Sunday, June 4, 2017
Updated results of a clinical trial that launched in 2007 were presented today by Ethan Basch, MD, of Memorial Sloan Kettering Cancer Center (MSK) and UNC Lineberger Comprehensive Cancer Center, at the annual meeting of the American Society of Clinical Oncology. Data showed that systematic symptom monitoring during outpatient chemotherapy using web-based patient-reported outcomes (PROs) improved overall survival.
“Although symptom management is a cornerstone of high-quality cancer care, prior research has shown that doctors miss up to half of patients’ symptoms during cancer treatment,” explained Dr. Basch. “PROs empower patients to actively report their symptoms and allow doctors and nurses to intervene early when necessary, ultimately improving the quality of life for patients. With these new data, we can now confirm the overall survival benefit as well.”
The randomized controlled trial compared web-based symptom monitoring with PROs versus the usual care in 766 MSK patients who received chemotherapy for metastatic cancers. After an average follow-up of seven years, the median overall survival of the PRO intervention arm was five months longer than the control arm (31.2 versus 26 months, respectively). These results are being further explored in a national implementation trial. Data from this trial were also published today in JAMA.
“Many of the drugs we’ve seen approved recently show similar or lower benefits for overall survival,” explained Dr. Basch. “This is a cost-effective way to improve outcomes and streamline symptom monitoring. Once patients have the tools to become more involved in their symptom management, we have found that they are more informed, conscientious, and mindful of their treatment. The next step is to efficiently implement this system on a greater scale to extend these benefits to more patients.”
In the study, a web-based PRO system allowed patients to easily report 12 common symptoms. Patients were asked to complete an online report a minimum of once a week and to rate their symptoms on a scale of one to four. Automatic email alerts were sent to nurses for severe or worsening symptoms, and symptom printouts were shared with the treating physician at appointments. This approach was previously shown to facilitate better treatment of symptoms, keep patients out of the ER, and enable them to remain on chemotherapy treatment for longer periods of time. The system provided an opportunity for patients to actively participate in their care, allowing for greater communication with the care team.
Specifically, the study showed that health-related quality of life improved more for participants in the intervention group than the usual care (34 percent versus 18 percent) and worsened among fewer (38 percent versus 53 percent). Patients who self-reported symptoms were less frequently admitted to the ER (34 percent versus 41 percent) or hospitalized (45 percent versus 49 percent), and they remained on chemotherapy longer (mean 8.2 versus 6.3 months).
Dr. Basch and colleagues at MSK have been pioneering the use of PROs to improve clinical care and drug development since 2005. The research team developed one of the first web-based systems that patients could access either at home or from computers at kiosks in waiting rooms to communicate symptoms directly to clinicians.