Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial

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

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Abstract

Purpose There is growing interest to enhance symptom monitoring during routine cancer care using patientreported 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.

Original languageEnglish (US)
Pages (from-to)557-565
Number of pages9
JournalJournal of Clinical Oncology
Volume34
Issue number6
DOIs
StatePublished - Feb 20 2016

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Physiologic Monitoring
Randomized Controlled Trials
Neoplasms
Postal Service
Quality of Life
Health
Hospital Emergency Service
Nurses
Drug Therapy
Tablets
Hospitalization
Outpatients
Physicians

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Basch, E., Deal, A. M., Kris, M. G., Scher, H. I., Hudis, C. A., Sabbatini, P., ... Schrag, D. (2016). Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. Journal of Clinical Oncology, 34(6), 557-565. DOI: 10.1200/JCO.2015.63.0830

Symptom monitoring with patient-reported outcomes during routine cancer treatment : A randomized controlled trial. / 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.

In: Journal of Clinical Oncology, Vol. 34, No. 6, 20.02.2016, p. 557-565.

Research output: Contribution to journalArticle

Basch, E, Deal, AM, Kris, MG, Scher, HI, Hudis, CA, Sabbatini, P, Rogak, L, Bennett, AV, Dueck, AC, Atkinson, TM, Chou, JF, Dulko, D, Sit, L, Barz, A, Novotny, P, Fruscione, M, Sloan, JA & Schrag, D 2016, 'Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial' Journal of Clinical Oncology, vol 34, no. 6, pp. 557-565. DOI: 10.1200/JCO.2015.63.0830

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 / Symptom monitoring with patient-reported outcomes during routine cancer treatment : A randomized controlled trial.

In: Journal of Clinical Oncology, Vol. 34, No. 6, 20.02.2016, p. 557-565.

Research output: Contribution to journalArticle

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abstract = "Purpose There is growing interest to enhance symptom monitoring during routine cancer care using patientreported 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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AU - Deal,Allison M.

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AU - Scher,Howard I.

AU - Hudis,Clifford A.

AU - Sabbatini,Paul

AU - Rogak,Lauren

AU - Bennett,Antonia V.

AU - Dueck,Amylou C.

AU - Atkinson,Thomas M.

AU - Chou,Joanne F.

AU - Dulko,Dorothy

AU - Sit,Laura

AU - Barz,Allison

AU - Novotny,Paul

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N2 - Purpose There is growing interest to enhance symptom monitoring during routine cancer care using patientreported 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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