The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline

A targeted literature review on the impact of tailored interventions on patient outcomes in oncology

Non-pharmacological approaches to managing symptoms and side effects of cancer treatments are not always aligned with true needs and characteristics of patients. Without proactive patient-tailored interventions to anticipate, prevent, and manage side effects, risk of patients experiencing treatment interruption or discontinuation increases. A targeted literature review identified published studies evaluating the impact of tailored (customized based on individual patient characteristics) non-pharmacological interventions on patient outcomes in oncology versus routine care (usual clinical practice), enhanced care (support beyond routine care, including additional patient education, psychological support, and medication tracking), or uniform engagement (non-tailored support offered in a uniform manner). Thirty completed clinical studies were included. Approximately 50% of interventions across studies were remote health education/self-management programs, and the remaining provided clinical follow-up for symptom management. All types of tailored intervention led to positive patient outcomes versus routine care. Significant improvements were seen in favor of self-efficacy for self-management (patient's belief in their ability to manage own symptoms and treatment; p < 0.05) and symptom burden (overall as well as specific symptoms including anxiety, nausea, vomiting; all p < 0.05), although there were inconsistent effects on health-related quality of life (HRQoL), healthcare resource utilization (HCRU), and adherence. Compared with enhanced care, most studies showed no consistent improvement for tailored interventions in symptom burden, self-efficacy, HRQoL, HCRU or adherence, although benefits were slightly more common in larger/longer studies. Tailored interventions were not consistently better than uniform engagement in improving outcomes, although the number of studies was limited, with small sample sizes/short follow-ups. In summary, tailored interventions showed positive benefits versus routine or enhanced care (the latter only in larger and longer studies). No consistent benefit was observed compared with uniform engagement. Clinical outcomes were most sensitive to type of intervention. Tools to both enhance and measure the process should be routinely incorporated in clinical trials.

Survivorship Care for People Affected by Advanced or Metastatic Cancer: Building on the Recent Multinational Association of Supportive Care in Cancer-ASCO Standards and Practice Recommendations

Although there is a growing number of people living with advanced or metastatic cancer, primarily because of more effective treatment regimens, there are limited estimates of the actual number of people living with advanced or metastatic cancer. Many people will have treatable but not curable cancers, may have survival measured in years, and may have periods on and off therapy. People with advanced or metastatic disease, as well as their families and caregivers, may experience significant unmet needs, overlapping yet distinct to those with potentially curable cancer. Recently, the Multinational Association of Supportive Care in Cancer and ASCO developed standards and practice recommendations relevant to the delivery of quality survivorship care for people living with advanced or metastatic cancer. The recommendations included seven domains: (1) person-centered care; (2) coordinated and integrated care; (3) evidence-based and comprehensive care; (4) evaluated and communicated care; (5) accessible and equitable care; (6) sustainable and resourced care; and (7) research and data-driven care. Immediate priorities to improve clinical care include focusing on (1) discussions regarding prognosis and goals of care; (2) routinely assessing physical, psychological, and social unmet needs with referral to appropriate supportive care services; and (3) creating blended models of care, incorporating elements of palliative care and survivorship services. Additional areas for focus include (1) advocacy and policy; (2) system design and health care delivery; (3) defining, measuring, and managing quality; (4) addressing inequity; and (5) research specifically focused on these cancer populations.

Completion Rate of Paper-Based and Electronic Patient Reported Outcome Measures in a Multidisciplinary Cancer Survivorship Clinical Setting

OBJECTIVE

Integrating Patient-Reported Outcome Measures (PROMs) into clinical practice is increasing, with research showing benefits in patient outcomes. However, evidence regarding patient's acceptance of PROMs is limited. Sydney Cancer Survivorship Centre (SCSC) clinic is a multidisciplinary clinic where clinicians use PROMs to guide patient consultation. This study explored SCSC patient acceptability of PROMs in clinical care by evaluating PROMs' completion rates.

METHODS

This retrospective audit of PROMs completion rates evaluates two periods: 1) September 2013-November 2019 (pre-coronavirus disease 2019) and 2) October 2020-September 2023, following the implementation of electronic PROMs. Overall, 866 new patients attended SCSC during the two audit periods, with 822 (95%) giving consent for data to be included. Descriptive statistical methods were used to analyse completion rates.

RESULTS

Between September 2013 and November 2019 (audit period 1), 656 new survivors attended the SCSC clinic; 622 (95%) consented to data use. The highest completion rate for paper-based PROMs was the food questionnaire (92%); with 91% for distress thermometer, symptoms, and exercise-related PROMs; 85% for quality of life; 77% for self-rated performance status, and 55.5% for a 3-day food diary. From October 2020 to September 2023 (period 2), the response rate for PROMs was 99% (n = 198/200) for initial clinic attendees; and 92% for electronic PROMs (n = 169/184).

CONCLUSIONS

Using comprehensive PROMs in clinical care is feasible. The completion rate was high; similar between paper-based and electronic PROMs. Comprehensive PROMs can guide clinical consultations. PROMs may improve communication between survivors and clinicians and enhance the quality of care.

Acceptability of an Electronic Patient-Reported Outcomes-Based Model of Care to Monitor Symptoms Related to Cancer Treatment with Immune Checkpoint Inhibitors: Results from the IePRO Randomized Controlled Trial

OBJECTIVES

This study analyzed the acceptability of an electronic patient-reported outcomes measures-based model of care (IePRO MoC) and the usability of its complementary ePROM mobile app to monitor and manage symptoms related to immune checkpoint inhibitors. In this MoC, symptoms reported by patients treated at an outpatient clinic were reviewed by oncology triage nurses who provided symptom management interventions by telephone.

METHODS

As part of a larger intervention trial (ClinicalTrials.gov.NCT05530187) we conducted an abductive, semantic thematic analysis through semistructured interviews of patients participating in the intervention arm. Acceptability was deduced from Sekhon et al's (2017) Theoretical Framework of Acceptability completed with inductively generated themes. Usability analysis was guided by the mHealth App Usability Questionnaire's domains by Zhoul et al (2019).

RESULTS

A total of 17 interviews were performed. The IePRO MoC was reported to be an acceptable intervention. Patients expressed feeling safe and empowered due to continuous monitoring and timely support from nurses. Personalized support motivated patients to use the MoC throughout treatment. Some questioned the predefined response options of the app, and the standardized approach regarding notifications and monitoring requirements. Despite high app usability, some expressed discomfort from being frequently reminded of their illness and being confronted with questions about their sexuality and other intimate themes.

CONCLUSIONS

The feedback loop between patients and nurses facilitated the acceptability of the IePRO MoC. The app's usability further facilitated adherence to the MoC. A more personalized approach regarding the frequency of assessments and the way symptoms are conveyed is recommended to decrease discomfort and support the implementation of similar MoCs in the future.

A study of a supportive application with integrated patient-reported outcomes in patients with advanced pancreatic or lung cancer (BetterEveryDay)

PURPOSE

We developed the supportive application with integrated patient-reported outcomes questionaries. This study tested the application' feasibility in patients with advanced pancreatic or lung cancer.

METHODS

In the study we included patients with advanced pancreatic or lung cancer of performance status 0-2 receiving 1st line systemic therapy. Patient-reported outcomes, adapted from the National Cancer Institute, and three self-reflecting questions were sent to the patients weekly. The predefined threshold of severity determined initiating of extraordinary healthcare professional' assistance. The primary endpoint was the proportion of patients who responded to at least two questionnaires by 12 weeks, with an 80 % completion rate of patient-reported outcomes considered as a requirement to continue with Part B. Secondary endpoints included proportion of patients logged on at least once, recruitment rate, time spent by personnel and application functionality and utility.

RESULTS

In total 30 patients with pancreatic cancer (n = 17) or lung cancer (n = 13) were included between August 2021 to December 2021. The proportion of patients responding to at least two questionnaires within 12 weeks was 87 %. A total of 29 patients (97 %) logged on at least once by 12 weeks. On average, participants completed eight questionnaires (range 0-14), including application evaluations, over the 12-week study period (range 0-14). The healthcare professional spent a mean of 21 min per patient on phone calls. Fourteen patients rated the application' functionality and utility at an average of 77 %.

CONCLUSIONS

The app with integrated weekly patient-reported outcomes and self-reflecting questions was feasible for patients with advanced pancreatic or lung cancer and time spent by personnel was acceptable. Based on these findings, a randomized follow-up phase (part B) evaluating the app's impact on clinical outcomes is currently ongoing.

CLINICAL TRIALS REGISTER

ID NCT04611867 (BetterEveryDay); Registration date November 2, 2020.

Confirmatory Factor Analysis of the Oral Epithelial Dysplasia Informational Needs Questionnaire

OBJECTIVE

The Oral Epithelial Dysplasia Information Needs Questionnaire (ODIN-Q) was developed to assess the informational needs of patients with oral epithelial dysplasia (OED). This study aimed to evaluate the six-factor ODIN-Q model to determine its psychometric properties and alignment with a theoretical framework.

METHODS

Confirmatory factor analysis (CFA) was conducted with 165 participants to assess the model's fit. Consensus-based standards for selecting health measurement instruments were followed, and five participants per item in the assessment tool were required for effective CFA. Various fit indices, factor loadings and inter-factor correlations were analysed.

RESULTS

The CFA results indicated a moderate model fit, which was consistent with other multidimensional patient-reported instruments. The average factor loading for all 33 items was 0.58 (highest = 0.84, lowest = 0.28). Only two items with relatively low loadings (< 0.3) were related to doctors' experience and lifestyle adjustments. Additionally, the ODIN-Q distinguished conceptually distinct domains with low inter-factor correlations (< 0.20).

CONCLUSION

The current six-factor ODIN-Q is a psychometrically sound instrument for assessing the informational needs of individuals with OED. Further cross-cultural assessments of the ODIN-Q are required to demonstrate its cultural sensitivity in other English-speaking patient cohorts and globally.

Comparison of Electronic Surveillance With Routine Monitoring for Patients With Lymphoma at High Risk of Relapse: Prospective Randomized Controlled Phase 3 Trial (Sentinel Lymphoma)

Background

Relapse is a major event in patients with lymphoma. Therefore, early detection may have an impact on quality of life and overall survival. Patient-reported outcome measures have demonstrated clinical benefits for patients with lung cancer; however, evidence is lacking in patients with lymphoma. We evaluated the effect of a web-mediated follow-up application for patients with lymphoma at high risk of relapse.

Objective

This study aims to demonstrate that monitoring patients via a web application enables the detection of at least 30% more significant events occurring between 2 systematic follow-up consultations with the specialist using an electronic questionnaire.

Methods

We conducted a prospective, randomized phase 3 trial comparing the impact of web-based follow-up (experimental arm) with a standard follow-up (control arm). The trial was based on a 2-step triangular test and was designed to have a power of 90% to detect a 30% improvement in the detection of significant events. A significant event was defined as a relapse, progression, or a serious adverse event. The study covered the follow-up period after completion of first-line treatment or relapse (24 months). Eligible patients were aged 18 years and older and had lymphoma at a high risk of relapse. In the experimental arm, patients received a 16-symptom questionnaire by email every 2 weeks. An email alert was sent to the medical team based on a predefined algorithm. The primary objective was assessed after the inclusion of the 40th patient. The study was continued for the duration of the analysis.

Results

A total of 52 patients were included between July 12, 2017, and April 7, 2020, at 11 centers in France, with 27 in the experimental arm and 25 in the control arm. The median follow-up was 21.3 (range 1.3-25.6) months, and 121 events were reported during the study period. Most events occurred in the experimental arm (83/119, 69.7%) compared with 30.2% (36/119) in the control arm. A median number of 3.5 (range 1-8) events per patient occurred in the experimental arm, and 1.8 (range 1-6) occurred in the control arm (P=.01). Progression and infection were the most frequently reported events. Further, 19 patients relapsed during follow-up: 6 in the experimental arm and 13 in the control arm (P<.001), with a median follow-up of 7.7 (range 2.8-20.6) months and 6.7 (range 1.9-16.4) months (P=.94), respectively. Statistical analysis was conducted after including the 40th patient, which showed no superiority of the experimental arm over the control arm. The study was therefore stopped after the 52nd patient was enrolled.

Conclusions

The primary objective was not reached; however, patient-reported outcome measures remain essential for detecting adverse events in patients with cancer, and the electronic monitoring method needs to demonstrate its effectiveness and comply with international safety guidelines.

Association Between Health-Related Quality of Life Measures and Survival Endpoints in Oncology Clinical Trials and in Clinical Decision Making: A Narrative Review

For decades, oncology research has primarily relied on survival-based endpoints, such as progression-free survival and overall survival, to evaluate treatment efficacy. However, recent studies and international guidelines underscore the importance of incorporating patient-reported outcomes through patient-reported outcomes measures (PROMs). PROMs provide a more comprehensive view of treatment effectiveness, integrating the concepts of 'living longer' and 'living better.' Health-related quality of life (HRQoL) improvements have an intrinsic value for the patient, with importance in the overall definition of treatment value. These findings have sparked discussions regarding the relationship between HRQoL and traditional survival endpoints, influencing both oncology clinical trials and their interpretation for decision-making processes in practice. To effectively integrate PROMs into research, the choice of study design, appropriate PROMs questionnaires, and timing of administration are critical. The clinician's ability to interpret HRQoL data with awareness is equally important to ensure good clinical decision making. A pivotal concept in this context is the minimum clinically important difference (MCID), which is essential to inform the interpretation of treatment effect size in terms of clinically relevant HRQoL changes. Incorporating PROMs fosters a patient-centered approach to cancer care, aligning treatment goals with individual preferences and values. By balancing survival outcomes with quality of life, and through empathetic communication, healthcare providers can deliver treatments that are not only effective but also resonate with patients' experiences and priorities.

Patient-Reported Outcomes Before and After Radiotherapy for Brain Metastases-A Prospective Cohort Study of 239 Non-Small-Cell Lung Cancer Patients

Introduction: Radiotherapy (RT) is a frequently offered treatment option for brain metastases (BMs) in patients with non-small-cell lung cancer (NSCLC). This study presents patient-reported outcomes (PROs) in a cohort of NSCLC with BMs treated with RT. This study researched how PRO scores at the start of RT may be useful in survival estimates and how PROs change over time after RT. Methods: NSCLC patients with first-time BMs treated with RT were identified in a prospective observational study. PROs were collected at the start of RT and monthly for up to 1 year. Differences in PRO mean scores at the start of RT (M0) and at month 2 (M2) after treatment are reported. Prognostic values of PROs were analyzed in a stepwise adjusted Cox model. Results: Of 294 patients identified, 239 (81%) responded at M0; 105/239 (44%) responded at both M0 and M2. High scores for weakness of legs at M0 were associated with short survival when adjusting for performance status and status of extracranial metastases. Those responding at M0 only had worse mean scores for overall QoL and PF but similar scores for fatigue and dyspnea compared to patients responding over time. At M2, patients with <6 months survival after RT reported worse scores for overall QoL, PF, fatigue, and dyspnea; long-term survivors reported stable scores. Conclusions: NSCLC patients diagnosed with BMs and expected survival < 6 months should be offered optimal palliative care rather than RT.

Incidence and management of diarrhoea associated with abemaciclib and endocrine therapy for hormone-receptor positive, HER2-negative metastatic breast cancer: the UK patients' experiences

PURPOSE

Addition of a CDK4/6 inhibitor to endocrine therapy (ET) prolongs survival in HR + /HER2-metastatic breast cancer (MBC). Gastrointestinal side effects, predominantly diarrhoea and abdominal pain, are common in patients receiving abemaciclib. This can potentially increase symptom burden, reduce quality of life (QoL) and affect treatment adherence. This longitudinal mixed-methods study with a 6-month follow-up explored patients' outcomes and experiences.

METHODS

Participants (n = 44) completed validated QoL measures at study-entry and at 1, 3 and 6 months. Weekly diarrhoea diaries with free-text response options assessed bowel movements and self-management strategies. Optional interviews gathered insight in patients' experiences.

RESULTS

Forty-two participants completed study measures at study-entry and 24 at 6 months. 17/42 reported no gastrointestinal side-effects. Above threshold diarrhoea (≥ 3 loose/liquid stools daily) was reported at least once by 25/42, with 3/42 having persistent symptoms. Strategies to control diarrhoea, employed by 28/42, included dietary modifications, non-prescribed medication-use and nonadherence (dose interruption or reduction). Meaningful decline on the QoL diarrhoea subscale was observed in 12/37 at 1 month, 13/28 at 3 months and 8/23 at 6 months. Free-text analysis showed that diarrhoea disrupted everyday life in those affected.

CONCLUSION

A proportion of this small sample of MBC patients treated with abemaciclib and ET-reported diarrhoea which affected symptom burden and QoL. Close symptom monitoring alongside targeted supportive/educational interventions should be introduced to reduce the negative impact on patients' lives.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: ISRCTN17281696.

Multicenter, open-label, randomized, controlled study to test the utility of electronic patient-reported outcome monitoring in patients with unresectable advanced cancers or metastatic/recurrent solid tumors

Electronic patient-reported outcome (ePRO) monitoring for patients undergoing cancer chemotherapy may provide qualified and early detection of adverse events or disease-related symptoms, leading to improved patient care. The aim of this study is to examine whether addition of ePRO monitoring to routine medical care contributes to improved overall survival and quality of life of cancer patients undergoing chemotherapy. Patients with unresectable advanced cancers or metastatic/recurrent solid tumors receiving systemic chemotherapy will be randomized to an ePRO monitoring group and a usual care group. The ePRO group will conduct weekly symptom monitoring using an electronic device after study enrollment until the end of the study. Monitoring results will be returned to medical personnel and used as information for patient care. The primary endpoints are overall survival and health related quality of life. The initial target sample size for the study was 1500 patients. However, due to delays in enrollment, the target was readjusted to 500 patients. Enrollment has been completed, and the study is now in the follow-up phase.

Sustainability and Time Trends in Electronic Patient-Reported Outcome Assessment in Routine Cancer Care: Systematic Scoping Review and Follow-Up Survey

BACKGROUND

Routine electronic assessment of patient-reported outcomes (ePROs) can improve cancer care; yet, its implementation in routine practice and long-term sustainability remain unclear. Understanding these aspects is critical to advancing the field.

OBJECTIVE

To review and describe the past and current status, time trends, and long-term sustainability of clinical ePRO applications in routine oncology care.

METHODS

We conducted a systematic review of publications on ePRO use in oncology care up to December 31, 2023, searching PubMed and Web of Science and extracting data on clinical ePRO applications. We included peer-reviewed studies including patients with cancer using ePRO assessments in clinical practice, excluding research letters and conference abstracts. Data from the review were analyzed using descriptive statistics and univariate regression models to evaluate time trends, with year of publication as the predictor. A follow-up survey was sent to authors of published ePRO applications to assess their current use of the application or reasons for discontinuation. Responses from the follow-up survey were analyzed descriptively.

RESULTS

For the review, we screened 2933 references, and 303 met inclusion criteria. Results showed that Europe was the most common region (n=141, 46.5%), and study populations consisted mostly of adult patients (n=276, 91.1%) under chemotherapy treatment (n=124, 40.9%) assessed in an outpatient setting (n=261, 86.1%). The EORTC (European Organisation for Research and Treatment of Cancer; n=77, 25.4%) and PRO-CTCAE (Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events) questionnaires (n=65, 21.5%) were most frequently integrated into ePRO applications. In the univariate analysis, we found that publications increased significantly over time (2003-2023, P<.001). Trends showed a rise in mobile app use (odds ratio [OR] 1.211, P<.001), remote assessments (OR 1.094, P=.002), and feedback provided to patients (OR 1.060, P=.04). Of the 303 studies, 221 unique clinical ePRO applications were identified, merging publications at the application level. The follow-up survey had a 35.3% response rate (78/221), with 61.1% of ePRO applications still in use, lasting a median of 5 years. The most common reason for discontinuation was a lack of funding and resources (42.9%, 12/28).

CONCLUSIONS

The field of ePRO assessment in oncology is rapidly evolving, with a shift toward remote, app-based tools and a growing emphasis on providing feedback to patients. We present, for the first time, data on the sustainability of ePRO use in routine care. While our findings offer valuable insights, they should be interpreted in light of potential response bias in the follow-up survey. Several ePRO applications remain in active use, highlighting potential for long-term integration into clinical practice. However, financial constraints, limited reimbursement models, and challenges with workflow integration continue to hinder broader and more sustainable adoption. Addressing these barriers will be essential to support the continued use of ePROs in clinical care.

Evaluating an electronic patient-reported outcome monitoring system in patients with prostate cancer in routine clinical care: a prospective observational study

PURPOSE

This study evaluated the feasibility, acceptability, and clinical utility of an electronic patient-reported outcome (ePRO) system for patients undergoing radiation therapy (RT) for prostate cancer in routine clinical practice.

METHODS

A prospective observational study was conducted at the Medical University of Innsbruck among patients receiving RT for primary or recurrent prostate cancer. The ePRO system was designed to capture patient-reported symptoms and health-related quality of life throughout treatment and follow-up, aiming to standardize symptom monitoring and improve continuity of care. Patients completed questionnaires at baseline, during treatment, and in follow-up with feasibility defined as ≥ 75% of patients completing at least 75% of scheduled assessments. Patients' acceptability was evaluated at baseline and at treatment end using self-developed questionnaires. Healthcare professionals' (HCPs) perception of clinical utility of the system was measured with a self-developed questionnaire.

RESULTS

Forty patients participated in the study with a median age of 71 years. The ePRO system was feasible, with an average completion rate of 87%, exceeding the feasibility threshold. Patient acceptability was high, with 98% (39/40) expressing willingness to use it regularly. HCPs' feedback was also positive, with all HCPs (100%, 8/8) reporting usefulness of the system in clinical care and 83% reporting that the system helped them in the clinical assessment of their patients.

CONCLUSION

The ePRO monitoring system was feasible and well-accepted among both patients and HCPs, demonstrating potential for continued use in routine clinical care. Further efforts are needed to optimize clinical integration and address barriers to ensure equitable access.

Exploratory analysis of electronic patient-reported outcomes collection: comparing online and in-clinic modalities in cancer care

PURPOSE

Patient reported outcome measures (PROMs) have been shown to improve cancer survival but are generally underutilized in cancer care. It is unclear whether electronic-PROMS (ePROMs) modality (online vs. in-clinic) may address barriers to completion. We examined whether patient sociodemographic and clinical factors differed by completion modality.

METHODS

Patients with cancer who had an oncologic provider visit from January 2021 to March 2023 at a tertiary cancer center were assigned the National Institute of Health's computer adaptive technology Patient-Reported Outcomes Measurement Information System instruments. Patients completed ePROMs either through online patient portal (online) up to 7 days before the visit or used a tablet at the clinic visit (in-clinic) if not completed online. Multivariable logistic regression model estimated associations between patient sociodemographic and clinical factors and completion modality.

RESULTS

A total of 8556 patients completed ePROMs (43.3% completed in-clinic). Females were less likely than males to complete ePROMs in-clinic (aOR = 0.89, 0.84-0.93) as were patients with commercial insurance (aOR = 0.83, 0.77-0.89) vs. Medicare; or saw radiation oncologist (aOR = 0.89, 0.83-0.96) vs. medical oncologist. However, patients were more likely to complete ePROMs in-clinic if they identified as Black race (aOR = 1.41, 1.33-1.49) vs. White; were single (aOR = 1.21, 1.14-1.29) or divorced/separated/widowed (aOR = 1.11, 1.04-1.18) vs. married; or saw a provider located in rural (aOR = 1.33, 1.25-1.42) vs. urban area.

CONCLUSIONS

Patients who were males, Blacks, unmarried, Medicare insured or saw providers located in rural area were more likely to complete ePROMs in-clinic. Given the preference for online completion before visits for real-time symptom monitoring, targeted efforts are needed to boost online PROMs completion.

PLAIN MESSAGE

This is a cross-sectional analysis of the associations between sociodemographic and clinical factors with two electronic patient reported outcome measures completion modalities. The results indicate that about half of patients completed online and half completed in-clinic, with males, Blacks, patients who were divorced/separated/widowed, had Medicare insurance and saw a medical oncologist completing electronic patient reported outcome measures in-clinic. We support offering both options while addressing barriers to either modality.

Improvements in health-related quality of life are maintained long-term in patients prescribed medicinal cannabis in Australia: The QUEST Initiative 12-month follow-up observational study

AIMS

Since 2016, more than one million new patients with chronic health conditions have been prescribed medicinal cannabis in Australia. We aimed to assess overall health-related quality of life (HRQL), pain, fatigue, sleep, anxiety, depression, and motor function in a large real-world sample of patients prescribed medicinal cannabis. We previously found all patient-reported outcomes improved in the first 3-months and hypothesised that improvements would be maintained to 12-months.

METHODS

The QUEST Initiative, a multicentre prospective study, recruited adult patients with any chronic health condition newly prescribed medicinal cannabis oil between November 2020 and December 2021. Participants identified by 114 clinicians across Australia completed validated questionnaires at baseline, then 2-weeks titration, and 1-,2-,3-,5-,7-,9- and 12-months follow-up.

RESULTS

Of 2744 consenting participants who completed baseline assessments, 2353 also completed at least one follow-up questionnaire and were included in analyses, with completion rates declining to 778/2353 (38%) at 12-months. Ages ranged between 18-97 years (mean 50.4y; SD = 15.4), 62.8% were female. Chronic conditions commonly treated included musculoskeletal pain (n = 896/2353; 38.1%), neuropathic pain (n = 547/2353; 23.2%), insomnia (n = 546/2353; 23.2%), anxiety (n = 520/2353; 22.1%), and mixed depressive and anxiety disorder (n = 263/2353; 11.2%). Clinically meaningful improvements were observed in HRQL: EQ-5D-5L index (d = 0.52) and QLQ-C30 summary scores (d = 0.91), PROMIS fatigue (d = 0.51) and sleep disturbance (d = 0.76). Participants diagnosed with chronic pain experienced clinically meaningful improvement in scores on QLQ-C30 pain (d = 0.5), PROMIS pain intensity (d = 0.76), and PROMIS pain interference (d = 0.76). There was significant improvement in DASS anxiety (d = 0.69) and DASS depression (d = 0.65) for those with anxiety or depressive conditions, but no motor function improvements observed for participants with movement disorders. All observed improvements were statistically significant.

CONCLUSIONS

Statistically significant and clinically meaningful improvements in overall HRQL, fatigue, and sleep disturbance were maintained over 12-months in patients prescribed medical cannabis for chronic health conditions. Anxiety, depression, insomnia, and pain also improved over time for those with corresponding health conditions.

STUDY REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12621000063819.

Symptom monitoring with electronic patient-reported outcomes during cancer treatment: final results of the PRO-TECT cluster-randomized trial

Symptoms are often underdetected during cancer treatment. To determine if symptom monitoring with electronic patient-reported outcomes (PROs) improves clinical outcomes, we conducted a cluster-randomized trial in which 52 oncology practices were assigned to PRO or usual care. At PRO practices, patients with metastatic cancer were invited to complete weekly symptom surveys. Severe or worsening symptoms generated alerts to the care team. The primary outcome was overall survival, and secondary outcomes included emergency visits, time to deterioration of physical function, symptoms, health-related quality of life (HRQL) and patient satisfaction with PRO. Among 1,191 enrolled patients, there was no difference in survival (hazard ratio (HR) 0.99 (95% confidence interval (CI), 0.83-1.17); P = 0.86). Time to first emergency visit was significantly prolonged with PRO compared to usual care (HR 0.84 ((95% CI, 0.71-0.98); P = 0.03), with a 6.1% reduction in the cumulative incidence of emergency visits and fewer mean visits at 12 months with PRO (1.02 versus 1.30; P < 0.001). Benefits also significantly favored PRO for delayed deterioration of physical function (median 12.6 versus 8.5 months, HR 0.73; P = 0.002), symptoms (12.7 versus 9.9, HR 0.69; P < 0.001) and HRQL (15.6 versus 12.2, HR 0.72; P = 0.001), which remained significant when considering deaths in analyses. Most patients felt that PRO improved discussions with the care team (77.0% (188/244)), made them feel more in control of their care (84.0% (205/244)) and would recommend it to other patients (91.4% (223/244)). Patients completed 91.5% (20,565/22,486) of expected weekly symptom surveys. These findings demonstrate that symptom monitoring with PRO meaningfully improves clinical outcomes, the patient experience and utilization of services and should be included as a standard part of quality cancer clinical care. Future studies of PRO in clinical care should focus on these outcomes rather than mortality as primary endpoints. ClinicalTrials.gov registration: NCT03249090.

Development and Validation of Integrated Palliative Care Outcome Scale Short Form for Efficient Specialist Palliative Care Screening in Oncology (ScreeningPALL): A Cross-Sectional Study

Background: Widespread implementation of specialist palliative care screening in oncology can be facilitated by efficient screening tools. It has been shown that patient-reported outcome measures are useful as screening tools and might reduce staff effort. Short forms could further improve feasibility. Objective: Development and validation of a short form of the Integrated Palliative Care Outcome Scale (IPOS) for use as a screening tool for specialist palliative care need in patients with incurable cancer. Design: In a cross-sectional study, patients completed the IPOS. In an independent process, the palliative care consultation service assessed specialist palliative care need in each patient through multiprofessional case review (reference standard). Statistical analysis included bootstrapping and binary logistic regression to select suitable items for an IPOS short form and receiver operating characteristics analyses for validation. Setting/Subjects: The analysis included 205 hospital episodes of 194 inpatients and outpatients with incurable cancer (prognosis <2 years) at a German Comprehensive Cancer Center. Results: Possible IPOS short forms of two to eight items showed acceptable or excellent accuracy in predicting specialist palliative care need. A six-item IPOS short form that included the most predictive items of each of the three IPOS dimensions identified specialist palliative care need with 87.5% sensitivity (specificity = 56.4%; area under the curve = 0.786). Conclusions: IPOS short forms can facilitate efficient screening for specialist palliative care need, and the validation results are comparable to the full version of IPOS. Results also indicate which symptoms and problems might be most relevant as red flags in routine data or staff-based screening approaches.

Benefits and Limitations of Real-World Patient-Reported Toxicity Symptom Monitoring for Guidelines and Care, as Perceived by Patients, Clinicians, and Guideline Developers

BACKGROUND

Toxicity monitoring should be modernized to include real-world patient-reported data. However, little is known about how stakeholders view the incorporation of real-world patient-reported toxicity symptoms into guidelines. This gap hinders the development of a sustained learning healthcare environment and limits the incorporation of this data into daily care.

METHODS

This qualitative study, reported according to COREQ, involved interviews with 29 plus 10 chronic myeloid leukemia (CML) patients and 18 CML clinicians, including eight hematologists/guideline developers. The interviews were audio-recorded, transcribed, and independently coded in Atlas.ti. A framework, adapted from systematically sourced literature, was used for coding. Codes were assessed as either beneficial or limiting. An expert panel of all CML guideline developers completed and prioritized the identified knowledge gaps through a RAND-modified Delphi procedure.

RESULTS

Thirty-one benefits and limitations of systematically monitoring patient-reported toxicity symptoms in the real world were identified. Compared to an existing framework, novel benefits centered around the use of aggregated data: Participants viewed real-world patient-reported toxicity symptoms as a way to systematically include patients' toxicity symptoms in the guidelines; personalize guideline advice; and fill knowledge gaps. The expert panel agreed on 14 knowledge gaps in chronic myeloid leukemia care that could be addressed through such data. Novel limitations focused on the suitability, acceptance, and applicability of toxicity symptom monitoring in routine clinical practice. Participants felt that this monitoring does not establish a causal link between medication and symptoms, and it has no added value over open conversation.

CONCLUSIONS

The benefits and limitations of adopting patient-reported real-world toxicity symptom monitoring need to be leveraged and addressed to ensure maximum value and uptake. Guideline developers viewed aggregated data as beneficial. The identified knowledge gaps provide concrete points of action for CML guideline development.

Psychological Intervention for Patients with Biopsychosocial Late Effects Following Surgery for Colorectal Cancer with Peritoneal Metastases-A Feasibility Study

Background: Up to 80% of patients experience late effects (LE) one year after surgery for peritoneal metastases (PM) from colorectal cancer (CRC). We tested the feasibility and outcome of a treatment strategy to address LEs. Methods: During January 2021-May 2023, patients who had undergone surgery for CRC-PM in Denmark were screened for biopsychosocial LEs (anxiety, depression, fear of cancer recurrence, insomnia, cognitive impairment, pain, fatigue). Patients scoring according to clinical cut-offs were referred to a Multi-Disciplinary Team conference (MDT). The patients, surgeon(s), nurse(s), and psychologists participated in the MDT, identified key concerns and proposed a personalized intervention. Pre- and post-intervention, patients completed a "Measure Yourself Concerns and Wellbeing" (MYCaW) questionnaire, rating the two most distressing LEs and general wellbeing on a 7-point Likert scale. Results: Of 28 eligible patients, 13 (59 years (mean), 85% women) accepted referral, participated in the MDT, and were offered a personalized intervention. The intervention was completed by 11 patients. Improvement in MYCaW score was observed 1 month postintervention for all three items: (1) the primary LE (p = 0.003, Hedges's g 1.54), (2) the secondary LE (p < 0.001, Hedges's g 1.65), and (3) general wellbeing (p = 0.005, Hedges's g 1.09). This improvement was sustained 6 months postintervention. The 15 non-participants were, in general, older (66 years (mean), men 73%). Conclusions: Screening for LEs and conducting an MDT can provide a personalized intervention plan, which patients are able to complete and may benefit from.

Development and psychometric evaluation of a patient-reported symptom index for patients with non-muscle invasive bladder cancer: the NMIBC-SI

BACKGROUND AND OBJECTIVE

Non-muscle invasive bladder cancer (NMIBC) is a chronic condition requiring frequent follow-up with endoscopic examinations, tumour resections and intravesical treatments. In this clinical context, patient-reported outcomes (PROs) have enormous potential to inform treatment assessment and recommendations for NMIBC. We aimed to develop and evaluate a patient-reported NMIBC Symptom Index (NMIBC-SI) to facilitate clinical research and enhance care.

METHODS

NMIBC-SI items were developed based on existing literature and qualitative interviews with patients and clinicians, and evaluated in two field tests: item reduction, using NMIBC-SI data from 220 patients on active treatment from nine Australian centres; reliability and validity evaluation of item-reduced version using NMIBC-SI data from 232 patients from five countries.

RESULTS

NMIBC-SI assesses disease and treatment-related symptom burden and two treatment-specific side-effects (cystoscopy, intravesical BCG/Chemotherapy). Composite analysis supported a single composite model including core symptom and cystoscopy index items (Intravesical index items were not tested due to small sample). Test-retest reliability was strong (range 0.894-0.91). As expected, the NMIBC-SI was able to discriminate between no treatment and any treatment groups, and no treatment and chemo/BCG groups, providing evidence towards validity.

CONCLUSIONS AND CLINICAL IMPLICATIONS

NMIBC-SI assesses patients' self-reported symptom burden and can be used to evaluate NMIBC treatments from the perspective of patients. The NMIBC-SI is acceptable to patients and has evidence for reliability and validity. Future validation work with patients with greater symptom burden is warranted.

Survivor-driven development of a PROM for use in routine colorectal cancer care

BACKGROUND AND PURPOSE

Despite the availability of patient reported outcome (PRO) measures (PROMs) for assessing survivorship care needs, their successful implementation remains limited. This study aimed to improve the likelihood of implementation success by actively engaging end-users in developing a PROM designed to address implementation barriers.

PATIENTS AND METHODS

Selected barriers for implementation were: (1) PROMs do not adequately address relevant issues, (2) PROMs can inhibit patient-clinician interaction, and (3) PROMs are not suitable for all patients. Management of these barriers were discussed at two 1-day workshops at Vejle Hospital with in-person attendance by colorectal cancer (CRC) survivors and informal caregivers (ICs). Relevant issues of CRC survivorship care (barrier 1) were defined based on data from four distinct sources. Solutions to overcoming barriers 2 and 3 were discussed at the workshops. Workshop data were guided by the Qualitative Analysis Guide of Leuven (QUAGOL) guide.

RESULTS

The four distinct sources provided data from 4,545 CRC survivors. Thirteen individuals attended the in-person workshops. The following constructs were identified as relevant (barrier 1): self-rated well-being relative to pre-diagnosis, late effects encompassing both psychological and physical aspects, the role of caregivers, identity considerations, support systems, economic impacts, rehabilitation needs, and information provision. Specific element (e.g., keywords, prioritisation and agenda-setting) were incorporated to facilitate patient-clinician interactions (barrier 2). All constructs were considered relevant across all stages of CRC survivorship (barrier 3). The final PROM comprised 34 items.

INTERPRETATION

This dialogue-tool is designed to address implementation barriers by providing direct feedback on relevant late effects and supportive care needs from CRC survivors to clinicians.

The effect of non-pharmacological supportive care interventions on patient-reported outcomes among patients with a brain tumour: A systematic review and meta-analysis

PURPOSE

Brain tumours are associated with significant disease burden with needs fluctuating throughout the disease trajectory. The aim of this systematic review and meta-analysis was to assess the effect of non-pharmacological supportive care interventions on patients with a primary brain tumour by means of patient-reported outcome measures.

METHODS

The following electronic databases were systematically searched: Academic Search Complete, APA PsycInfo, APA PsycArticles, CINAHL Plus, Cochrane, PubMed, and Web of Science. Additional records were located from Google Scholar, reference tracking, and hand searching. Title, abstract, and full-text screenings were completed by two independent reviewers. Data were extracted using a standardised extraction table. Quality appraisal was conducted using the Mixed Method Appraisal Tool. Results were described via narrative synthesis or meta-analyses of standardised scores for randomised controlled trials.

RESULTS

From 1261 records, nine studies were included. Various interventions were utilised including five exercise-based interventions (aerobics, Pilates, yoga, in-patient rehabilitation and out-patient rehabilitation), two cognitive rehabilitation programs, and two psychosocial interventions. Eight of the nine interventions benefitted patients with statistically significant improvement to at least one aspect of their wellbeing. Meta-analyses of randomised controlled trials for all interventions found standardised mean improvements to the outcomes of quality of life (0.34, p-value = 0.037), psychological wellbeing (0.35, p-value = 0.001), cognitive symptoms (0.41, p-value = 0.016), and fatigue (0.31, p-value <0.001).

CONCLUSION

Non-pharmacological supportive care interventions showed positive effects in reducing symptom burden among patients with primary brain tumours. Further research with larger sample sizes is needed to confirm these findings.

Study protocol for putting the 'Person' in the PiCTuRE: an exploratory sequential mixed methods-based design, exploring how precision medicine is implemented and experienced by people living with a primary tumour of the craniospinal axis

INTRODUCTION

Primary tumours of the brain and spine are rare, heterogeneous, and frequently associated with significant morbidity and mortality. Advances in precision oncology and personalised medicine offer the potential to accelerate diagnosis, improve clinical outcomes, and yield critical insights into the molecular biology of these cancers of unmet need. Despite this, patient engagement in this area remains limited. Well-organised neuro-oncological biorepositories-those that are clinically integrated, fully consented, and derived from routine care-are limited and fragmented, which impedes progress. Therefore, it is crucial to examine the barriers to tissue donation and data integration within the NHS by analysing patients' lived experiences. The PiCTuRE (Personalised Consent in Tissue donation for neuroscience Research, lived Experiences) study aims to develop a digital platform that provides customised, individualised, and interactive support to assist patients in their decision-making regarding tissue donation for research and participation in related clinical trials.

METHODS & ANALYSIS

PiCTuRE is a multistage, mixed-methods, exploratory sequential investigation aimed at understanding the lived experiences of individuals donating tissue for research. It consists of three phases: Phase 1 involves an online survey to collect lived experience data, followed by semi-structured interviews to further explore individual perspectives. Thematic analysis will be performed to identify key themes. In Phase 2, patient-reported experience data will be gathered through co-design and statistically analysed to validate content for the development of the digital platform. Phase 3 will refine this intervention through iterative cycles of Phases 1 and 2, in collaboration with patients with lived experience of brain or spine tumours, to prepare it for integration into routine clinical practice.

ETHICS AND DISSEMINATION

Ethical approval has been obtained via the Medical Sciences Interdivisional Research Ethics Committee (MS IDREC), University of Oxford (R79248/RE001). Findings will be disseminated via podium presentations, public patient initiatives in partnership with charities, in peer-reviewed publications and via social media.

TRIAL REGISTRATION NUMBER

ISRCTN12601034.

Survival Endpoints: Patient-Reported Experience Measures and Patient-Reported Outcome Measures as Quality Indicators for Outcomes

Heterogeneity of cancer necessitates individualised cancer care as well as tailored survival endpoints-one size no longer fits all. In the past few years, apart from the standard clinical efficacy endpoints, patient reported outcomes have gathered a momentum as one among the quality indicators in the realm of practice changing oncology. These standardised and validated self-reporting instruments use a patients' viewpoint to assess the status of their health and their experience whilst receiving health care. This review explores the relevance of patient reported measures in the present clinical scenario and issues regarding its implementation amidst the barriers and challenges. These measures should be judiciously accounted as surrogate markers along with survival endpoints; for providing value based, highly comprehensive cancer care. New policy guidelines incorporating patient reported outcomes should be planned and formulated for future practice in oncology.

How to monitor the side effects of treatments in cancer patients

PURPOSE OF REVIEW

Monitoring the side effects of treatments in cancer patients is a key challenge in clinical practice, especially with the development of oral therapies.The impact on patients is multifaceted: morbidity or even life-threatening risks in the case of severe side effects; deterioration in quality of life and functional abilities; lower adherence to treatments; reduced dose intensity, which can affect the efficacy of therapies.

RECENT FINDINGS

The availability of digital tools for remote patient monitoring is transforming our ability to track these patients effectively. These tools enable monitoring of a large number of patients while identifying those experiencing difficulties; early detection of side effects.

SUMMARY

The aim of this article is to provide an overview of the use of digital tools for patient follow-up, their relevance, benefits, and the impact on both patients and healthcare organization.

Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment

Ototoxicity is among the adverse events related to cancer treatment that can have far-reaching consequences and negative impacts on quality-of-life for cancer patients and survivors of all ages. Ototoxicity management (OtoM) comprises the prevention, diagnosis, monitoring, and treatment, including rehabilitation and therapeutic intervention, of individuals who experience hearing loss, tinnitus, or balance/vestibular difficulties following exposures to ototoxic agents, including platinum chemotherapy (cisplatin, carboplatin) and cranial radiation. Despite the well-established physical, socioeconomic, and psychological consequences of hearing and balance dysfunction, there are no widely adopted standards for clinical management of cancer treatment-related ototoxicity. Consensus recommendations and a roadmap are needed to guide development of effective and feasible OtoM programs, direct research efforts, address the needs of caregivers and patients at all stages of cancer care and survivorship. Here we review current evidence and propose near-term to longer-term goals to advance OtoM in five strategic areas: (1) beneficiary awareness, empowerment, and engagement, (2) workforce enhancement, (3) program development, (4) policy, funding, and sustainability, and (5) research and evaluation. The goal is to identify needs and establish a roadmap to guide worldwide adoption of standardized OtoM for cancer treatment and improved outcomes for patients and survivors.

Limited Benefit of Routine Clinical Follow-Up for Relapse Detection in Diffuse Large B-Cell Lymphoma Patients in Complete Remission Following First-Line Treatment

Despite advances in treatment, approximately 15% of patients with diffuse large B-cell lymphoma (DLBCL) who achieve complete remission (CR) after first-line therapy will experience a relapse. However, there is no consensus on the optimal follow-up strategies for detecting relapse after achieving CR. This population-based study, based on the Danish Lymphoma Registry (LYFO), identified a total of 1634 patients diagnosed with DLBCL between 2010 and 2017, including 105 patients who achieved CR following first-line R-CHOP-like therapy and subsequently relapsed. The median follow-up time was 6 years (range 3-8 years). Most cases of relapse were symptomatic (83%), with B symptoms and peripheral lymphadenopathy being the most common. Asymptomatic relapses were identified through physical examination (1%), blood tests (3%), or imaging findings (13%). The proportion of relapses identified outside routine visits was 70%. Only 5% of scheduled routine visits led to a relapse diagnosis, whereas 74% of unscheduled visits initiated by the patient outside routine follow-up resulted in relapse detection. Our findings highlight that systematic, scheduled monitoring of patients in remission after first-line treatment contributes only modestly to the early detection of disease recurrence. Future studies should explore alternative methods of relapse surveillance rather than relying solely on pre-scheduled clinical follow-up.

Digital and nurse-led support intervention in primary care during the first year after curative intent treatment for breast or prostate cancer: study protocol of two cluster randomised controlled pilot trials

INTRODUCTION

The period directly after primary treatment for breast or prostate cancer is a time when patients feel unprepared about how to manage life and address unexpected health challenges. Supportive care should focus on identifying symptoms and concerns and involving survivors in their self-care. Interventions using a blended model encompassing remote and in-person components may inform how supportive care can be organised. This protocol describes two pilot randomised controlled trials with the aim to investigate the acceptability, feasibility and potential effects of a 6 month digital and nurse-led support intervention in primary care for patients with breast or prostate cancer during the first year after primary treatment.

METHODS AND ANALYSIS

Two cluster randomised pilot trials including patients with breast or prostate cancer during the first year after ending primary treatment will run from 2023 in primary care centres in Region Stockholm. The trials will have an estimated sample size of 20 patients in each arm. The intervention groups receive a digital and nurse-led support intervention in combination with standard care, and the control groups receive standard care alone. To assess acceptability and feasibility, the participants in the intervention groups and the study nurses will be interviewed. Furthermore, digitally logged data and field notes by study-specific nurses will be analysed. Data collection for the potential effects of the intervention is conducted through self-reported standardised and validated questionnaires at baseline, and at 3, 6, 12, 18 and 24 months. Data entry and analyses will be blinded to the researchers. Qualitative data will be analysed with content analysis, quantitative data will be evaluated by comparing changes within and between groups.

ETHICS AND DISSEMINATION

This project was reviewed and approved by the Swedish Ethical Review Authority. Study results will be published in peer-reviewed journals and presented at scientific and professional meetings.

TRIAL REGISTRATION NUMBERS

ClinicalTrials.gov, NCT06471452 and NCT05100121.

Evaluating the implementation of PROMs and PREMs in routine clinical care: co-design of tools from the perspective of patients and healthcare professionals

BACKGROUND

Implementation of patient-reported measures (PRMs) is an integral element for patient-centered models; however, there is still hardly any quantitative evidence regarding its impact in routine care settings. The objective of this study was to codesign two concise tools that allow for a standardized and longitudinal assessment of the implementation of PRMs in routine care in terms of acceptability and perceived value from the perspective of both patients and healthcare professionals.

METHODS

A list of constructs and items to be presented, separately, to patients and healthcare professionals was created from evidence gathered through a narrative literature review. Focus groups, composed of either patients or healthcare professionals from different chronic conditions, were conducted for the co-design of independent assessments. Once agreement was reached, the content validity was examined in separate consensus meetings.

RESULTS

A total of 10 patients and 10 healthcare professionals participated in the focus groups. After 7 focus groups, the PRMs Implementation Assessment Tool for patients (PRMIAT-P) was developed with 33 items in 9 constructs, and the tool for healthcare professionals (PRMIAT-HP) had 33 items in 16 constructs. Content validity was confirmed for both tools.

CONCLUSIONS

The perspective of patients and healthcare professionals regarding the implementation of PRMs in routine care can be evaluated quantitively with the PRMIAT tools. These tools are understandable, concise and comprehensive, and can be used in multiple settings and for different chronic conditions. They have been codesigned as a standard set to facilitate both longitudinal assessments and performing benchmarking among different initiatives.

Real-World Patient-Reported Outcome Measure Implementation: Challenges and Successes of a Pan-Canadian Initiative to Improve the Future of Patient-Centered Cancer Care

PURPOSE

Implementation of patient-reported outcome measures (PROMs) in routine care continues to be limited, despite their demonstrated efficacy and substantial investments. We report on the lessons learned and the challenges of the concerted implementation of the same PROMs across teams in nine provinces/territories (jurisdictions) in Canada, as well as the solutions to move implementation forward despite cost containments and the COVID-19 pandemic.

METHODS

Each team from nine jurisdictions submitted a final report describing their PROM implementation project. Reports were analyzed for themes on lessons learned, challenges, and solutions. Themes were compared for similarities and differences. The Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines were used.

RESULTS

Six key lessons learned were identified from eight challenges. To address these challenges, 27 solutions were used. The six lessons learned were as follows: Harness the power of change management, ensure consistent stakeholder engagement at all levels for success, establish buy-in as soon as possible, plan to maintain buy-in through changing circumstances, identify ways to make technology the solution, and optimal implementation includes a sustainability plan. Examples of solutions included the following: develop a multipronged, multilevel communication plan; include change management experts on the team; identify champions; restructure and reprioritize as needed; leverage existing technology; and leave a permanent trace of the project.

CONCLUSION

To our knowledge, this is the first analysis to synthesize lessons learned from real-world PROM implementation across geographically diverse jurisdictions. We identified generalizable solutions that other health care managers and policymakers can use to accelerate PROM implementation, despite pervasive implementation barriers. Future studies can integrate these solutions with methods and tools from implementation science (eg, theoretical frameworks, implementation strategies) for more successful spread and scale of PROMs.

Defining patient-reported outcomes in diabetes, obesity, cardiovascular disease, and chronic kidney disease for clinical practice guidelines - perspectives of the taskforce of the Guideline Workshop

Recent clinical practice guidelines for diabetes, obesity, cardiovascular disease (CVD) and chronic kidney disease (CKD) emphasise a holistic, person-centred approach to care. However, they do not include recommendations for the assessment of patient-reported outcomes (PROs), which would - dependent on the topic of guideline - be important for improving shared decision-making, patients' concordance with guideline recommendations, clinical outcomes and health-related quality of life (HRQoL). The Taskforce of the Guideline Workshop discussed PROs in diabetes, obesity, CVD and CKD as well as the relevance of their inclusion in clinical practice guidelines for the management of these conditions.

Real-world ePRO use and clinical outcomes using electronic patient-reported symptom monitoring for patients with advanced non-small-cell lung cancer receiving first-line pembrolizumab

Aim: This ambispective observational study assessed the impact of Noona, an electronic patient-reported outcomes (ePRO) platform, for patients with non-small cell lung cancer (NSCLC) treated in a community oncology setting. Methods: Adults with advanced NSCLC, ECOG performance status of 0-2, who received first-line (1L) pembrolizumab (monotherapy or with chemotherapy) were eligible. Those initiating pembrolizumab from 1 July 2017 to 30 June 2019, identified retrospectively (historical cohort), were compared with those initiating pembrolizumab from 1 October 2019 to 30 September 2021 who were prospectively offered Noona (standard of care [SoC] cohort). The Kaplan-Meier method and Cox proportional hazards models were used to compare pembrolizumab real-world time on treatment (rwToT; primary outcome measure) and rw time to next treatment or death (rwTTNTD) between historical and SoC cohorts. Healthcare resource use (HCRU) was compared using generalized linear models with Poisson distribution. Analyses were repeated to compare outcomes in the SoC cohort between Noona users (created a profile and used any function ≥one-time during 1L therapy) and nonusers with >42 days on 1L pembrolizumab. Data cutoff was 30 June 2020 and 30 September 2022 for historical and SoC cohorts, respectively. Results: Median pembrolizumab rwToT was 4.4 months (95% CI: 3.9-5.1) in the historical cohort (n = 448) versus 4.1 months (95% CI: 3.3-4.8) in the SoC cohort (n = 462; adjusted hazard ratio [aHR], 0.9; 95% CI: 0.8-1.0; p = 0.14 vs historical cohort). In the SoC cohort, 147 of 341 eligible patients (43%) established a Noona profile; 122/341 (36%) were Noona users. Median rwToT was 6.4 months (95% CI: 5.1-7.4) and 6.9 months (95% CI: 5.6-7.6) among Noona users and Noona nonusers (n = 219), respectively (aHR, 1.1; 95% CI: 0.8-1.4; p = 0.95 vs Noona users). The rwTTNTD and HCRU were comparable in historical versus SoC cohorts and for Noona users versus nonusers. During the first year after establishing a Noona profile, 92 of 147 patients (63%) used the platform; monthly use was 32-42%, and checking laboratory results was the most used function overall (by 52% of the 147). Conclusion: Notwithstanding the null findings of this study, positive results of ePRO use in clinical trials and observational studies support the treatment-related symptom monitoring and survival benefits of ePRO utilization.

Implementation of the e-IPOS in Home Palliative Cancer Care: A Quasiexperimental Pilot Study

INTRODUCTION

Electronic patient-reported outcome measures (e-PROMs) offer advantages in palliative cancer care, including rapid completion, improved data quality and direct storage, improving clinical decision-making. The electronic Integrated Palliative Care Outcome Scale (e-IPOS) in this context enables thorough self-assessment by patients, enhancing symptom management and self-reflection of their current situation.

AIM

To evaluate the feasibility of implementing the e-IPOS in home palliative cancer care.

OUTCOMES

The primary outcomes included the enrollment consent rate, study retention rate, e-IPOS completion rate and response completeness, and the number of clinical assessments and interventions performed during home visits. The secondary outcomes were the number of unscheduled visits and patients' perceived quality of life.

DESIGN

A two-group quasiexperimental clinical pilot study. The control group received standard palliative care, the intervention group received standard care along with weekly e-IPOS completion during home visits. Both groups were enrolled for 4 weeks.

SETTING/PARTICIPANTS

Adults with advanced cancer from the home palliative care unit of the Istituto Nazionale dei Tumori of Milan.

RESULTS

Twenty-three patients were enrolled (74.19%), and 20 completed the study (drop-out: 13.04%). 82.5% of the expected e-IPOS responses were received, of which 96.9% were fully complete. In the intervention group, the Wilcoxon test showed an increase in identified needs and documented interventions (P < .05) and a decrease in unscheduled visits (P < .05).

CONCLUSION

It is feasible to recruit people via home palliative care for an e-IPOS implementation study. Future fully powered studies should investigate the feasibility and assess patients' perceptions of its use to better understand its clinical benefits.

Patient-Reported Outcomes Between Whole-Breast Plus Regional Irradiation and Whole-Breast Irradiation Only in pN1 Breast Cancer After Breast-Conserving Surgery and Taxane-Based Chemotherapy: A Randomized Phase 3 Clinical Trial (KROG 17-01)

PURPOSE

The role of regional node irradiation (RNI) with whole-breast irradiation (WBI) in patients with pN1 breast cancer receiving taxane-based adjuvant chemotherapy is not well defined. The KROG 1701 trial, a phase 3, multicenter, noninferiority study, aimed to compare the disease-free survival between WBI+RNI and WBI alone in this patient cohort. Comprehensive patient-reported outcomes (PROs) collected at multiple timepoints are reported.

METHODS AND MATERIALS

The trial (NCT03269981) enrolled patients with pN1 breast cancer after breast-conserving surgery and taxane-based adjuvant chemotherapy, allocating them to receive either WBI+RNI or WBI only. PROs were assessed using European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaires Core 30and breast cancer-specific module 23 modules at baseline, during radiation therapy, and at subsequent follow-up intervals of 3 to 6 months, and annually up to 4 years.

RESULTS

From April 2017 to December 2021, 840 patients were enrolled; 777 received intervention as assigned, and 750 completed baseline PRO questionnaires (387 in WBI+RNI, 363 in WBI only). All PRO domains showed improvements over time (P < .001). During radiation therapy, the WBI+RNI group reported greater fatigue and nausea. Higher arm symptom scores were observed in the WBI+RNI group 3 months post-treatment (P = .030). No other significant PRO domain differences, including arm/breast symptoms, were observed between the 2 groups.

CONCLUSIONS

In patients with pN1 breast cancer treated with taxane-based chemotherapy, adding RNI to WBI resulted in minor, temporary declines in specific PRO domains, but these differences were not clinically significant. This indicates that overall patient experience between WBI+RNI and WBI is comparable, supporting the safety and patient tolerability of both treatments.

Bridging the digital divide for outpatients treated with anticancer chemotherapy: a retrospective quantitative and qualitative analysis of an adapted electronic Patient Reported Outcome program

PURPOSE

Using electronic patient-reported outcomes (ePRO) in clinical trial has shown benefits for patients. However, the digital divide can lead to unequal access to telehealth. We investigated whether a dedicated support program could bridge that divide.

METHODS

Between February 2021 and June 2022, outpatients undergoing chemotherapy for cancer at our teaching hospital in France were given the Onco'nect® ePRO application if they were affected by the digital divide. They were also offered a dedicated support program that included the lending of a tablet, access to healthcare professionals, training, technical support, and peer-to-peer guidance. We conducted semi-structured interviews to assess the challenges they faced.

RESULTS

We enrolled 22 patients, of whom 10 (45%) made good use of the application and completed > 50% of the questionnaires in the application, while 5 (23%) completed > 75%. However, 12 (55%) of the 22 patients remained poor users of the application over a median participation of 4 months (IQR, 3-7). We also measured social deprivation but found no association with questionnaire completion rate. The under-use of Onco'nect® was due not only to the patients' understanding of its clinical benefit or to their computer skills, but also to poor health literacy and strong emotional responses to using the application.

CONCLUSION

Dedicated support programs help many patients make the most of telehealth. However, most of our patients in the digital divide under-used the ePRO application, primarily due to their poor health literacy.

Patient Voices: Multimethod Study on the Feasibility of Implementing Electronic Patient-Reported Outcome Measures in a Comprehensive Cancer Center

BACKGROUND

"Patient Voices" is a software developed to promote the systematic collection of electronic patient-reported outcome measures (ePROMs) in routine oncology clinical practice.

OBJECTIVE

This study aimed to assess compliance with and feasibility of the Patient Voices ePROM system and analyze patient-related barriers in an Italian comprehensive cancer center.

METHODS

Consecutive patients with cancer attending 3 outpatient clinics and 3 inpatient wards were screened for eligibility (adults, native speakers, and being able to fill in the ePROMs) and enrolled in a quantitative and qualitative multimethod study. Compliance, reasons for not administering the ePROMs, patients' interaction needs, and patient-perceived System Usability Scale (range 0-100) were collected; semistructured interviews were carried out in a subsample of patients.

RESULTS

From June 2020 to September 2021, a total of 435 patients were screened, 421 (96.7%) were eligible, and 309 completed the ePROMs (309/421, 73.4%; 95% CI 69.8%-77.5%; mean age 63.3, SD 13.7 years). Organization problems and patient refusal were the main reasons for not administering the ePROMs (outpatients: 40/234, 17.1% and inpatients: 44/201, 21.9%). Help for tablet use was needed by 27.8% (47/169) of outpatients and 10.7% (15/140) of inpatients, while the support received for item interpretation was similar in the 2 groups (outpatients: 36/169, 21.3% and inpatients: 26/140, 18.6%). Average System Usability Scale scores indicated high usability in both groups (outpatients: mean 86.8, SD 15.8 and inpatients: mean 83.9, SD 18.8). Overall, repeated measurement compliance was 76.9% (173/225; outpatients only). Interviewed patients showed positive attitudes toward ePROMs. However, there are barriers to implementation related to the time and cognitive effort required to complete the questionnaires. There is also skepticism about the usefulness of ePROMs in interactions with health care professionals.

CONCLUSIONS

This study provides useful information for future ePROM implementation strategies, aimed at effectively supporting the routine clinical management and care of patients with cancer. In addition, these findings may be relevant to other organizations willing to systematically collect PROMs or ePROMs in their clinical routines.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03968718; https://clinicaltrials.gov/study/NCT03968718.

First-time use of electronic patient-reported outcome measures in a cluster randomized trial: a qualitative study

BACKGROUND

Although there is clear evidence supporting the beneficial effects of regularly assessing patient-reported outcomes (PROs), the comprehensive integration of patient-reported outcome measures (PROMs) into routine cancer care remains limited. This study aimed to explore the facilitators and barriers encountered by principal investigators (PIs) (oncologists) and study nurses during the implementation of the Eir ePROM within a cluster randomized trial (c-RCT) in cancer outpatient clinics. Additionally, we sought to examine the influence of Eir on the working routines of the participants.

METHODS

Individual semi-structured interviews and a focus group were conducted with nine oncologists and study nurses involved in the implementation of the ePROM tool Eir. Interviews elucidated their experiences of barriers and facilitators when implementing Eir through a cluster randomized trial. Data were analysed according to Framework Analysis, using both an inductive and deductive approach. The Consolidated Framework for Implementation Research (CFIR) was used in the deductive stages of analysis.

RESULTS

Three overarching themes were identified from the data: (1) Willingness to invest; accepting that new eras come with a cost, (2) Management anchoring; changes start at the top, and (3) Creation of a cohesive framework; fostering collective comprehension. We found a notable disparity between oncologists and nurses in their willingness to invest time and effort in implementing the tool. While participants recognized the need to transform patient consultation methods to benefit from digital symptom management, opinions varied on whether the potential benefits justified the associated cost. Furthermore, the degree of management anchoring at various levels significantly impacted the implementation process. At the local level, it was seen as either a facilitator or a barrier, influencing the outcome of the implementation. Additionally, establishing a cohesive framework was crucial, as this fostered a collective understanding among those involved in the implementation.

CONCLUSIONS

Our study underscores the importance of considering the diverse perspectives of health care professionals and fostering interprofessional collaboration for the successful implementation of ePROMs in healthcare settings. Future research should explore strategies to bridge professional disparities and promote a shared understanding of the value provided by ePROMs.

Developing alert thresholds and self-management advice for people receiving immune checkpoint inhibitors: a Multinational Association for Supportive Care in Cancer modified Delphi survey

BACKGROUND

Remote monitoring using electronic patient-reported outcomes (ePROs) may help identify immune-related adverse events (irAEs) and direct self-management. There is no consensus regarding thresholds to alert providers about potentially severe irAEs or when to instigate evidence-based self-management. We aimed to develop consensus around alert thresholds and self-management advice for side-effects suggestive of an irAE which can be deployed as part of remote monitoring systems.

METHODS

A two-round international modified Delphi survey including co-authors of major international irAE guidelines and selected immuno-oncology experts was conducted. Round 1 (R1): participants reviewed alert thresholds graded as per the Common Terminology Criteria for Adverse Events (CTCAE) and self-management statements for 36 side-effects. Participants stated whether they agreed or disagreed with the proposed thresholds and self-management statements. If ≥ 75% of participants agreed, consensus was reached. Prior to Round 2 (R2), thresholds and self-management statements that did not reach consensus in R1 were modified. In R2, participants were asked whether they agreed or disagreed with the modifications.

RESULTS

In R1, 34 participants responded (North America: 18, 52.9%; Europe: 12, 35.3%; Asia-Pacific: 4, 11.8%; median duration of experience in current role, 13.5 years (range, 3-46 years)), with 33 complete responses received. Twenty-nine alert thresholds and 33 self-management statements reached consensus. For R2, seven alert thresholds were increased from CTCAE Grade 1 to 2 based on participant comments, and three self-management statements were amended. Six self-management statements which achieved consensus were amended and re-presented in R2. In R2, 31 participants responded (North America: 18, 58.1%; Europe: 9, 29%; Asia-Pacific: 4, 12.9%; median duration of experience in current role, 13 years (range, 3-40 years)), with 30 complete responses received. All seven alert thresholds and nine self-management statements achieved consensus.

CONCLUSION

This survey developed international consensus regarding alert thresholds and self-management advice for common, clinically relevant side-effects suggestive of an irAE for ePRO monitoring systems with international applicability. Self-management statements will inform written materials for patients.

Patient-reported outcomes in the subpopulation of patients with mismatch repair-deficient/microsatellite instability-high primary advanced or recurrent endometrial cancer treated with dostarlimab plus chemotherapy compared with chemotherapy alone in the ENGOT-EN6-NSGO/GOG3031/RUBY trial

OBJECTIVE

In the ENGOT-EN6-NSGO/GOG3031/RUBY trial, dostarlimab+carboplatin-paclitaxel demonstrated significant improvement in progression free survival and a positive trend in overall survival compared with placebo+carboplatin-paclitaxel, with manageable toxicity, in patients with primary advanced or recurrent endometrial cancer. Here we report on patient-reported outcomes in the mismatch repair-deficient/microsatellite instability-high population, a secondary endpoint in the trial.

METHODS

Patients were randomized 1:1 to dostarlimab+carboplatin-paclitaxel or placebo+carboplatin-paclitaxel every 3 weeks for 6 cycles followed by dostarlimab or placebo monotherapy every 6 weeks for ≤3 years or until disease progression. Patient-reported outcomes, assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Endometrial Cancer Module, were prespecified secondary endpoints. A mixed model for repeated measures analysis, a prespecified exploratory analysis, was conducted to generate least-squares means to compare between-treatment differences while adjusting for correlations across multiple time points within a patient and controlling for the baseline value. Results are provided with 2-sided, nominal p values.

RESULTS

Of 494 patients enrolled, 118 were mismatch repair-deficient/microsatellite instability-high. In this population, mean change from baseline to end of treatment showed visual improvements in global quality of life (QoL), emotional and social function, pain, and back/pelvis pain for dostarlimab+carboplatin-paclitaxel. Meaningful differences (least-squares mean [standard error]) favoring the dostarlimab arm were reported for change from baseline to end of treatment for QoL (14.7 [5.45]; p=0.01), role function (12.7 [5.92]); p=0.03), emotional function (14.3 [4.92]; p<0.01), social function (13.5 [5.43]; p=0.01), and fatigue (-13.3 [5.84]; p=0.03).

CONCLUSIONS

Patients with mismatch repair-deficient/microsatellite instability-high primary advanced or recurrent endometrial cancer receiving dostarlimab+carboplatin-paclitaxel demonstrated improvements in several QoL domains over patients receiving placebo+carboplatin-paclitaxel. The observed improvements in progression free survival and overall survival while improving or maintaining QoL further supports dostarlimab+carboplatin-paclitaxel as a standard of care in this setting.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03981796.

Improving real-world evaluation of patient- and physician-reported tolerability: niraparib for recurrent ovarian cancer (NiQoLe)

BACKGROUND

Maintenance niraparib at an individualized starting dose (ISD) is established in platinum-sensitive recurrent ovarian cancer (PSROC). However, patients' perspectives on the burden of prolonged maintenance therapy have not been reported in prospective trials or routine practice.

METHODS

In the real-life multicenter NiQoLe study, patients with PSROC received ISD maintenance niraparib. The primary objective was to describe physician-reported adverse events (AEs) leading to treatment modification during the first 3 months. Secondary endpoints included patient-reported outcomes (symptomatic AEs using PRO-CTCAE, self-reported fatigue, and impact on daily activities/function using FACT-F) collected remotely weekly using a specifically designed electronic device.

RESULTS

Most (80%) of 139 treated patients (median age = 70 years) began niraparib at 200 mg/day. Median treatment duration was 5.7 (range = 0.2-21.4) months. During the first 3 months, 86 patients (62%) required treatment modification (median = 27 days to modification). Physician-reported grade ≥3 niraparib-related AEs occurred in 34 patients (24%); 68 patients (49%) had treatment modification for AEs, predominantly thrombocytopenia. The most frequent patient-reported AEs (PRO-CTCAE) were fatigue, insomnia, constipation, and dry mouth. Self-reported AEs were severe in 66% of patients. At baseline, 33% of patients reported severe fatigue (FACT-F), which generally persisted during niraparib. Physicians systematically underestimated major patient-reported symptoms.

CONCLUSIONS

In routine practice, niraparib dose modification was often required during the first 3 months despite individualized dosing. Physicians underestimated the burden of fatigue and symptomatic AEs. Digital self-reporting of AEs is feasible, provides patient-centered information complementing physician-reported AEs, and allows fuller appreciation of toxicity in real-world studies.

CLINICAL TRIAL INFORMATION

NCT03752216.

Demographic and clinical impact on preoperative BREAST-Q ePROM completion and baseline outcomes in women undergoing breast cancer surgery: a quantitative descriptive study at a Danish university hospital

OBJECTIVES

This study aimed to investigate patients' use of electronic Patient-Reported Outcome Measures (ePROMs) and understand the demographic and clinical factors that may be correlated with patient responses to the BREAST-Q at the preoperative stage of breast cancer. The BREAST-Q is a PROM in questionnaire format, developed and validated to assess satisfaction and quality of life for breast surgery patients.The hypothesis tested is that considering disparities in geography, age and education among responders is essential for capturing a diverse patient population in future Patent-Reported Outcome Measures initiatives, examining how these characteristics are associated with Patent-Reported Outcome Measures utilisation and outcomes.

DESIGN

Quantitative descriptive study.

SETTING

Electronic Patient-Reported Outcome Measures were collected between 6 September 2021 and 5 September 2022 from patients recruited from an outpatient clinic at a Plastic- and Breast Surgery Department at a University Hospital in Denmark.

PARTICIPANTS

Participants include a total of 629 Danish-speaking women diagnosed with breast cancer and scheduled for breast cancer surgery, with a final participation rate of 468.

INTERVENTION

Preoperative ePROMs and demographic data were collected between September 2020 and 2021 through patients' secure national digital post-box.

MAIN OUTCOME MEASURES

Demographic variables of both responders and non-responders were assessed using t-tests, Mann-Whitney U tests and χ2 tests. Linear regression models were employed to determine the demographic variables associated with BREAST-Q subscale scores.

RESULTS

The response rate for ePROMs was 72.5% with a median age of responders at 62 years. Older patients reported lower breast satisfaction (unadjusted coefficient bu=-0.26 (95% CI -0.44; -0.07), p=0.006) but better physical well-being (adjusted coefficient ba=0.23 (0.08; 0.37), p<0.001). Lower educational achievement was correlated with reduced breast satisfaction and psychosocial and sexual well-being; for example, patients with a master's/doctoral level education scored 14.29 points higher in psychosocial well-being (95% CI 6.50; 22.07, p<0.001) compared with those with lower secondary education. Cohabiting patients reported psychosocial well-being scores approximately four points higher than those living alone (ba=3.91 (0.06; 7.75), p=0.046). Body mass index (BMI) was negatively associated with sexual well-being, with a 0.75-point decline per additional BMI point (ba=-0.75, (-1.12; -0.37), p<0.001).

CONCLUSIONS

The present study demonstrates a positive attitude towards completing BREAST-Q as ePROMs among women diagnosed with breast cancer in the investigated region in Denmark. However, completion rates for ePROMs varied by demographic factors such as age, marital status and access to healthcare. Younger, more educated, married patients with lower BMI who lived near major cities were more likely to report better pretreatment outcomes.

Late-line options for patients with metastatic colorectal cancer: a review and evidence-based algorithm

Over the past few years, several novel systemic treatments have emerged for patients with treatment-refractory metastatic colorectal cancer, thus making selection of the most effective later-line therapy a challenge for medical oncologists. Over the past decade, regorafenib and trifluridine-tipiracil were the only available drugs and often provided limited clinical benefit compared to best supportive care. Results from subsequent practice-changing trials opened several novel therapeutic avenues, both for unselected patients (such as trifluridine-tipiracil plus bevacizumab or fruquintinib) and for subgroups defined by the presence of actionable alterations in their tumours (such as HER2-targeted therapies or KRASG12C inhibitors) or with no acquired mechanisms of resistance to the previously received targeted agents in circulating tumour DNA (such as retreatment with anti-EGFR antibodies). In this Review, we provide a comprehensive overview of advances in the field over the past few years and offer a practical perspective on translation of the most relevant results into the daily management of patients with metastatic colorectal cancer using an evidence-based algorithm. Finally, we discuss some of the most appealing ongoing areas of research and highlight approaches with the potential to further expand the therapeutic armamentarium.

Adherence, clinical benefits, and adverse effects of endocrine therapies among women with nonmetastatic breast cancer in developing countries: A systematic review and meta-analysis

BACKGROUND

Despite significant advances in breast cancer control and survival with endocrine therapies (ETs), treatment utilization and outcomes in developing countries have not been adequately explored. This review evaluated ET adherence, potential benefits, and harms in populations across developing countries.

METHODS

A literature search was conducted through August 2023 in five databases: PubMed, Cochrane Library, Web of Science, Global Health, and WHO Global Index Medicus. Retrieved records were screened to identify observational research presenting at least one outcome in women with nonmetastatic breast cancer in developing countries who received ET (tamoxifen or aromatase inhibitors). A random effects model was used to compute the rates of adherence, discontinuation, adverse events (AEs), disease progression, and death.

RESULTS

A total of 104 studies met the inclusion criteria. Risk of bias was low in most studies, and a large portion of the patients involved Asians. The overall heterogeneity between studies was partially attributed to variations in study design or outcome measurement method. Results showed a pooled adherence rate of 75% (95% confidence interval [CI], 67%-81%) and a discontinuation rate of 16% (95% CI, 10%-25%). Treatment side effects and young age consistently emerged as significant predictors of nonadherence. A wide range of AEs was identified in our analysis. The estimated average rates of cancer recurrence and mortality at 5-years were 16% and 8%, respectively.

CONCLUSIONS

The findings of this study underscore suboptimal ET use in developing countries and provide comprehensive insights into treatment experiences in the real-world setting. Targeted strategies are warranted to enhance adherence and subsequently optimize treatment benefits.

The Usefulness of the ASSUSTENT Application and ASSIST Brochure in Cancer Patients Using Sunitinib

Purpose of ResearchThe ASSUSTENT application and the ASSIST brochure have been developed to support medication intake and symptom monitoring. This study aimed to evaluate patient experiences and the factors that are a barrier to or facilitate the use of these tools. Additionally, the effect of their use on Health-Related Quality of Life (HRQoL) and satisfaction with information about medication was also assessed.MethodsAn exploratory study with a mixed method design was performed. Patients starting or already using sunitinib were asked to use the application or the brochure for 6 months. They completed questionnaires about their experiences with the intervention, that is, the Satisfaction with Information about Medication scale (SIMS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) at baseline (T0), three months (T1), and 6 months (T2) following inclusion. Patients were also asked to participate in a semi-structured interview at T2. The main study endpoint was the feasibility of the use of the application and the brochure.ResultsOf the 22 (65%) patients who signed the informed consent, 19 (86%) completed T0, 15 (68%) T1, and 12 (54%) T2. Twelve agreed to be interviewed. Both the application and brochure were considered user friendly and useful to manage symptoms and prepare for consultations. Patients were generally satisfied with the information about medication. The mean global HRQoL increased from 69 (T0) to 84 (T2).ConclusionAs supplements to usual care, both the application and the brochure met the needs of cancer patients using sunitinib. Their use led to an increased self-efficacy in managing symptoms. The availability of the brochure adds to patient-centered care and equal access to care, and increases self-efficacy.

The Use of Patient-Reported Outcomes in Clinical Practice: A National Survey of Hand Surgeons

Purpose

Patient-reported outcome measures (PROMs) use in practice could be limited secondary to logistical constraints and lack of consensus regarding PROMs' clinical value. Therefore, the goals of this study are to determine (1) the use of PROMs by practicing hand surgeons, (2) which questionnaires are most used and the purpose for collection, and (3) the barriers to use.

Methods

A survey of American Society for Surgeons of the Hand members was conducted in May 2023. Demographic data of respondents, PROMs collected, and implementation and barriers to use were assessed. Associations between variables were determined by Fischer exact tests and logistic regression.

Results

A total of 419 surveys were completed from the 4,523 individuals contacted, representing a 9.3% response rate. Eighty-one percent (81%) were US/Canadian respondents, and 19% reported as other nationalities, with other nationalities reporting use of PROMs at a higher rate than US/Canadian respondents. Odds of PROM use were higher for academic, hybrid, and hospital employed respondents relative to those in private practice settings. The 247 (58%) respondents who did not use PROMs cited barriers including logistic or administrative concerns, uncertainty on application in practice, having no interest, and cost concerns. The most frequently used upper-extremity questionnaire among the 172 (42%) respondents using PROMs was the QuickDASH (Disabilities of the Arm, Shoulder, and Hand), which was used by 112 respondents (65.1%). Patient-reported outcome measures were collected for research/database purposes by 130 (76%) and monitoring routine clinical care by 103 (60%). Among those using PROMs for clinical care, 79 (77%) of respondents use PROMs for postoperative recovery monitoring and 52 (55%) for counseling regarding surgical expectations.

Conclusions

Patient-reported outcome measure use varies by practice setting, with most respondents not collecting PROMs. There remains large variability in the application of PROMs, and further research is needed to determine and demonstrate the value of PROMs in hand surgery for routine clinical care.

Type of study/level of evidence

Prognostic IIc.

Professional-patient discrepancies in assessing lung cancer radiotherapy symptoms: An international multicentre study

BACKGROUND AND PURPOSE

We investigate discrepancies in the assessment of treatment-related symptoms in lung cancer between healthcare professionals and patients, and factors contributing to these discrepancies.

MATERIALS AND METHODS

Data from 515 participants in the REQUITE study were analysed. Five symptoms (cough, dyspnoea, bronchopulmonary haemorrhage, chest wall pain, dysphagia) were evaluated both before and after radiotherapy. Agreement between healthcare professionals and people with lung cancer was quantified using Gwet's-AC2 coefficient. The influence of clinical variables, comorbidities, and quality-of-life outcomes on agreement was examined through stratified analyses.

RESULTS

We found varying levels of agreement between healthcare professionals and people with lung cancer. Bronchopulmonary haemorrhage and dysphagia exhibited very good agreement (meanAC2 > 0.81), while cough and chest wall pain showed substantial agreement (meanAC2 = 0.64 and 0.76, respectively). Dyspnoea had the lowest agreement (meanAC2 = 0.59), with prior chemotherapy significantly reducing agreement levels. Chronic obstructive pulmonary disease (COPD) and early cancer stages also contributed to discrepancies in dyspnoea assessments. Regarding quality-of-life, the most relevant factor was fatigue, which reduced agreement in the assessment of dyspnoea (AC2 = 0.55 vs 0.70), dysphagia (AC2 = 0.48 vs 0.69), cough (AC2 = 0.58 vs 0.82), and chest wall pain (AC2 = 0.77 vs 0.91).

CONCLUSIONS

Our findings indicate strong alignment between healthcare professionals' and people with lung cancer evaluations of observable treatment-related symptoms, but less consistency for subjective symptoms such as dyspnoea. Factors such as prior chemotherapy, COPD, and cancer stage should be considered when interpreting symptom assessments. Furthermore, our study underscores the importance of integrating quality-of-life considerations, particularly fatigue, into symptom evaluations to mitigate potential biases in symptom perception.

Proactive Symptom Monitoring by Pharmacists Using a Cancer Patient Support App in Out-patient Oral Multi-kinase Inhibitor Therapy: Feasibility Study of a Small Patient Population

BACKGROUND/AIM

Measures to control adverse events (AEs) in the use of oral multi-kinase inhibitors (OMI) are important for the continuation of treatment.

PATIENTS AND METHODS

In this study, oncology pharmacists monitored symptoms of patients receiving outpatient therapy with OMIs in real-time using a smartphone Web app for the early detection/early treatment of AEs. This feasibility study evaluated the effects of using the app in 10 patients compared with data from 10 patients who did not use the app.

RESULTS

In the app group, grade 3 AEs were reported in all patients on the day of their occurrence. In contrast, in the no-app group, it took 1-22 days for pharmacists to detect these AEs, among whom 2 patients needed emergency consultations and admissions due to grade 3 AEs. In the app group, 1 patient had an emergency consultation, without admission. The percentage of patients requiring 10 minutes or more for symptom checking during the interview before the physician's examination was significantly lower (p=0.001), and the frequency of telephone calls was also significantly lower (p=0.029) in the app group compared to the no app group.

CONCLUSION

Using the Web app facilitates the early detection of AEs, contributing to reducing the need for emergency consultations and admissions, and minimizing the time pharmacists spend confirming symptoms with patients.