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      Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial.

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          Abstract

          There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited.

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          The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature.

          J. M. Valderas, A. Kotzeva, M Espallargues … (2008)
          The purpose of this paper is to summarize the best evidence regarding the impact of providing patient-reported outcomes (PRO) information to health care professionals in daily clinical practice. Systematic review of randomized clinical trials (Medline, Cochrane Library; reference lists of previous systematic reviews; and requests to authors and experts in the field). Out of 1,861 identified references published between 1978 and 2007, 34 articles corresponding to 28 original studies proved eligible. Most trials (19) were conducted in primary care settings performed in the USA (21) and assessed adult patients (25). Information provided to professionals included generic health status (10), mental health (14), and other (6). Most studies suffered from methodologic limitations, including analysis that did not correspond with the unit of allocation. In most trials, the impact of PRO was limited. Fifteen of 23 studies (65%) measuring process of care observed at least one significant result favoring the intervention, as did eight of 17 (47%) that measured outcomes of care. Methodological concerns limit the strength of inference regarding the impact of providing PRO information to clinicians. Results suggest great heterogeneity of impact; contexts and interventions that will yield important benefits remain to be clearly defined.
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            Electronic patient-reported outcome systems in oncology clinical practice.

            Antonia Bennett, Roxanne E Jensen, Ethan Basch (2015)
            Patient-reported outcome (PRO) questionnaires assess topics a patient can report about his or her own health. This includes symptoms (eg, nausea, fatigue, diarrhea, pain, or frequent urination), physical functioning (eg, difficulty climbing stairs or difficulty fastening buttons), and mental health (eg, anxiety, fear, or worry). Electronic PRO (ePRO) systems are used in oncology clinical care because of 1) their ability to enhance clinical care by flagging important symptoms and saving clinicians time; 2) the availability of standardized methods for creating and implementing PROs in clinics; and 3) the existence of user-friendly platforms for patient self-reporting like tablet computers and automated telephone surveys. Many ePRO systems can provide actionable links to clinical care such as summary reports in a patient's electronic medical record and real-time e-mail alerts to providers when patients report acute needs. This review presents 5 examples of ePRO systems currently in use in oncology practice. These systems support multiple clinical activities, including assessment of symptoms and toxicities related to chemotherapy and radiation, postoperative surveillance, and symptom management during palliative care and hospice. Patient self-reporting is possible both at clinical visits and between visits over the Internet or by telephone. The implementation of an ePRO system requires significant resources and expertise, as well as user training. ePRO systems enable regular monitoring of patient symptoms, function, and needs, and can enhance the efficiency and quality of care as well as communication with patients. Copyright © 2012 American Cancer Society, Inc.
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              Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial.

              Donna Malveaux, S. Wright, K Shah … (2011)
              Patients receiving cancer-related thoracotomy are highly symptomatic in the first weeks after surgery. This study examined whether at-home symptom monitoring plus feedback to clinicians about severe symptoms contributes to more effective postoperative symptom control. We enrolled 100 patients receiving thoracotomy for lung cancer or lung metastasis in a two-arm randomized controlled trial; 79 patients completed the study. After hospital discharge, patients rated symptoms twice weekly for 4 weeks via automated telephone calls. For intervention group patients, an e-mail alert was forwarded to the patient's clinical team for response if any of a subset of symptoms (pain, disturbed sleep, distress, shortness of breath, or constipation) reached a predetermined severity threshold. No alerts were generated for controls. Group differences in symptom threshold events were examined by generalized estimating equation modeling. The intervention group experienced greater reduction in symptom threshold events than did controls (19% v 8%, respectively) and a more rapid decline in symptom threshold events. The difference in average reduction in symptom interference between groups was -0.36 (SE, 0.078; P = .02). Clinicians responded to 84% of e-mail alerts. Both groups reported equally high satisfaction with the automated system and with postoperative symptom control. Frequent symptom monitoring with alerts to clinicians when symptoms became moderate or severe reduced symptom severity during the 4 weeks after thoracic surgery. Methods of automated symptom monitoring and triage may improve symptom control after major cancer surgery. These results should be confirmed in a larger study.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): J. Clin. Oncol.
                Title: Journal of clinical oncology : official journal of the American Society of Clinical Oncology
                ISSN (Electronic): 1527-7755
                ISSN (Print): 0732-183X
                Publication date (Electronic): Feb 20 2016
                Volume: 34
                Issue: 6
                Affiliations
                [1 ] Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA. ebasch@med.unc.edu.
                [2 ] Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
                Article
                Publisher Item ID: JCO.2015.63.0830
                DOI: 10.1200/JCO.2015.63.0830
                PubMed ID: 26644527
                SO-VID: eefd3c17-ea0b-4f2a-ac09-2112b817c28b
                Copyright © © 2015 by American Society of Clinical Oncology.
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