PROs at the point-of-care lengthened survival, reduced readmissions and improved QoL in advanced cancer patients

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Increasing evidence that PROs improve care

Ethan Basch (MD, MSc), Director at the Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill and a strong proponent of patient-reported outcomes being used in routine clinical care recently published a letter outlining some of his group’s recent research entitled “Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment” (JAMA, June 4, 2017).

In this randomized controlled trial, they enrolled 766 consecutive patients initiating routine chemotherapy for metastatic solid tumors. Patients were randomized in to two groups: 1) a usual care control group where their symptoms were discussed during clinical encounters and patients could contact the office by telephone between visits concerning systems 2) a PRO group where patients provided self-report of 12 common symptoms from the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CT-CAE) via a web-based PRO questionnaire platform. In this PRO group, when a patient reported a severe or worsening symptom an email alert was triggered to a clinical nurse responsible for the care of the patient. Additionally a report profiling each participant’s symptom burden history was generated at clinic visits for the treating oncologist.

Increased survival and improved quality-of-life

Overall survival was assessed in June 2016 after 517 of 766 participants (67%) had died, at which the median follow-up was 7 years. The found that median overall survival was 31.2 months (95 CI, 24.5-39.6) in the PRO group and 26.0 months (95% CI, 22.1-30.9) in the usual care group. This difference of 5 months was statistically significant, p=0.03. In the group’s previous paper they also found that health-related quality of life improved on average by 34% as measured by the EQ-5D at 6 months after enrollment in the PRO group versus 18% in the usual care group which was again found to be statistically significant, p<0.001. In this same paper, they found that there was a lower rate of ER admissions and hospitalizations in the PRO group, patients were able to stay on chemotherapy for longer in the PRO group and surprisingly benefits were greatest among those who had lacked prior computer experience.

Implications

This important work provides strong evidence that the capture and use of patient-reported outcomes in routine care can have significant beneficial effects on patient outcomes that matter. It showed that the act of proactively tracking patient symptoms between visits and using that information to inform proactive outreach boosted survival by an average of 5 months (19%), while also improving health-related quality of life and reducing emergency admissions. If this kind of benefit could be achieved through a drug, it would surely be reimbursed for thousands of dollars per patient. At Outcomes.com our goal is to democratize the kind of technology used in the PRO group of this study, making it available for the benefit of patients worldwide.

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