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Self-Reported Health Data Improves Outcomes in Cancer Study

"Symptom self-reporting engages patients as active participants and may improve the experience, efficiency, and outcomes of care."

By Frank Irving

- A newly published research study conducted at Memorial Sloan Kettering Cancer Center finds clinical benefits associated with patient-generated health data during cancer care. Among patients receiving routine outpatient chemotherapy for advanced solid tumors, those who self-reported symptoms via email on tablet computers had improved quality-of-life scores vs. those whose symptoms were monitored at the discretion of clinicians.

In a newly published clinical study, patients who self-reported symptoms via email had better outcomes than patients who received usual care.

The study was published online Dec. 7 before inclusion in the current print edition of the Journal of Clinical Oncology by corresponding author Ethan Basch, MD, and colleagues.

The researchers conducted a randomized controlled trial at New York’s Memorial Sloan Kettering “to test whether systemic web-based collection of patient-reported symptoms during chemotherapy treatment, with automated alerts to clinicians for severe or worsening symptoms, improves health-related quality of life (HRQL) as well as survival, quality-adjusted survival, emergency room use and hospitalization.” Selected patients had metastatic disease with tumor types that represented a spectrum of symptoms.

Prior to randomization, participants were assigned to subgroups based on computer experience; those in the experienced group had regular access to a computer and used email at least weekly. The study reports prior evidence that patients with computer experience are more receptive to electronic self-reporting than those with less computer experience.

Participants were trained to use Symptom Tracking and Reporting (STAR), a web-based interface “previously established as easy to use” for cancer patients with high-burden symptoms. Those in the experienced subgroup could use STAR to self-report either through wireless touchscreen tablet computers or freestanding kiosks, whereas those in the inexperienced subgroup used STAR only at clinic visits. The experienced patients had remote access to STAR, and received a weekly email reminder encouraging, but not requiring, a between-visit report.

The overall results:

  • The outcomes measure, HRQL, improved among 34 percent of participants in the intervention group vs. 18 percent of those receiving usual care. HRQL worsened in 38 percent of those in the intervention group vs. 53 percent receiving usual care.
  • Mean HRQL declined by less in the intervention group than usual care.
  • Patients in the intervention group were less frequently admitted to the ER or hospitalized and remained on chemotherapy longer than those who received usual care.
  • STAR triggered email alerts to nurses whenever a patient-reported symptom worsened by predetermined levels. Nurses frequently initiated clinical actions in response to email alerts.

The researchers did not perform a cost-utility analysis, but reported resource use as “relatively modest.”

“In the context of a changing healthcare delivery system where both population management and patient centeredness are prioritized, symptom self-reporting engages patients as active participants and may improve the experience, efficiency, and outcomes of care,” the researchers concluded. “Given the favorable outcomes we have demonstrated with a simple prototype, further work to refine optimal strategies for engaging both patients and clinicians in harnessing technology to improve care should be a priority.”

An accompanying commentary in the same journal edition emphasized the potential of patient-reported outcome assessment to improve the “precision and patient-centeredness of cancer care — making sure the right care is delivered to the right patients at the right time.”