According to the findings, people with advanced cancer who communicated their symptoms weekly using an electronic survey had about a third better physical function and more than 15% better control of their symptoms compared to those who were evaluated less frequently through in-person clinical visits. from a multi-state study conducted at 52 local cancer clinics. The PRO-TECT (pattendant Rexported Ooutcome tO Enhance Canchor treatment) was led by researchers at the Lineberger Comprehensive Cancer Center at the University of North Carolina.
The findings were published online on June 5, 2022 in the Journal of the American Medical Association and presented simultaneously at the American Society of Clinical Oncology annual meeting in Chicago in 2022, provided more in-depth analyzes of data presented at a virtual ASCO plenary presentation in November 2021.
An estimated 50 percent of cancer-related symptoms go undetected and go unreported. Electronic systems that enable patient-reported outcome studies (PRO) can identify symptoms early and prompt clinicians to intervene before symptoms become more complicated or complex, improving outcomes.
1,191 participants took part in the trial. About half (593) were randomly assigned to complete a weekly Internet-based or automated telephone system survey with questions about common symptoms, performance status, and falls. The other half were assigned to a usual care group, which often meant waiting until their next regularly scheduled clinic visit to report any symptoms. The most common symptoms reported in the electronic survey were fatigue, nausea, insomnia, loss of appetite, diarrhea, pain, difficulty breathing and constipation. Alerts were sent to nurses if a patient’s reported symptoms were severe or worsening.
We had a very high level of engagement with patients and their care teams in this study, with patients completing over 90 percent of their symptom surveys, and nurses often contacted patients when severe or worsening symptoms were reported electronically. This likely reflects how many patients and caregivers have become accustomed to telecare and electronic communications.”
UNC Lineberger’s Ethan Basch, MD, MSc, the paper’s lead author
Notably, about a third of participants, mostly in rural areas, chose to report their symptoms through an optional computerized telephone system rather than the Internet. This could be a result of limited broadband access in rural areas, or other factors that need to be addressed in future studies to ensure that access to programs like PRO-TECT is truly equitable, said Basch, the Richard Goldberg Distinguished Professor and head of the medical oncology at UNC School of Medicine, director of UNC Lineberger’s Cancer Outcomes Research Program and chief physician at North Carolina Cancer Hospital.
Patients in the PRO group were significantly more likely to experience clinically meaningful benefits compared to the control group, including a 35% better ability to function physically, a 16.1% better control of their symptoms, and a 41% better overall health-related quality of life. These were all clinically meaningful improvements over the current standard of care.
The researchers noted that while the improvements were robust after three months of telehealth reporting, the improvements disappeared after a year. Basch suggests that part of the decline could be attributed to patients having their needs resolved, but may also be due to the reduced number of study participants at one year due to the limited life expectancy of those with advanced cancers. Another factor may have been the COVID-19 pandemic; many healthcare teams were stretched and had to prioritize their time, potentially limiting their ability to proactively participate in PRO-TECT.
“PRO-TECT is a way to bring patients together with their healthcare team and help identify those who are most at risk,” Basch said. “And because we had equal success at all 52 practices in 25 states, it shows that there is broad acceptance for this type of intervention.”
The next goal of the researcher is to determine the best models for widespread implementation and how to make the intervention more efficient for practice. The impact of PROs on overall survival and people’s financial ability to afford care, whether in-clinic or through telehealth, are analyzes the researchers are currently conducting and hope to report in the near future.
UNC Lineberger Comprehensive Cancer Center
Basch, E., et al. (2022) Effect of electronic symptom monitoring on patient-reported outcomes in patients with metastatic cancer. JAMA† doi.org/10.1001/jama.2022.9265.