What are patients’ biggest concerns? A patient reported outcome case-management system.

Abstract

6572 Background: Cancer patients (pts) receive complex care that may cause physical, emotional, & financial sequelae. Current practice limits clinician time to address patient concerns. The Patient Reported Outcome Quality Of Life (PROQOL) system was developed as a self-reported electronic questionnaire to assess symptoms, QOL and provide data about bothersome issues. Our aim was to determine if the PROQOL system improves QOL without negatively impacting routine clinic workflow. Methods: Eligible pts had multiple myeloma, amyloidosis, head & neck or gynecologic cancer seen in Hematology/Oncology clinics at Mayo Clinic, and were stratified by stem cell transplant and active treatment status. Pts were randomized 2:1 to PROQOL system or usual care. PROQOL system was offered prior to every visit. Pts select from various categories about their single biggest concern, and receive a printed list of actionable resources based on selected concern. Clinicians also receive the PROQOL results to review with pts. Providers and pts randomized to PROQOL completed a “was it worth it survey” (WIWI). An 8 item Linear Analogue Self-Assessment was used to assess QOL. The study was powered to detect a 0.5 standard deviation difference in QOL between groups. Herein we report the planned results of first 6 months. Results: Among the first 118 pts accrued, 55% were female, median age was 63 (32-86), & 93% were on therapy. Median time from diagnosis to PROQOL was 26 months. The PROQOL system took 3.6 minutes to complete. Baseline median QOL (range) was 7 (3-10) for both groups. The most common PROQOL issue selected was “cancer & diagnosis” (36.5%) followed by “physical health” (35.3%). Specific concerns were related to treatment plan, prognosis, fatigue, sleep, and neuropathy. WIWI showed: 71% of pts thought it was worthwhile, 83% would participate again, 80% would recommend it, & 65% used resources provided. 80% of providers reported the PROQOL did not interfere with care & 75% believed the pt wellbeing may improve. Conclusions: Notably treatment plan & prognosis remain pts' greatest concern despite being over 2 year from diagnosis.The PROQOL system demonstrates integrated PRO reporting in clinic is quick & worthwhile to pts & providers.

Baseline Quality of Life is a Strong and Independent Prognostic Factor for Overall Survival in Metastatic Colorectal Cancer

“…5,32 This approach to PRO assessment resulted in improved QOL and treatment tolerance, and it was strongly endorsed by both patients and clinical staff. 33 Whether interventions to improve QOL or maintain optimal QOL would translate into improved survival has been explored. Previous attempts to answer this question in the setting of breast cancer trials have yielded conflicting results.…”

“… 5 , 32 This approach to PRO assessment resulted in improved QOL and treatment tolerance, and it was strongly endorsed by both patients and clinical staff. 33 …”

Feasibility of a Patient-Reported Outcomes Quality of Life Instrument to Improve Care in Underserved, Ethnic Minority Cancer Patients

“…[25] Data from our pilot phase also showed the difference in spectrum of concerns identified by PROQOL when administered to a predominantly Caucasian population at Mayo Clinic vs. the minority population at MIHS. [9] While 'Cancer Diagnosis, Treatment and Survivorship' was one of the two top concerns for both cohorts, 'Money' emerged as an equally important concern in the minority population as opposed to 'Physical Health' in Caucasian population.…”

“…[8] Recently, it has been modified and piloted with a predominantly Caucasian population in a Hematology and Medical Oncology practice to better understand treatment toxicity, emotional duress from the diagnosis and barriers to improved care. [9] The instrument provides patients an opportunity to report concerns on less commonly discussed issues that may impact their health management, such as social factors and personal relationships.…”