ATIENT REPORTED OUTCOMES IN THE DAILY PRACTICE IN CLINICAL ONCOLOGY: A SYSTEMATIC REVIEW

A rapid state-of the-art review of client-reported outcomes measures used to assess dogs' clinical signs and quality of life during chemotherapy

BACKGROUND

Quality of life is an essential component of decision-making in veterinary oncology. Poor management of adverse events during chemotherapy can impair dogs' quality of life and be life-threatening. Consequently, client-reported outcome measures (CROMs) are being proposed to help assess both clinical signs and quality of life. The purpose of this rapid review was to: (1) identify existing CROMs that have been used to assess dogs' clinical signs and quality of life during chemotherapy; and (2) evaluate their methodological development to inform adaptation or development of a CROM for use in routine clinical practice, including remote monitoring. Databases (Scopus, Web of Science, PUBMED/MEDLINE) were searched for CROMs (questionnaires) completed by a non-expert family member about their companion dog. CROM content (domains measured) and scale quality were appraised.

RESULTS

Ten CROMs were identified and three were variations of the same tool. Content of the CROMs varied considerably (range 3-17 domains) with gastrointestinal being the most frequently measured clinical sign cluster (9/10 studies), followed by mobility/ambulatory activity (7/10) and global quality of life (6/10). No CROMs adhered to quality standards for the development of questionnaires and most failed to include qualitative design methods and basic psychometric assessment to ensure reliability and validity (such as internal consistency, test-retest reliability or factor analysis).

CONCLUSION

The validity and reliability of existing chemotherapy CROMs for dogs remains under-tested. Although CROMs combined with remote digital monitoring have the potential to enhance patient care, as has been demonstrated with physician-based oncology, there is a need to apply quality standards to ensure optimal validation. Interdisciplinary collaborations would likely improve CROM quality and clinical utility thereby allowing veterinary healthcare professionals to better support their patients.

Impact of Additional Active Treatment for Prostate Cancer on Health-related Quality of Life of Men: Results from the EUPROMS 2.0 1-year Follow-up Survey

Background and objective

In 2019 and 2021, Europa Uomo initiated the Europa Uomo Patient Reported Outcome Study (EUPROMS) and the EUPROMS 2.0 survey, with the goal of collecting data on patients' self-reported perspective on physical and mental well-being outside of a clinical trial setting, to be able to investigate the burden of prostate cancer (PCa) treatment from a patient-to-patient perspective. Acknowledging the importance of collecting quality of life (QoL) follow-up data, a 1-yr follow-up (1yrFU) study was conducted to assess the effect of additional PCa treatment on QoL.

Methods

Men with PCa who participated in the EUPROMS 2.0 survey and indicated that they were open to collection of a follow-up measurement were reinvited to complete the 1yrFU survey. The EUPROMS 2.0 1yrFU survey included the validated European Quality of Life 5 Dimension 5 Level (EQ-5D-5L), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30), Expanded Prostate Cancer Index Composite Short Form (EPIC-26), and International Index of Erectile Function (IIEF)-15 overall satisfaction domains. Descriptive statistics were used to assess demographic characteristics and to analyze the patient-reported outcome data.

Key findings and limitations

A total of 1006 (54%) men completed the survey. The median age at the time of questionnaire completion was 72 yr (interquartile range 66-76 yr). Of them, 641 men (64%) underwent no new treatment, while 365 men (36%) underwent new treatment, including 247 (247/365, 68%) for PCa. In total, 114 patients (46%) underwent new androgen deprivation therapy (ADT) and 81 (33%) new external beam radiotherapy (EBRT). It is indicated that the impact of new ADT and EBRT on sexual function is immediate and detrimental, and continues to last over time. However, for men who underwent EBRT or radical prostatectomy earlier and did not undergo new treatment, slight improvements on various domains are reported.

Conclusions and clinical implications

The EUPROMS 2.0 1yrFU study provides additional information on treatments that are already in common use and will help future PCa patients to make informed and shared decisions on PCa treatment.

Patient summary

The follow-up data on quality of life collected by Europa Uomo can be used to inform future prostate cancer (PCa) patients about the impact of undergoing (multiple) PCa treatment(s).

[ePROs in the routine care of a major oncology center: Results and experiences]

BACKGROUND

To what extent and under what conditions electronically captured patient-reported outcomes (ePROs) can be used in routine medical care and contribute to improved patient care is a widely discussed question. In the field of oncology, few studies in Germany have focused this topic that go beyond the scope of time-limited studies.

METHOD

First, we present the centrally coordinated collection of ePROs in the routine care of a comprehensive cancer center of the German Cancer Aid in its development, and then describe its qualitative dimension. Subsequently, the intervention is discussed using the Consolidated Framework of Implementation Research.

RESULTS

Since the implementation started in 2019, over 2,000 patients from the interdisciplinary outpatient clinic of the oncology center have been surveyed. The number of respondents varied between 19 and 65 per month. Over the five years of the reporting period, numerous adjustments have been made regarding content and usage purposes as well as technical and personnel structures. The consistent purpose of use was screening for supportive needs, initially related to psycho-oncology, later expanded to include sports therapy, smoking cessation programs, social and nutritional counseling. The instruments used varied accordingly; health-related quality of life and psychological stress were consistently surveyed.

DISCUSSION

Successful use of ePROs in oncological routine care requires personnel and technical resources as well as a high degree of adaptability. In our case, the complexity of a centrally coordinated ePRO collection within an interdisciplinary cancer center is of particular importance. Path dependencies arising from initial decisions, such as the survey software, need to be considered during implementation. Reservations about the intervention and the importance of opinion leaders for successful deployment have been observed. External conditions such as the certification system of oncology centers in Germany proved to be another relevant factor.

CONCLUSION

Overall, the analysis examines a segment of the ongoing digitization process of the hospital system directed towards needs-based, individualized patient care.

Understanding factors impacting patient-reported outcome measures integration in routine clinical practice: an umbrella review

PURPOSE

Patient-report outcome measures (PROMs) have gained widespread support as a mechanism to improve healthcare quality. We aimed to map out key enablers and barriers influencing PROMs implementation strategies in routine clinical practice.

METHODS

An umbrella review was conducted to identify reviews exploring enablers and barriers related to the integration of PROMs in routine clinical practice from January 2000 to June 2023. Information on key enablers and barriers was extracted and summarised thematically according to the Theoretical Domains Framework.

RESULTS

34 reviews met our criteria for inclusion. Identified reviews highlighted barriers such as limited PROMs awareness among clinicians and patients, perceived low value by clinicians and patients, PROMs that were too complex or difficult for patients to complete, poor usability of PROMs systems, delayed feedback of PROMs data, clinician concerns related to use of PROMs as a performance management tool, patient concerns regarding privacy and security, and resource constraints. Enablers encompassed phased implementation, professional training, stakeholder engagement prior to implementation, clear strategies and goals, 'change champions' to support PROMs implementation, systems to respond to issues raised by PROMs, and integration into patient pathways. No consensus favoured paper or electronic PROMs, yet offering both options to mitigate digital literacy bias and integrating PROMs into electronic health records emerged as important facilitators.

CONCLUSIONS

The sustainable implementation of PROMs is a complex process that requires multicomponent organisational strategies covering training and guidance, necessary time and resources, roles and responsibilities, and consultation with patients and clinicians.

Baseline functioning scales of EORTC QLQ-C30 predict overall survival in patients with gastrointestinal cancer: a meta-analysis

PURPOSE

A consensus has not been reached on the value of quality of life (QoL) as a prognostic factor for survival in gastrointestinal cancer. This meta-analysis aimed to investigate the association between functioning scales of the EORTC QoL Questionnaire Core 30 (QLQ-C30) and the overall survival (OS) in patients with gastrointestinal cancer.

METHODS

A systematic literature search was conducted in PubMed, Web of Science, and Embase databases, until February 7, 2023. The studies included were those that investigated the association between baseline QoL measured by the functioning scales of EORTC QLQ-C30 and OS in patients with gastrointestinal cancer. The prognostic capacity of QoL was calculated by pooling the adjusted hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

Twenty-four studies' analyses reported by 22 eligible articles involving 11,609 patients were included. When compared with good parameters of QoL, poor global QoL (HR 1.81; 95% CI 1.53-2.13), physical functioning (HR 1.51; 95% CI 1.31-1.74), social functioning (HR 1.67; 95% CI 1.30-2.15), and role functioning scale (HR 1.42; 95% CI 1.20-1.29) were significantly associated with decreased OS. For each 10-point increase in QLQ-C30 parameters, the pooled HR of OS was 0.87 (95% CI 0.83-0.92) for global QoL, 0.87 (95% CI 0.83-0.92) for physical functioning, and 0.93 (95% CI 0.88-0.97) for role functioning. However, each 10-point increase in social, emotional, or cognitive functioning scale did not significantly predict OS.

CONCLUSIONS

Baseline health-related QoL defined by the physical functioning or global QoL scale of EORTC QLQ-C30 significantly predicts OS in patients with gastrointestinal cancer.

Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study

BACKGROUND

Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging.

OBJECTIVE

This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes.

METHODS

This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System-Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility.

RESULTS

The portal adoption rate was 72% (103/143), and the portal use rate was 76.7% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67% (69/103). The combined completion rate of the ESASr and DT&PL was 78.4% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33% (26/79) initiated messaging, 73% (58/79) received messages, and 85% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age (β=-.45), ESASr engagement (β=.5), symptom interference (β=.4), and received knowledge (β=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (β=-.31), ESASr engagement (β=.37), symptom interference (β=.60), self-care self-efficacy (β=.37), and received knowledge (β=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up.

CONCLUSIONS

This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted.

Effects of Patient-Reported Outcome Tracking and Health Information Provision via Remote Patient Monitoring Software on Patient Outcomes in Oncology Care: A Systematic Review and Meta-Analysis

OBJECTIVES

The authors sought to 1) review the literature on the remote care model that uses remote patient monitoring software (RPMS) as key mechanisms in oncology care for symptom tracking and health information provision and (2) compare the remote care model to standard care in terms of health-related quality of life, symptom burden, health management self-efficacy, anxiety, and depression.

DATA SOURCES

The search was conducted on March 23, 2022, in the Cochrane Library, MEDLINE/PubMed, PsycINFO, and CINAHL databases.

RESULTS

The primary strategies for applying digital technology in remote care models are patient-reported outcomes (PRO) tracking and health information delivery. Common PRO measurements applied in the RPMS include quality of life, symptom burden, self-efficacy, anxiety, and depression. Nine randomized controlled trials testing seven RPMS interventions were examined. Compared to standard care, remote patient monitoring via RPMS was related to greater quality of life and lower physical symptom burden during cancer therapy. The RPMS incorporated into routine clinical care with nurses providing remote monitoring performed better on PRO than that not integrated.

CONCLUSION

The RPMS-based remote care model improves patient outcomes during cancer treatment, and it is not inferior to standard care until the RPMS function is more integrated with existing clinical care.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are well-positioned to engage patients in self-care skills via RPMS and can play a vital role in integrating such a model of remote patient care into routine care practices.