,

Leuthold²,

Thomssen³

et al. 2021

J Med Internet Res

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Background Electronic patient-reported outcomes (ePRO) are a relatively novel form of data and have the potential to improve clinical practice for cancer patients. In this prospective, multicenter, observational clinical trial, efforts were made to demonstrate the reliability of patient-reported symptoms. Objective The primary objective of this study was to assess the level of agreement κ between symptom ratings by physicians and patients via a shared review process in order to determine the future reliability and utility of self-reported electronic symptom monitoring. Methods Patients receiving systemic therapy in a (neo-)adjuvant or noncurative intention setting captured ePRO for 52 symptoms over an observational period of 90 days. At 3-week intervals, randomly selected symptoms were reviewed between the patient and physician for congruency on severity of the grading of adverse events according to the Common Terminology Criteria of Adverse Events (CTCAE). The patient-physician agreement for the symptom review was assessed via Cohen kappa (κ), through which the interrater reliability was calculated. Chi-square tests were used to determine whether the patient-reported outcome was different among symptoms, types of cancer, demographics, and physicians’ experience. Results Among the 181 patients (158 women and 23 men; median age 54.4 years), there was a fair scoring agreement (κ=0.24; 95% CI 0.16-0.33) for symptoms that were entered 2 to 4 weeks before the intended review (first rating) and a moderate agreement (κ=0.41; 95% CI 0.34-0.48) for symptoms that were entered within 1 week of the intended review (second rating). However, the level of agreement increased from moderate (first rating, κ=0.43) to substantial (second rating, κ=0.68) for common symptoms of pain, fever, diarrhea, obstipation, nausea, vomiting, and stomatitis. Similar congruency levels of ratings were found for the most frequently entered symptoms (first rating: κ=0.42; second rating: κ=0.65). The symptom with the lowest agreement was hair loss (κ=–0.05). With regard to the latency of symptom entry into the review, hardly any difference was demonstrated between symptoms that were entered from days 1 to 3 and from days 4 to 7 before the intended review (κ=0.40 vs κ=0.39, respectively). In contrast, for symptoms that were entered 15 to 21 days before the intended review, no congruency was demonstrated (κ=–0.15). Congruency levels seemed to be unrelated to the type of cancer, demographics, and physicians’ review experience. Conclusions The shared monitoring and review of symptoms between patients and clinicians has the potential to improve the understanding of patient self-reporting. Our data indicate that the integration of ePRO into oncological clinical research and continuous clinical practice provides reliable information for self-empowerment and the timely intervention of symptoms. Trial Registration ClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731

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Going beyond (electronic) patient-reported outcomes: harnessing the benefits of smart technology and ecological momentary assessment in cancer survivorship research

Cited by 23 publications

References 36 publications

A Narrative Review on the Collection and Use of Electronic Patient-Reported Outcomes in Cancer Survivorship Care with Emphasis on Symptom Monitoring

A Narrative Review on the Collection and Use of Electronic Patient-Reported Outcomes in Cancer Survivorship Care with Emphasis on Symptom Monitoring

Social cognitive variables and physical activity during chemotherapy for breast cancer: An intensive longitudinal examination

The Effect of Collaborative Reviews of Electronic Patient-Reported Outcomes on the Congruence of Patient- and Clinician-Reported Toxicity in Cancer Patients Receiving Systemic Therapy: Prospective, Multicenter, Observational Clinical Trial

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