The DOI matches its Crossref record; 31 of the 32 references it cites were found in a registry or an index.
Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer: A Randomized Clinical Trial
Open accessAbstract
Importance: Electronic systems that facilitate patient-reported outcome (PRO) surveys for patients with cancer may detect symptoms early and prompt clinicians to intervene. Objective: To evaluate whether electronic symptom monitoring during cancer treatment confers benefits on quality-of-life outcomes. Design, Setting, and Participants: Report of secondary outcomes from the PRO-TECT (Alliance AFT-39) cluster randomized trial in 52 US community oncology practices randomized to electronic symptom monitoring with PRO surveys or usual care. Between October 2017 and March 2020, 1191 adults being treated for metastatic cancer were enrolled, with last follow-up on May 17, 2021. Interventions: In the PRO group, participants (n = 593) were asked to complete weekly surveys via an internet-based or automated telephone system for up to 1 year. Severe or worsening symptoms triggered care team alerts. The control group (n = 598) received usual care. Main Outcomes and Measures: The 3 prespecified secondary outcomes were physical function, symptom control, and health-related quality of life (HRQOL) at 3 months, measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30; range, 0-100 points; minimum clinically important difference [MCID], 2-7 for physical function; no MCID defined for symptom control or HRQOL). Results on the primary outcome, overall survival, are not yet available. Results: Among 52 practices, 1191 patients were included (mean age, 62.2 years; 694 [58.3%] women); 1066 (89.5%) completed 3-month follow-up. Compared with usual care, mean changes on the QLQ-C30 from baseline to 3 months were significantly improved in the PRO group for physical function (PRO, from 74.27 to 75.81 points; control, from 73.54 to 72.61 points; mean difference, 2.47 [95% CI, 0.41-4.53]; P = .02), symptom control (PRO, from 77.67 to 80.03 points; control, from 76.75 to 76.55 points; mean difference, 2.56 [95% CI, 0.95-4.17]; P = .002), and HRQOL (PRO, from 78.11 to 80.03 points; control, from 77.00 to 76.50 points; mean difference, 2.43 [95% CI, 0.90-3.96]; P = .002). Patients in the PRO group had significantly greater odds of experiencing clinically meaningful benefits vs usual care for physical function (7.7% more with improvements of ≥5 points and 6.1% fewer with worsening of ≥5 points; odds ratio [OR], 1.35 [95% CI, 1.08-1.70]; P = .009), symptom control (8.6% and 7.5%, respectively; OR, 1.50 [95% CI, 1.15-1.95]; P = .003), and HRQOL (8.5% and 4.9%, respectively; OR, 1.41 [95% CI, 1.10-1.81]; P = .006). Conclusions and Relevance: In this report of secondary outcomes from a randomized clinical trial of adults receiving cancer treatment, use of weekly electronic PRO surveys to monitor symptoms, compared with usual care, resulted in statistically significant improvements in physical function, symptom control, and HRQOL at 3 months, with mean improvements of approximately 2.5 points on a 0- to 100-point scale. These findings should be interpreted provisionally pending results of the primary outcome of overall survival. Trial Registration: ClinicalTrials.gov Identifier: NCT03249090.
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“A large cluster randomized trial reported encouraging rates of 91.5% adherence to patients' weekly ePRO reporting during RPM in the metastatic setting.13”
From Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium (2024) · cites this paper as [13]
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“However, several randomized clinical trials with similar interventions have proven that RPM significantly improves symptom burden in comparison with routine care.7,13,14”
From Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium (2024) · cites this paper as [13]
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“the PRO-TECT trial demonstrated improved patient-reported outcomes across metastatic cancer types using electronic monitoring [5]”
From Implementing UK Oncology Nursing Society–Informed Digital Symptom Triage With Episode-Based Review in Routine NHS Acute Oncology: Service Evaluation (2026) · cites this paper as [5]
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Interpreting the significance of changes in health-related quality-of-life scores.
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Basch, E., Deal, A. M., Kris, M. G., Scher, H. I., Hudis, C. A., Sabbatini, P., Rogak, L., Bennett, A. V., Dueck, A. C., Atkinson, T. M., et al. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2015.63.0830 · Cited by 2,593
Self-citationBasch, E., Deal, A. M., Dueck, A. C., Scher, H. I., Kris, M. G., Hudis, C., & Schrag, D. (2017) · JAMA · doi:10.1001/jama.2017.7156 · Cited by 2,302
Self-citationDueck, A. C., Mendoza, T. R., Mitchell, S. A., Reeve, B. B., Castro, K. M., Rogak, L. J., Atkinson, T. M., Bennett, A. V., Denicoff, A. M., O'Mara, A. M., et al. (2015) · JAMA Oncology · doi:10.1001/jamaoncol.2015.2639 · Cited by 1,030
Self-citationKotronoulas, G., Kearney, N., Maguire, R., Harrow, A., Domenico, D. D., Croy, S., & MacGillivray, S. A. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2013.53.5948 · Cited by 953
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Self-citationQuality of life research within the EORTC—the EORTC QLQ-C30
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Research works printed but not linked: 2
- Stover, 2019, Demographic and symptom differences in PRO-TECT trial (AFT-39) cancer patients electing to complete weekly home patient-reported outcome measures (PROMs) via an automated phone call vs. email: implications for implementing PROs into routine care., Qual Life Res, 28, S1
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The Lancet Breast Cancer Commission
Coles, C. E., Earl, H. M., Anderson, B. O., Barrios, C. H., Bienz, M., Bliss, J. M., Cameron, D., Cardoso, F., Cui, W., Francis, P. A., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)00747-5 · Cited by 209
Patient-Reported Outcome Measures in Cancer Care
Balitsky, A. K., Rayner, D. G., Britto, J., Lionel, A. C., Ginsberg, L., Cho, W., Wilfred, A. M., Sardar, H., Cantor, N., Mian, H. S., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.24793 · Cited by 134
Basch, E., Schrag, D., Jansen, J., Henson, S. R., Ginos, B., Stover, A. M., Carr, P. M., Spears, P. A., Jönsson, M., Deal, A. M., et al. (2025) · Nature Medicine · doi:10.1038/s41591-025-03507-y · Cited by 94
Self-citationPatient-Reported Outcomes, Digital Health, and the Quest to Improve Health Equity
Pritchett, J. C., Patt, D., Thanarajasingam, G., Schuster, A., & Snyder, C. (2023) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk_390678 · Cited by 65
Self-citationBasch, E., Rocque, G., Mody, G., Mullangi, S., & Patt, D. (2023) · JCO Clinical Cancer Informatics · doi:10.1200/cci.22.00187 · Cited by 58
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Metadata
- Authors
- Basch, E., Schrag, D., Henson, S., Jansen, J., Ginos, B., Stover, A. M., Carr, P., Spears, P. A., Jonsson, M., Deal, A. M., Bennett, A. V., Thanarajasingam, G., Rogak, L. J., Reeve, B. B., Snyder, C., Bruner, D., Cella, D., Kottschade, L. A., Perlmutter, J., Geoghegan, C., Samuel-Ryals, C. A., Given, B., Mazza, G. L., Miller, R., Strasser, J. F., Zylla, D. M., Weiss, A., Blinder, V. S., & Dueck, A. C.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Memorial Sloan Kettering Cancer Center (US)
- Mayo Clinic in Arizona (US)
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- Mayo Clinic (US)
- Duke University (US)
- Johns Hopkins University (US)
- Emory University (US)
- Northwestern University (US)
- Gemini Group, Ann Arbor, Michigan
- Patient and Partners, Madison, Connecticut
- Michigan State University (US)
- American Society of Clinical Oncology (US)
- Christiana Care Health System (US)
- Park Nicollet Health Services (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Basch, Ethan
- ORCID
- Basch, Ethan
- Schrag, Deborah
- Jansen, Jennifer
- Stover, Angela M.
- Spears, Patricia A.
- Deal, Allison M.
- Bennett, Antonia V.
- Thanarajasingam, Gita
- Rogak, Lauren J.
- Reeve, Bryce B.
- Snyder, Claire
- Bruner, Deborah
- Cella, David
- Kottschade, Lisa A.
- Perlmutter, Jane
- Geoghegan, Cindy
- Given, Barbara
- Mazza, Gina L.
- Miller, Robert
- Zylla, Dylan M.
- Weiss, Anna
- Blinder, Victoria S.
- Dueck, Amylou C.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2022-06-28
- Volume
- 327
- Issue
- 24
- Pages
- 2413
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC9168923
- OpenAlex
- W4281790169
- Cited by
- 413
- References
- 32
- Citations by year
- 2026: 117 · 2025: 112 · 2024: 102 · 2023: 71 · 2022: 11
- FWCI
- 30.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- Patient-Centered Outcomes Research Institute
- National Cancer Institute (P30CA008748, P30CA016086, P30CA014236)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- electronic symptom monitoring, patient-reported outcomes, metastatic cancer, health-related quality of life, physical function, symptom management, EORTC QLQ-C30, internet-based survey, community oncology practice, early symptom detection, cancer treatment side effects
- MeSH terms
- Patient Reported Outcome Measures, Adult, Electronics, Female, Health Status Indicators, Humans, Male, Middle Aged, Neoplasm Metastasis, Neoplasms, Quality of Life, Surveys and Questionnaires, Neoplasms, Second Primary, Telemedicine, Monitoring, Ambulatory, Internet
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