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

doi:10.1200/JCO.2015.63.0830

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

Research output: Contribution to journal › Article › peer-review

813 Scopus citations

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 language	English (US)
Pages (from-to)	557-565
Number of pages	9
Journal	Journal of Clinical Oncology
Volume	34
Issue number	6
DOIs	https://doi.org/10.1200/JCO.2015.63.0830
State	Published - Feb 20 2016

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., 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. (2016). Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. Journal of Clinical Oncology, 34(6), 557-565. https://doi.org/10.1200/JCO.2015.63.0830

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. https://doi.org/10.1200/JCO.2015.63.0830

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

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.",

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

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T1 - Symptom monitoring with patient-reported outcomes during routine cancer treatment

T2 - A randomized controlled trial

AU - Basch, Ethan

AU - Deal, Allison M.

AU - Kris, Mark G.

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

AU - Fruscione, Michael

AU - Sloan, Jeff A.

AU - Schrag, Deborah

PY - 2016/2/20

Y1 - 2016/2/20

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.

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

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