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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“Although prior ePRO work is promising [29, 32], major knowledge gaps persist regarding the optimal implementation of ePROs in routine oncologic care.”
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Background
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Advancing anticancer drug development: Overcoming challenges and exploring new therapeutic strategies
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Acute and Late Adverse Events Associated With Radical Radiation Therapy Prostate Cancer Treatment: A Systematic Review of Clinician and Patient Toxicity Reporting in Randomized Controlled Trials
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Reflections on the national patient-reported outcome measures (PROMs) programme: Where do we go from here?
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Atkinson, T. M., Stover, A. M., Storfer, D. F., Saracino, R. M., D’Agostino, T. A., Pergolizzi, D., Matsoukas, K., Li, Y., & Basch, E. (2017) · Epidemiologic Reviews · doi:10.1093/epirev/mxx008 · Cited by 40
Self-citation
The Role of Palliative Care in Oncology
Agarwal, R., & Epstein, A. S. (2017) · Seminars in Interventional Radiology · doi:10.1055/s-0037-1608702 · Cited by 40
From the Child’s Word to Clinical Intervention: Novel, New, and Innovative Approaches to Symptoms in Pediatric Palliative Care
Brock, K. E., Wolfe, J., & Ullrich, C. (2018) · Children · doi:10.3390/children5040045 · Cited by 58
“With regard to clinical outcomes, feedback of PRO to clinicians in the aforementioned study conducted by Basch and colleagues resulted in fewer emergency room visits and hospitalizations [55].”
Result
Early Palliative Care: Pro, but Please Be Precise!
Gärtner, J., Daun, M., Wolf, J., von Bergwelt‐Baildon, M., & Hallek, M. J. (2019) · Oncology Research and Treatment · doi:10.1159/000496184 · Cited by 40
Symptom Assessment in Patients with Advanced Cancer: Are the Most Severe Symptoms the Most Bothersome?
Li, B., Mah, K., Swami, N., Pope, A. J., Hannon, B. L., Lo, C., Rodin, G., Le, L. W., & Zimmermann, C. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0622 · Cited by 39
Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial
Gomis‐Pastor, M., Mirabet, S., Roig, E. S., Loidi, V. B., López, L., Ros, S., Tugas, E. G., Malagarriga, N. M., & Mangues, M. A. (2021) · Healthcare · doi:10.3390/healthcare9040463 · Cited by 39
Measuring Atopic Eczema Control and Itch Intensity in Clinical Practice
Leshem, Y. A., Chalmers, J. R., Apfelbacher, C., Katoh, N., Gerbens, L. A. A., Schmitt, J. M., Spuls, P. I., Thomas, K. S., Howells, L., Williams, H. C., et al. (2022) · JAMA Dermatology · doi:10.1001/jamadermatol.2022.4211 · Cited by 39
PRO-cision Medicine: Personalizing Patient Care Using Patient-Reported Outcomes
Jensen, R. E., & Snyder, C. F. (2015) · Journal of Clinical Oncology · doi:10.1200/jco.2015.64.9491 · Cited by 39
Benefits of Digital Symptom Monitoring With Patient-Reported Outcomes During Adjuvant Cancer Treatment
Basch, E., Leahy, A. B., & Dueck, A. C. (2021) · Journal of Clinical Oncology · doi:10.1200/jco.20.03375 · Cited by 39
Self-citation
Clinical decision support for therapeutic decision-making in cancer: a systematic review
Beauchemin, M., Murray, M. T., Sung, L., Hershman, D. L., Weng, C., & Schnall, R. (2019) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2019.07.019 · Cited by 38
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Lee, Y. C., King, M. T., O’Connell, R. L., Lanceley, A., Joly, F., Hilpert, F., Davis, A. J., Roncolato, F. T., Okamoto, A., Bryce, J., et al. (2022) · International Journal of Gynecological Cancer · doi:10.1136/ijgc-2021-003142 · Cited by 38
“One of the most influential trials reported improvements in HRQL and overall survival using self-ratings of 12 symptoms commonly experienced during chemotherapy, 31 33 including nine of the symptoms assessed by MOST.”
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Meryk, A., Kropshofer, G., Hetzer, B., Riedl, D., Lehmann, J., Rumpold, G., Haid, A., Holzner, B., & Crazzolara, R. (2021) · Pediatric Blood & Cancer · doi:10.1002/pbc.29279 · Cited by 38
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Milella, M., Bassi, C., Boggi, U., Brunetti, O., Cavaliere, A., Crippa, S., Vita, F. D., Falconi, M., Frassineti, G. L., Giommoni, E., et al. (2021) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2021.103571 · Cited by 37
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Nipp, R. D., Horick, N., Qian, C. L., Knight, H. P., Kaslow-Zieve, E. R., Azoba, C. C., Elyze, M., Landay, S. L., Kay, P. S., Ryan, D. P., et al. (2022) · JAMA Oncology · doi:10.1001/jamaoncol.2021.7643 · Cited by 38
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Matthies, L. M., Taran, F., Keilmann, L., Schneeweiß, A., Simoes, E., Hartkopf, A. D., Sokolov, A. N., Walter, C. B., Sickenberger, N., Wallwiener, S., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/10004 · Cited by 37
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Rogers, S. N., Allmark, C., Bekiroglu, F., Edwards, R. T., Fabbroni, G., Flavel, R., Highet, V., Ho, M. W. S., Humphris, G. M., Jones, T. M., et al. (2020) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-020-06533-3 · Cited by 37
Management of Distress in Patients with Cancer—Are We Doing the Right Thing?
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“Recent research using systematic, web-based assessment of patient-reported symptoms, paired with automated alerts to the medical team when symptoms worsened, demonstrated both improved quality of life and increased survival among patients with metastatic cancer [30, 31].”
Method
Patient-Reported Outcomes in Pediatric Cancer Registration Trials: A US Food and Drug Administration Perspective
Murugappan, M. N., King‐Kallimanis, B. L., Reaman, G. H., Bhatnagar, V., Horodniceanu, E. G., Bouchkouj, N., & Kluetz, P. G. (2021) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djab087 · Cited by 37
Are Health Literacy and Patient Activation Related to Health Outcomes in Breast Cancer Patients?
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“Patients with cancer who are enabled to be more involved in monitoring their health have been shown e172 HLRP: Health Literacy Research and Practice • Vol. 5, No. 3, 2021 to have significantly better HRQoL and fewer emergency department (ED) admissions (Basch et al., 2016).”
Background
Discrepancy in the perception of symptoms among patients and healthcare providers after lung cancer surgery
Wei, X., Yu, H., Dai, W., Xu, W., Yu, Q., Pu, Y., Wang, Y., Liao, J. X., Li, Q., & Shi, Q. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06506-0 · Cited by 37
“In addition, PROs can also help enhance communication between patients and their healthcare team, foster sharing of treatment decisions [38], and improve the patients’ overall survival [22] and prognosis [36].”
Background
Using Patient-reported Outcome Measures to Improve Health Care
Browne, J. P., Cano, S., & Smith, S. C. (2017) · Medical Care · doi:10.1097/mlr.0000000000000792 · Cited by 38
Natural language processing for automated classification of qualitative data from interviews of patients with cancer
Fang, C., Markuzon, N., Patel, N., & Rueda, J.-D. (2022) · Value in Health · doi:10.1016/j.jval.2022.06.004 · Cited by 36
Electronic symptom monitoring after lung cancer surgery: establishing a core set of patient-reported outcomes for surgical oncology care in a longitudinal cohort study
Yu, H., Cheng, L., Wei, X., Wang, Y., Xu, W., Tang, L., Dai, W., Liao, J. X., Yang, P., Gong, R., et al. (2024) · International Journal of Surgery · doi:10.1097/js9.0000000000001855 · Cited by 37
“…that digital techniques, such as smartphones, web-based or interactive voice response systems, and patient-reported outcome (PRO)-based symptom management, enhance recovery, improve daily functioning and quality-of-life [4,5] , optimize healthcare utilization [6] , and prolong survival [7 – 9] .”
Background
Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: a cluster preference randomized controlled trial
Rogers, S. N., Lowe, D., Lowies, C., Yeo, S. T., Allmark, C., Mcavery, D., Humphris, G. M., Flavel, R., Semple, C. J., Thomas, S. J., et al. (2018) · BMC Cancer · doi:10.1186/s12885-018-4355-0 · Cited by 36
Supportive Care Needs in Glioma Patients and Their Caregivers in Clinical Practice: Results of a Multicenter Cross-Sectional Study
Renovanz, M., Maurer, D., Lahr, H., Weimann, E., Deininger, M., Wirtz, C. R., Ringel, F. A., Singer, S., & Coburger, J. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00763 · Cited by 35
Quality of life in bladder cancer patients receiving medical oncological treatment; a systematic review of the literature
Taarnhøj, G. A., Johansen, C., & Pappot, H. (2019) · Health and Quality of Life Outcomes · doi:10.1186/s12955-018-1077-6 · Cited by 36
“Despite recent literature highlighting the evident benefit of regular symptom reporting and early handling of side effects by patient-reported outcomes, the implementation of such in daily practice has yet to occur [1 – 3].”
Background
Collection of electronic patient-reported symptoms in patients with advanced cancer using Epic MyChart surveys
Zylla, D. M., Gilmore, G., Steele, G. L., Eklund, J. P., Wood, C. M., Stover, A. M., & Shapiro, A. C. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-05109-0 · Cited by 36
Guideline-Recommended Symptom Management Strategies That Cross Over Two or More Cancer Symptoms
Kwekkeboom, K. L., Wieben, A. M., Stevens, J., Tostrud, L. J., & Montgomery, K. E. (2020) · Oncology nursing forum · doi:10.1188/20.onf.498-511 · Cited by 37
“, 2018) and quality of life (Basch et al., 2016) and potentially extend survival (Basch et al.”
Background
Participatory co-design and normalisation process theory with staff and patients to implement digital ways of working into routine care: the example of electronic patient-reported outcomes in UK renal services
Knowles, S. E., Ercia, A., Caskey, F. J., Rees, M., Farrington, K., & van der Veer, S. N. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06702-y · Cited by 36
“Routine ePRO collection has the potential to improve patient care and outcomes [4, 5], including detection of health problems that would otherwise go unnoticed.”
Background

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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