Getting ready for real-world use of electronic patient-reported outcomes (ePROs) for patients with cancer: A National Comprehensive Cancer Network ePRO Workgroup paper

Patient Engagement in the Implementation of Electronic Patient-Reported Outcome Tools: The Experience of Two Early-Adopter Institutions in the Pan-Canadian Radiotherapy Patient-Reported Outcome Initiative

AIMS

To share the patient and community engagement experience of two Canadian early adopter sites that implemented electronic patient-reported outcomes collection in radiotherapy practice.

MATERIALS AND METHODS

In the first institution, the McGill University Health Centre, a socio-technical stakeholder co-design approach was used to develop a patient portal application (Opal) with built-in ePRO collection capability. Patient and family members were engaged through patient co-leadership, focus groups, semi-structured interviews, a persistent feedback form in the resultant application, and user satisfaction surveys. In the second institution, the Nova Scotia Health (NSH) centres of Dalhousie University's Department of Radiation Oncology, an industry-provided patient engagement tool was deployed. Patient and community engagement in the deployment effort was purposive to promote digital inclusion and diverse representation. Engagement was operationalized via a community feedback session and involvement of patient representatives in oversight committees.

RESULTS

The McGill experience highlighted 3 particular points of concern for patients when collecting ePROs: (1) Data flow should be two-way such that patients have access to their data from the hospital (lab results, clinical notes) as well as providing their data to the hospital (ePROs); (2) If ePROs are collected, they should be used actively by clinicians or the incentive for patients to continue reporting will be diminished; (3) The inherent rigour of electronic data collection may risk frustrating patients due to the inability to skip questions or spoil responses. The Dalhousie/NSH experience demonstrated the value and importance of including a diverse set of community representatives in building an ePRO program so that it can proactively account for real-world complexities and the challenge of simultaneously addressing the needs of diverse communities.

CONCLUSION

Two early-adopter Canadian cancer care programs reported on their experience and lessons learned with patient and community engagement in the rollout of their ePRO collection initiatives.

Impact of smoking status on engagement in remote symptom monitoring after oncologic surgery: Implications for symptom management and readmission rates

BACKGROUND

Remote symptom monitoring (RSM) is an evidence-based strategy shown to mitigate postoperative morbidity; however, platform engagement is required to benefit from RSM. Patients who report current smoking are at high risk for postoperative complications, but it is unknown whether smoking status influences engagement with RSM, symptom severity, or unanticipated acute care visits.

METHODS

This observational case-control study was conducted in patients undergoing ambulatory oncologic surgery at a large cancer center. The authors examined the effect of current smoking status on adherence to an electronically delivered postoperative recovery-assessment tool. Symptom severity and readmissions by smoking status were also analyzed.

RESULTS

In total, 19,481 patients who underwent surgery and were enrolled in RSM were included. The nonresponse rate (28%) in current smokers was significantly greater than the rate observed in never smokers (21%; odds ratio, 1.38; 95% confidence interval, 1.17-1.63; p < .0001). Current smokers reported higher symptom scores for pain, wound swelling, constipation, and anxiety. The observed 30-day readmission rates were 3.6% for current smokers and 2.6% for never smokers, with overlapping confidence intervals.

CONCLUSIONS

Current smokers report higher symptom burden after surgery yet are less likely to adopt proactive digital postoperative recovery strategies like RSM. Implementation strategies are needed to improve the engagement of current smokers in RSM if benefits are to be realized in this high-risk population.

Challenges and solutions to system-wide use of precision oncology as the standard of care paradigm

The personalised oncology paradigm remains challenging to deliver despite technological advances in genomics-based identification of actionable variants combined with the increasing focus of drug development on these specific targets. To ensure we continue to build concerted momentum to improve outcomes across all cancer types, financial, technological and operational barriers need to be addressed. For example, complete integration and certification of the 'molecular tumour board' into 'standard of care' ensures a unified clinical decision pathway that both counteracts fragmentation and is the cornerstone of evidence-based delivery inside and outside of a research setting. Generally, integrated delivery has been restricted to specific (common) cancer types either within major cancer centres or small regional networks. Here, we focus on solutions in real-world integration of genomics, pathology, surgery, oncological treatments, data from clinical source systems and analysis of whole-body imaging as digital data that can facilitate cost-effectiveness analysis, clinical trial recruitment, and outcome assessment. This urgent imperative for cancer also extends across the early diagnosis and adjuvant treatment interventions, individualised cancer vaccines, immune cell therapies, personalised synthetic lethal therapeutics and cancer screening and prevention. Oncology care systems worldwide require proactive step-changes in solutions that include inter-operative digital working that can solve patient centred challenges to ensure inclusive, quality, sustainable, fair and cost-effective adoption and efficient delivery. Here we highlight workforce, technical, clinical, regulatory and economic challenges that prevent the implementation of precision oncology at scale, and offer a systematic roadmap of integrated solutions for standard of care based on minimal essential digital tools. These include unified decision support tools, quality control, data flows within an ethical and legal data framework, training and certification, monitoring and feedback. Bridging the technical, operational, regulatory and economic gaps demands the joint actions from public and industry stakeholders across national and global boundaries.

Assessing patients' needs in the follow-up after treatment for colorectal cancer-a mixed-method study

PURPOSE

The accessibility of cancer care faces challenges due to the rising prevalence of colorectal cancer (CRC) coupled with a shrinkage of healthcare professionals-known as the double aging phenomenon. To ensure sustainable and patient-centred care, innovative solutions are needed. This study aims to assess the needs of CRC patients regarding their follow-up care.

METHODS

This study uses a mixed-method approach divided in three phases. The initial phase involved focus group sessions, followed by semi-structured interviews to identify patients' needs during follow-up. Open analysis was done to define main themes and needs for patients. In the subsequent quantitative phase, a CRC follow-up needs questionnaire was distributed to patients in the follow-up.

RESULTS

After two focus groups (n = 14) and interviews (n = 5), this study identified six main themes. Findings underscore the importance of providing assistance in managing both physical and mental challenges associated with cancer. Participants emphasised the need of a designated contact person and an increased focus on addressing psychological distress. Furthermore, patients desire individualised feedback on quality of life questionnaires, and obtaining tailored information. The subsequent questionnaire (n = 96) revealed the priority of different needs, with the highest priority being the need for simplified radiology results. A possible approach to address a part of the diverse needs could be the implementation of a platform; nearly 70% of patients expressed interest in the proposed platform.

CONCLUSIONS

CRC patients perceive substantial room for improvement of their follow-up care. Findings can help to develop a platform fulfilling the distinct demands of CRC patients during follow-up.

Lessons Learned and Practice Pearls: Optimal Integration of Electronic Patient-Reported Outcomes in the Medical Oncology Clinic

This editorial reviews the many opportunities and obstacles associated with ePRO integration in oncology