Clinical utility and user perceptions of a digital system for electronic patient-reported symptom monitoring during routine cancer care: findings from the PRO-TECT trial
Open accessAbstract
PURPOSE: There is increasing interest in implementing digital systems for remote monitoring of patients’ symptoms during routine oncology practice. Information is limited about the clinical utility and user perceptions of these systems. METHODS: PRO-TECT is a multicenter trial evaluating implementation of electronic patient-reported outcomes (ePROs) among adults with advanced and metastatic cancers receiving treatment at US community oncology practices (ClinicalTrials.gov identifier: NCT03249090 ). Questions derived from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) are administered weekly by web or automated telephone system, with alerts to nurses for severe or worsening symptoms. To elicit user feedback, surveys were administered to participating patients and clinicians. RESULTS: Among 496 patients across 26 practices, the majority found the system and questions easy to understand (95%), easy to use (93%), and relevant to their care (91%). Most patients reported that PRO information was used by their clinicians for care (70%), improved discussions with clinicians (73%), made them feel more in control of their own care (77%), and would recommend the system to other patients (89%). Scores for most patient feedback questions were significantly positively correlated with weekly PRO completion rates in both univariate and multivariable analyses. Among 57 nurses, most reported that PRO information was helpful for clinical documentation (79%), increased efficiency of patient discussions (84%), and was useful for patient care (75%). Among 39 oncologists, most found PRO information useful (91%), with 65% using PROs to guide patient discussions sometimes or often and 65% using PROs to make treatment decisions sometimes or often. CONCLUSION: These findings support the clinical utility and value of implementing digital systems for monitoring PROs, including the PRO-CTCAE, in routine cancer care.
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Previous studies have demonstrated that when given an option, elderly patients, patients from lower socioeconomic backgrounds, and from black ethnicities tend to choose web-based or automated telephone interfaces for ePRO reporting compared to a mobile app interface.
“Indeed, previous studies have demonstrated that when given an option, elderly patients, patients from lower socioeconomic backgrounds, and from black ethnicities tend to choose web-based or automated telephone interfaces for ePRO reporting compared to a mobile app interface.23,36,37”
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 [23]
The Discussion (page unavailable) reports that almost 40% chose automated telephone rather than web reporting, particularly older patients and those with lower educational levels. It does not establish a preference among Black patients or patients from lower socioeconomic backgrounds. The Digital ePRO System and Questions section describes web and telephone options, not a separate mobile-app interface for comparison. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBasch et al [46] leveraged patient-reported outcomes to enhance communication between patients and clinicians, transforming symptom monitoring into a navigation mechanism for timely intervention and treatment adjustment.
“For example, Basch et al [46] leveraged patient-reported outcomes to enhance communication between patients and clinicians, transforming symptom monitoring into a navigation mechanism for timely intervention and treatment adjustment.”
From User-Centered Design for Digital Patient-Navigation Tools in Oncology: Scoping Review (2026) · cites this paper as [46]
The Digital ePRO System and Questions section (page unavailable) describes alerts to nurses for severe or worsening symptoms, symptom-management pathways, and reports used to guide discussions and care. The paper also reports that patients perceived improved discussions with clinicians. It does not establish that the system led to timely interventions or treatment adjustments; it says clinicians were not required to take particular actions in response to the reports or alerts. (LLM, conf=0.85)
Experimental — accuracy not yet measuredDigital tools could add to clinician workload when alerts were excessive, outputs were not actionable, or responsibilities for responding were unclear.
“Several studies showed that digital tools could add to clinician workload when alerts were excessive, outputs were not actionable, or responsibilities for responding were unclear [23,45,50,55].”
From Digital health technologies in oncology services: A scoping review of clinical implementation, organisational evidence gaps, and policy implications (2026) · cites this paper as [23]
The Discussion (page unavailable) says frequent alerts added to nurses’ existing workload, and 47% of nurses felt there were too many. The paper does not link added workload to unactionable outputs; it generally describes the information as useful. Its Digital ePRO System and Questions section says clinical responses were not prescribed, but does not establish that responsibility for responding was unclear. (LLM, conf=0.86)
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“For example, Basch et al [46] leveraged patient-reported outcomes to enhance communication between patients and clinicians, transforming symptom monitoring into a navigation mechanism for timely intervention and treatment adjustment.”
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- Authors
- Basch, E., Stover, A. M., Schrag, D., Chung, A., Jansen, J., Henson, S., Carr, P., Ginos, B., Deal, A., Spears, P. A., Jonsson, M., Bennett, A. V., Mody, G., Thanarajasingam, G., Rogak, L. J., Reeve, B. B., Snyder, C., Kottschade, L. A., Charlot, M., Weiss, A., Bruner, D., & Dueck, A. C.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Harvard University (US)
- Mayo Clinic (US)
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Memorial Sloan Kettering Cancer Center (US)
- Duke University (US)
- Johns Hopkins University (US)
- Brigham and Women's Hospital (US)
- Emory University (US)
- ORCID
- Venue
- JCO Clinical Cancer Informatics
- Published
- 2020-11
- Volume
- 4
- Issue
- 4
- Pages
- 947-957
- ISSN
- 2473-4276 (ISSN-L)
- PMC
- PMC7768331
- OpenAlex
- W3095896260
- Cited by
- 194
- References
- 26
- Citations by year
- 2026: 18 · 2025: 38 · 2024: 39 · 2023: 46 · 2022: 37 · 2021: 16
- FWCI
- 8.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JCO Clinical Cancer Informatics (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- American Association for Cancer Research
- Bristol-Myers Squibb
- AstraZeneca
- GlaxoSmithKline
- Patient-Centered Outcomes Research Institute (IHS‐1511‐33392)
- Array BioPharma
- National Institutes of Health (KL2TR002379)
- Genentech
- Centers for Medicare and Medicaid Services
- Gillings School of Public Health
- National Cancer Institute (CA016086, UG1CA233373, P30CA008748, P30CA016086)
- National Center for Research Resources (M01RR000585)
- National Center for Advancing Translational Sciences
- 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 patient-reported outcomes, remote symptom monitoring, PRO-CTCAE, community oncology practice, clinical implementation, user perception, patient-reported symptoms
- MeSH terms
- Patient Reported Outcome Measures, Adult, Electronics, Humans, Medical Oncology, Neoplasms, Perception
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