Usability of Electronic Patient-Reported Outcome Measures for Older Patients With Cancer: Secondary Analysis of Data from an Observational Single Center Study

Abstract

Background Patient-reported outcomes are considered the gold standard for assessing subjective health status in oncology patients. Electronic assessment of patient-reported outcomes (ePRO) has become increasingly popular in recent years in both clinical trials and practice. However, there is limited evidence on how well older patients with cancer can complete ePRO assessments. Objective We aimed to investigate how well adult patients with cancer of different age ranges could complete ePRO assessments at home and in a treatment facility and to identify factors associated with the ability to complete questionnaires electronically. Methods This retrospective longitudinal single-center study involved survivors of cancer who participated in inpatient rehabilitation. Patients completed ePRO assessments before rehabilitation at home (T1) and after rehabilitation at the facility (T2). We analyzed the rate of patients who could complete the ePRO assessment at T1 and T2, the proportion of patients who required assistance, and the time it took patients to complete standardized questionnaires. Multivariate logistic regression analyses were conducted to identify predictors of ePRO completion rate and the need for assistance. Results Between 2017 and 2022, a total of 5571 patients were included in this study. Patients had a mean age of 60.3 (SD 12.2) years (range 18 to 93 years), and 1135 (20.3%) of them were classified as geriatric patients (>70 years). While more than 90% (5060/5571) of all patients completed the ePRO assessment, fewer patients in the age group of >70 years (924/1135, 81.4% at T1 vs 963/1135, 84.8% at T2) completed the assessment. Approximately 19% (1056/5571) of patients reported a need for assistance with the ePRO assessment at home, compared to 6.8% (304/4483) at the institution. Patients older than 70 years had a significantly higher need for assistance than those in younger age groups. Moreover, a gender difference was observed, with older women reporting a higher need for assistance than men (71-80 years: women requiring assistance 215/482, 44.6% vs men 96/350, 27.4%; P<.001 and >80 years: women 102/141, 72.3% vs men 57/112, 50.9%; P<.001). On average, patients needed 4.9 (SD 3.20) minutes to remotely complete a 30-item questionnaire (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire) and patients in the older age groups took significantly longer compared to younger age groups. Lower age and higher physical functioning were the clearest predictors for both the ePRO completion rate and the need for assistance in the multivariate regression analysis. Conclusions This study’s results indicate that ePRO assessment is feasible in older individuals with cancer, but older patients may require assistance (eg, from relatives) to complete home-based assessments. It may be more feasible to conduct assessments in-house in this population. Additionally, it is crucial to carefully consider which resources are necessary and available to support patients in using ePRO devices.

The advantages, disadvantages, threats, and opportunities of electronic patient-reported outcome systems in cancer: A systematic review

“…According to Table 1 , The advantages of ePRO were found to be diverse, with “Improved Quality of Life and Care” being the most prominent, cited in 45 studies (28.48%). 14 – 16 , 18 , 31 – 71 This was followed by “Real-time and Remote Monitoring” with 39 references (24.68%), highlighting its significance in real-time health monitoring, which can significantly impact patient outcomes 1 , 16 – 18 , 31 , 33 , 34 , 36 – 39 , 43 , 44 , 47 , 49 …”

“…Several studies have highlighted the potential benefits and challenges of ePRO systems in cancer care, including improved health-related quality of life 14 – 16 enhanced patient engagement 17 and favorable cost-effectiveness. 18 Additionally, ePRO systems are effective in providing longitudinal monitoring of treatment and symptoms, facilitating better communication with specialists, 19 and they are providing a more comprehensive and meaningful clinical insight regarding screening, diagnosis, and response to treatment.…”

“… 18 Additionally, ePRO systems are effective in providing longitudinal monitoring of treatment and symptoms, facilitating better communication with specialists, 19 and they are providing a more comprehensive and meaningful clinical insight regarding screening, diagnosis, and response to treatment. 14 – 16 These systems, characterized by user-friendly interfaces and personalized feedback mechanisms, contribute not only to efficient reporting but also to heightened patient satisfaction. 20 , 21 However, challenges such as methodological limitations, feasibility concerns, and technical barriers need to be addressed for their widespread adoption.…”

Application of Patient-Reported Outcome Measurements in Adult Tumor Clinical Trials in China: Cross-Sectional Study

“…Researchers are encouraged to follow relevant guidelines and principles and actively engage in conducting high-quality tumor clinical trials to improve well-established PRO protocols and enrich the array of available PRO instruments, thereby advancing personalized population health. In addition, it is suggested to encourage and provide relevant support to patients who have difficulties in completing the PRO reports [ 51 ].…”

Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing

“…Mobile health apps have features that can address older adults’ needs and expectations, contributing to enhanced cancer self-management [ 10 - 12 ]. Cancer apps designed for older adults have been reported to enable better communication [ 13 ], the potential for patient-reported outcome collection [ 14 ], and the feasibility of electronic rapid frailty screening [ 15 - 17 ]. If self- and symptom-management support for older adults with cancer is tailored to the usability and capability preferences of older adults, they can optimize the management of cancer symptoms [ 7 , 8 ].…”