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Multicenter Study
. 2021 Dec:162:1-8.
doi: 10.1016/j.lungcan.2021.09.020. Epub 2021 Sep 30.

Electronic patient-reported outcomes monitoring during lung cancer chemotherapy: A nested cohort within the PRO-TECT pragmatic trial (AFT-39)

Gita N Mody  1 , Angela M Stover  2 , Mian Wang  2 , Bellinda L King-Kallimanis  3 , Jennifer Jansen  2 , Sydney Henson  2 , Arlene E Chung  2 , Mattias Jonsson  2 , Antonia Bennett  2 , Angela B Smith  2 , William A Wood  2 , Alison Deal  2 , Brenda Ginos  4 , Amylou C Dueck  4 , Deborah Schrag  5 , Ethan Basch  2
Affiliations
Multicenter Study

Electronic patient-reported outcomes monitoring during lung cancer chemotherapy: A nested cohort within the PRO-TECT pragmatic trial (AFT-39)

Gita N Mody et al. Lung Cancer. 2021 Dec.

Abstract

Objectives: Patients with lung cancer have high symptom burden and diminished quality of life. Electronic patient-reported outcome (PRO) platforms deliver repeated longitudinal surveys via web or telephone to patients and alert clinicians about concerning symptoms. This study aims to determine feasibility of electronic PRO monitoring in lung cancer patients receiving treatment in community settings.

Methods: Adults receiving treatment for advanced or metastatic lung cancer at 26 community sites were invited to participate in a prospective trial of weekly electronic PRO symptom monitoring for 12 months (NCT03249090). Surveys assessing patients' satisfaction with the electronic PRO system were administered at 3 months. Descriptive statistics were generated for demographics, survey completion rates, symptom occurrence, and provider PRO alert management approaches. Pairwise relationships between symptom items were evaluated using intra-individual repeated-measures correlation coefficients.

Results: Lung cancer patients (n = 118) participating in electronic PROs were older (mean 64.4 vs 61.9 years, p = 0.03), had worse performance status (p = 0.002), more comorbidities (p = 0.02), and less technology experience than patients with other cancers. Of delivered weekly PRO surveys over 12 months, 91% were completed. Nearly all (97%) patients reported concerning (i.e., severe or worsening) symptoms during participation, with 33% of surveys including concerning symptoms. Pain was the most frequent and longest lasting symptom and was associated with reduced activity level. More than half of alerts to clinicians for concerning symptoms led to intervention. The majority (87%) would recommend using electronic PRO monitoring to other lung cancer patients.

Conclusions: Remote longitudinal weekly monitoring of patients with lung cancer using validated electronic PRO surveys was feasible in a multicenter, community-based pragmatic study. A high symptom burden specific to lung cancer was detected and clinician outreach in response to alerts was frequent, suggesting electronic PROs may be a beneficial strategy for identifying actionable symptoms and allow opportunities to optimize well-being in this population.

Keywords: Lung cancer; Patient-reported outcomes; Quality of life; Symptoms.

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Conflict of interest statement

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
Weekly electronic PRO survey delivery and reminder schedule.
Fig. 2.
Fig. 2.
Electronic PRO survey completion rates by lung cancer patients over 12 months on study.
Fig. 3.
Fig. 3.
Frequency of patients with alerts for concerning symptoms during study period.
Fig. 4.
Fig. 4.
Most common words per patient written in “other symptoms” survey item.
Fig. 5.
Fig. 5.
Lung cancer patient feedback on weekly PRO survey.
See this image and copyright information in PMC

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