Examining How Online Patient-Reported Outcomes Make a Difference in Cancer Care

In a webinar hosted by Carevive, researcher Ethan Basch, MD, MSc, discussed the findings of his recent study linking electronic patient-reported outcomes (PROs) to better survival outcomes for patients with cancer.

Setting the stage for Basch’s presentation, Carevive’s chief clinical officer, Carrie Tompkins Stricker, PhD, RN, explained that the burgeoning cancer population and the persistent obstacle of non-adherence to oncology drugs are “all the more reason why integrating the patient voice into the cancer care continuum becomes crucial.” As physicians spend more time on administrative tasks, new research finds that clinicians are unaware of up to half of all symptoms experienced by patients with cancer.

Carevive’s cloud-based care planning technology aims to bring the patient voice into the clinical oncology decision-making process. This background made it an ideal candidate to partner with Basch on his upcoming trial of electronic symptom reporting in cancer centers nationwide. This trial, which is anticipated to conclude in 2022, aims to expand on the promising results of a single-center study published by Basch and colleagues in the Journal of Clinical Oncology in 2016.

Basch’s presentation of this research at the 2017 American Society of Clinical Oncology focused on the primary outcome of overall survival, namely the remarkable finding that patients receiving chemotherapy for metastatic tumors who used a Web-based symptom-reporting tool lived on average 5 months longer than the group receiving usual care, who discussed their symptoms only at clinic appointments. During Carevive’s webinar, he offered some more details and potential explanations for these findings.

Basch noted that the study patients were willing and able to report their symptoms online, even if they were elderly, experienced high symptom burden, had little or no computer experience, or were close to death. Overall, patients self-reported their symptoms 73% of the time after receiving a weekly e-mail reminder to log in and answer an online questionnaire. Clinicians also were willing to trust this information, as nurses took action in response to the electronic symptom reports 77% of the time.

In addition to the findings of longer median survival time, 31% more of the self-reporting arm experienced significant improvement in quality of life compared with the control group. The researchers also observed reduced healthcare utilization, as 7% fewer patients in the self-reporting arm visited the emergency department (ED) throughout the study.

Basch offered 3 potential mechanisms of action supported by the study findings. First, the symptom notification system prompted clinicians to intervene early, as evidenced by the high response rate by nurses and the low rate of ED visits. Also, the self-reporting group showed better physical functioning and self-care, which could mean that improved symptom control kept them more functional, which is linked to better survival. Finally, by improving the management of chemotherapy side effects, patients may have been able to endure more intensive treatment, and indeed the self-reported group was able to receive chemotherapy 2 months longer, on average, than the control group.

Overall, Basch said, these findings support the conclusion that “this approach should be considered for inclusion as a part of standard symptom management.”

In a question and answer session, he elaborated on the next steps of integrating electronic PRO reporting into practice. The findings from this study should be interpreted in the broader context of the healthcare system’s growing interest in self-reporting and patient engagement, especially considering the movement towards accountability and value. Essentially, “the horse is out of the barn for PROs,” Basch said, and the real question is how they will be standardized and implemented across institutions.

When Stricker asked whether lack of experience with technology was a barrier to online symptom reporting, Basch explained that his study found surprisingly positive results among this group, indicating the feasibility of such approaches. However, he noted that the technology must be easy to use and that there must be enough clinician buy-in to make patients feel that their doctor or nurse listens to the symptom information and values the patient’s participation.

When an audience member asked if the psychological effect of having one’s symptoms quickly responded to could have contributed to the improved survival time, Basch acknowledged that the answer was out of his field of expertise but was certainly possible, and he guessed that “it’s nice to feel that someone’s listening to you in real-time.” Basch also noted that the upcoming national trial plans to collect data on patient satisfaction throughout the study to further delve into this effect.