Patient-Reported Outcomes, Digital Health, and the Quest to Improve Health Equity

Abstract

The theme of the 2023 American Society of Clinical Oncology Annual Meeting is Partnering With Patients: The Cornerstone of Cancer Care and Research. As we aim to partner with patients to improve their health care, digital tools have the potential to enhance patient-centered cancer care and make clinical research more accessible and generalizable. Using electronic patient-reported outcomes (ePROs) to collect patients' reports of symptoms, functioning, and well-being facilitates patient-clinician communication and improves care and outcomes. Early studies suggest that racial and ethnic minority populations, older patients, and patients with less education may benefit even more from ePRO implementation. Clinical practices looking to implement ePROs can refer to the resources of the PROTEUS Consortium (Patient-Reported Outcomes Tools: Engaging Users & Stakeholders). Beyond ePROs, in response to the COVID-19 pandemic, cancer practices have rapidly adopted other digital tools (eg, telemedicine, remote patient monitoring). As implementation grows, we must be aware of the limitations of these tools and implement them in ways to promote optimal function, access, and ease of use. Infrastructure, patient, provider, and system-level barriers need to be addressed. Partnerships across all levels can inform development and implementation of digital tools to meet the needs of diverse groups. In this article, we describe how we use ePROs and other digital health tools in cancer care, how digital tools can expand access to and generalizability of oncology care and research, and prospects for broader implementation and use.

Virtual Care for Patients with Advanced Well Differentiated Gastroenteropancreatic Neuroendocrine Tumor (GEP-NET)

“…It offers increased comfort and convenience. This is supported by patient-reported outcomes showing a high level of satisfaction with virtual oncology care [19,20]. It also reduces patients' travel time and associated costs.…”

Telehealth and Outcomes in Patients With Cancer

“…Interventions such as increasing broadband access in rural areas, providing formal education and language integration on telehealth platforms, and incorporating incentives and sustainable reimbursement models for adoption of telehealth may improve access and successful use, which can be readily measured over time. 50,51…”

“…Although there are many limitations to this retrospective study and its binary classification of telehealth visits as successful or unsuccessful, the notion of defining a successful encounter and measuring associations with both patient characteristics and other clinical outcomes may ultimately contribute to further research into optimizing this new frontier. Interventions such as increasing broadband access in rural areas, providing formal education and language integration on telehealth platforms, and incorporating incentives and sustainable reimbursement models for adoption of telehealth may improve access and successful use, which can be readily measured over time 50,51 …”

Challenges and solutions to system-wide use of precision oncology as the standard of care paradigm

“…These digital tools enable clinicians to act immediately on reported symptoms when needed with discrete clinical intervention. Several bodies of evidence point out that electronic collection of PROs improves patient outcomes, including longer time on treatment, better quality of life, and higher probability of survival compounded with reduced healthcare service utilisation (Pritchett et al, 2023 ). In the US, the Centers for Medicare and Medicaid Innovation included ePRO in the Enhancing Oncology Model programme, suggesting that ePRO implementation should be the standard for high-quality cancer care (Basch et al, 2020 ).…”