Home-based monitoring improves quality of life
In a study led by UNC Lineberger's Dr. Ethan Basch, cancer patients reporting symptoms electronically had fewer emergency visits.
People with metastatic cancer who regularly report their symptoms via a home-based electronic monitoring system experienced improved quality of life, according to UNC Lineberger Comprehensive Cancer Center researchers and their colleagues.
In the study, both groups had similar overall survival rates, but those patients using home-based monitoring had better clinical outcomes and well-being and fewer emergency department visits than those who didn鈥檛 file reports.
The results from the national multicenter study appeared Feb. 7 in鈥�.
鈥淒octors and nurses are often unaware of symptoms and side effects that can worsen for cancer patients between office visits, leading to complications and unnecessary suffering,鈥� said lead author. He is the Richard M. Goldberg Distinguished Professor of Medicine and chief of medical oncology at UNC School of Medicine and director of the鈥�痑t UNC Lineberger. 鈥淭he patient-reported outcomes, or PRO, system was developed to enable patients to report their own symptoms and side effects. Our study showed that PRO keeps care teams informed so that they can intervene promptly to help patients.鈥�
The Patient Reported Outcomes To Enhance Cancer Treatment randomized clinical trial was conducted in 52 community oncology practices in 26 states to assess the real-world impact of electronic PRO symptom monitoring on clinical outcomes compared to usual care.
Although there was no overall survival difference between people who used PRO and those who did not, which was the study鈥檚 primary outcome, there were numerous quality-of-life benefits:
- A 6.1% reduction in emergency visits for patients who used PRO compared to those who had usual care. There also was a 16% longer time before a first emergency visit with PRO compared to usual care.
- People in the PRO arm experienced a significant delay in deterioration of physical function, a 31% delay in symptoms and a 28% improvement in health-related quality-of-life factors compared to those who did not use PRO.
- Most patients felt that PRO improved discussions with their care team, made them feel more in control of their care and would recommend it to other patients.
鈥淓lectronic medical recordkeeping has been a bane for some physicians and patients who find it frustrating to navigate patient portal systems 鈥� mitigating those frustrations was a central consideration in configuring the PRO system in this study,鈥� Basch said. 鈥淧RO largely circumvents physicians and is managed by nurses and/or patient navigators, whose jobs often encompass symptom management and care coordination. The PRO systems have also proven very easy for patients to use, in terms of technical ability.鈥�
The trial was designed to be generalizable across all cancer types and treatments. The study results, based on the diversity of the dozens of types of cancers represented in the patient population, confirmed this generalizability.
Although these are the final results from the PRO-TECT study, the investigators are planning sub-study analyses based on interviews with patients, nurses and doctors. There will also be various methodological evaluations of the PRO technology and an evaluation of results based on various patient characteristics such as cancer type, race and geography.
鈥淲hile there have been some studies evaluating the benefits of PRO for patients with earlier stage cancers who get chemotherapy, radiation or surgeries for their cancer, there is less conclusive evidence of benefit for PRO in nonmetastatic disease. We certainly hope researchers will take an interest in establishing more studies to provide evidence of that benefit,鈥� Basch said.
A complete listing of authors, funding sources and disclosures is available in the .
