Cited by 2,593Cancer survivorship and careMobile Health and mHealth ApplicationsPain Management and Opioid Use

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Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial

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Basch, Ethan, Deal, Allison M., Kris, Mark G., Scher, Howard I., Hudis, Clifford A., Sabbatini, Paul, Rogak, Lauren, Bennett, Antonia V., Dueck, Amylou C., Atkinson, Thomas M., Chou, Joanne F., Dulko, Dorothy, Sit, Laura, Barz, Allison, Novotny, Paul, Fruscione, Michael, Sloan, Jeff A., Schrag, Deborah·2016·Journal of Clinical Oncology

DOI 10.1200/jco.2015.63.0830PMC PMC4872028

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Abstract

Purpose: There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited. Methods: We randomly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians. Those with home computers received weekly e-mail prompts to report between visits. Treating physicians received symptom printouts at visits, and nurses received e-mail alerts when participants reported severe or worsening symptoms. The primary outcome was change in health-related quality of life (HRQL) at 6 months compared with baseline, measured by the EuroQol EQ-5D Index. Secondary endpoints included emergency room (ER) visits, hospitalizations, and survival. Results: Among 766 patients allocated, HRQL improved among more participants in the intervention group than usual care (34% v 18%) and worsened among fewer (38% v 53%; P < .001). Overall, mean HRQL declined by less in the intervention group than usual care (1.4- v 7.1-point drop; P < .001). Patients receiving intervention were less frequently admitted to the ER (34% v 41%; P = .02) or hospitalized (45% v 49%; P = .08) and remained on chemotherapy longer (mean, 8.2 v 6.3 months; P = .002). Although 75% of the intervention group was alive at 1 year, 69% with usual care survived the year (P = .05), with differences also seen in quality-adjusted survival (mean of 8.7 v. 8.0 months; P = .004). Benefits were greater for participants lacking prior computer experience. Most patients receiving intervention (63%) reported severe symptoms during the study. Nurses frequently initiated clinical actions in response to e-mail alerts. Conclusion: Clinical benefits were associated with symptom self-reporting during cancer care.

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Background
Hospitalisations and emergency department visits in cancer patients receiving systemic therapy: Systematic review and meta-analysis
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Patient and clinician opinions of patient reported outcome measures (PROMs) in the management of patients with rare diseases: a qualitative study
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Careful Breakthrough Cancer Pain Treatment through Rapid-Onset Transmucosal Fentanyl Improves the Quality of Life in Cancer Patients: Results from the BEST Multicenter Study
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Incorporating PROMIS Symptom Measures into Primary Care Practice—a Randomized Clinical Trial
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Symptom Care at Home
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Calidad de Vida: a systematic review of quality of life in Latino cancer survivors in the USA
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The European Code of Cancer Practice
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SymptomCare@Home
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Digital Health for Geriatric Oncology
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Living with Metastatic Cancer: A Roadmap for Future Research
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“Relative to usual care, routine eHealth PRO monitoring was associated with less decline in quality of life, fewer emergency room admissions, longer treatment with chemotherapy, and longer survival (median five months survival benefit for metavivors) [142,143].”
Background
Digital Monitoring and Management of Patients With Advanced or Metastatic Non-Small Cell Lung Cancer Treated With Cancer Immunotherapy and Its Impact on Quality of Clinical Care: Interview and Survey Study Among Health Care Professionals and Patients
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Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021)
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How health-related quality of life assessment should be used in advanced colorectal cancer clinical trials
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Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium
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Self-citation
Adherence to Report and Patient Perception of an Interactive App for Managing Symptoms During Radiotherapy for Prostate Cancer: Descriptive Study of Logged and Interview Data
Langius-Eklöf, A., Christiansen, M., Lindström, V., Blomberg, K., Hälleberg Nyman, M., Wengström, Y., & Sundberg, K. (2017) · JMIR Cancer · doi:10.2196/cancer.7599 · Cited by 48
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Patient-reported Outcome Measurements on the Tolerance of Magnetic Resonance Imaging-guided Radiation Therapy
Tetar, S., Bruynzeel, A. M. E., Bakker, R., Jeulink, M., Slotman, B. J., Oei, S. S., Haasbeek, C. J. A., Jong, K. D., Senan, S., & Lagerwaard, F. J. (2018) · Cureus · doi:10.7759/cureus.2236 · Cited by 48
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Leveraging Patient-Reported Outcomes Using Data Visualization
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Establishing a Core Outcome Measure for Life Participation: A Standardized Outcomes in Nephrology-kidney Transplantation Consensus Workshop Report
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Elements of Palliative Care in the Last 6 Months of Life: Frequency, Predictors, and Timing
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Gustavell, T., Sundberg, K. K., & Langius‐Eklöf, A. (2020) · JMIR mhealth and uhealth · doi:10.2196/17855 · Cited by 48
“It has been reported that patients undergoing cancer treatments who report symptoms to health care professionals through mHealth systems and receive support for symptom management have higher quality of life, less symptom distress [15-17], and improved 2-year survival [18] compared with patients not using such systems.”
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Patient-Reported Outcomes in Pediatric Oncology
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Self-citation
Core Components for a Clinically Integrated mHealth App for Asthma Symptom Monitoring
Rudin, R. S., Fanta, C. H., Predmore, Z., Kron, K., Edelen, M. O., Landman, A., Zimlichman, E., & Bates, D. W. (2017) · Applied Clinical Informatics · doi:10.4338/aci-2017-06-ra-0096 · Cited by 49
Health-related quality of life among cancer patients in their last year of life: results from the PROFILES registry
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“Furthermore, monitoring QoL and symptoms increases awareness among health care professionals to better anticipate on patients’ changing needs [27, 28] and improves clinical outcomes (i.”
Background
Addressing the Survivorship Care Needs of Patients Receiving Extended Cancer Treatment
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BackgroundMethodInfluential
Clinical outcomes of digital sensor alerting systems in remote monitoring: a systematic review and meta-analysis
Iqbal, F. M., Lam, K., Joshi, M., Khan, S. N., Ashrafian, H., & Darzi, A. W. (2021) · npj Digital Medicine · doi:10.1038/s41746-020-00378-0 · Cited by 46
“Basch et al.35 clustered groups into computer experienced and computer in-experienced but numbers across various arms were unequal for selected outcome measures.”
Background
Significantly longer time to deterioration of quality of life due to CANKADO PRO-React eHealth support in HR+ HER2− metastatic breast cancer patients receiving palbociclib and endocrine therapy: primary outcome analysis of the multicenter randomized AGO-B WSG PreCycle trial
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“setting, routine PROM collection has the potential to inform and guide patient-centered care and clinical decisions, increase patients' satisfaction with their care, and decrease health care visits.(3,13,14) There are a number of national and regional trauma registries, to which PROMs could provide information from th…”
Background
Implementation and early adaptation of patient-reported outcome measures into an electronic health record: A technical report
Gold, H. T., Karia, R. J., Link, A. P., Lebwohl, R., Zuckerman, J. D., Errico, T. J., Slover, J. D., Buckland, A. J., Mann, D. M., & Cantor, M. N. (2018) · Health Informatics Journal · doi:10.1177/1460458218813710 · Cited by 46
“6 Examples of the effectiveness of capturing and acting on PROMs are found in orthopedics, 5,7–12 cancer care, 13–17 and other clinical areas.”
Background
1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting
Desai, A. V., Klimek, V. M., Chow, K. Y., Epstein, A. S., Bernal, C., Anderson, K., Okpako, M., Rawlins-Duell, R., Kramer, D., Romano, D. R., et al. (2018) · Journal of Oncology Practice · doi:10.1200/jop.18.00346 · Cited by 47
Introducing Computed Tomography Simulation–Free and Electronic Patient-Reported Outcomes–Monitored Palliative Radiation Therapy into Routine Care: Clinical Outcomes and Implementation Experience
Schuler, T., Back, M., Hruby, G., Carroll, S. L., Jayamanne, D. T., Kneebone, A. B., Stevens, M. J., Lamoury, G., Morgia, M., Wong, S., et al. (2020) · Advances in Radiation Oncology · doi:10.1016/j.adro.2020.100632 · Cited by 46
“14 It is also a foundational ingredient of a learning health system 15 that uses research-quality routine care data to generate new evidence, aids safe implementation of new insights, and provides guidance for clinical decisions.”
Effect of coronary artery bypass grafting on quality of life: a meta-analysis of randomized trials
Creber, R. M., Dimagli, A., Spadaccio, C., Myers, A., Moscarelli, M., Demetres, M. R., Little, M., Fremes, S. E., & Gaudino, M. F. L. (2021) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcab075 · Cited by 45
Examining the Effectiveness of Electronic Patient-Reported Outcomes in People With Cancer: Systematic Review and Meta-Analysis
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“%) were included in the meta-analysis exploring the effect of any HRQOL measure closest to 6 months (Figure 2 [24,27,28,31,32,34,35,38]).”
Influential
Pilot randomized trial of an electronic symptom monitoring and reporting intervention for hospitalized adults undergoing hematopoietic stem cell transplantation
Bryant, A. L., Coffman, E. M., Phillips, B., Tan, X. M., Bullard, E., Hirschey, R., Bradley, J., Bennett, A. V., Stover, A. M., Song, L., et al. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-04932-9 · Cited by 45
Self-citation
Systematic review of clinical practice guidelines for colorectal and anal cancer: the extent of recommendations for managing long-term symptoms and functional impairments
Wiltink, L. M., White, K., King, M. T., & Rutherford, C. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05301-7 · Cited by 45
“A number of trials have shown benefit of using patient-reported outcomes for routinely screening during treatment [27, 28]; their potential benefit in long-term follow-up of CRC should be investigated.”
Background
Patient-Reported Outcome Measures as Complementary Information to Clinician-Reported Outcome Measures in Patients With Psoriasis
Barbieri, J. S., & Gelfand, J. M. (2021) · JAMA Dermatology · doi:10.1001/jamadermatol.2021.3341 · Cited by 45
COVID-19 Emergency and the Need to Speed Up the Adoption of Electronic Patient-Reported Outcomes in Cancer Clinical Practice
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“Second, the early, proactive identification of worsening symptoms and toxicities could help prevent the occurrence of severe adverse events needing emergency room (ER) access and hospitalization.(21,22) This is always useful, but particularly in this moment, given the vital importance of reducing hospital contacts.”
Background
Patient-Reported Outcome Measures as an Intervention: A Comprehensive Overview of Systematic Reviews on the Effects of Feedback
Wittich, L., Tsatsaronis, C., Kuklinski, D., Schöner, L., Steinbeck, V., Busse, R., & Rombey, T. (2024) · Value in Health · doi:10.1016/j.jval.2024.05.013 · Cited by 44

Authors: 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., Chou, J. F., Dulko, D., Sit, L., Barz, A., Novotny, P., Fruscione, M., Sloan, J. A., & Schrag, D.
Affiliations: University of North Carolina at Chapel Hill (US)
Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children’s Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic,...
ORCID: Basch, Ethan
Deal, Allison M.
Kris, Mark G.
Scher, Howard I.
Hudis, Clifford A.
Sabbatini, Paul
Rogak, Lauren
Bennett, Antonia V.
Dueck, Amylou C.
Atkinson, Thomas M.
Chou, Joanne F.
Dulko, Dorothy
Sit, Laura
Novotny, Paul
Fruscione, Michael
Sloan, Jeff A.
Schrag, Deborah
Venue: Journal of Clinical Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 2016-02-20
Volume: 34
Issue: 6
Pages: 557-565
ISSN: 0732-183X (ISSN-L)
1527-7755
DOI: 10.1200/jco.2015.63.0830
PMC: PMC4872028
OpenAlex: W2195040438
Cited by: 2,593
References: 36
Citations by year: 2026: 252 · 2025: 263 · 2024: 321 · 2023: 288 · 2022: 316 · 2021: 299 · 2020: 292 · 2019: 191 · 2018: 180 · 2017: 143 · 2016: 44
FWCI: 53.87
Type: journal article
Language: en
Update notices: correction (2019-02-07)
correction (2016-06-20)
Open access: green
www.ncbi.nlm.nih.gov
Locations: Journal of Clinical Oncology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Memorial Sloan-Kettering Cancer Center
Society of Memorial Sloan Kettering
National Cancer Institute (P30CA008748, P30CA015083, P30CA016086)
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords: patient-reported outcomes, symptom monitoring, cancer chemotherapy, health-related quality of life, advanced solid tumors, e-mail alerts, emergency department visits, hospitalization, survival, quality-adjusted survival, computer literacy, outpatient oncology
MeSH terms: Adult, Aged, Aged, 80 and over, Ambulatory Care, Antineoplastic Agents, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Middle Aged, Neoplasms, Quality of Life, Survival Rate, Internet, Nurse's Role, Electronic Mail, Self Report, Symptom Assessment

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Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial

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