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. 2025 May 1;8(5):e259852.
doi: 10.1001/jamanetworkopen.2025.9852.

Remote Symptom Monitoring With Electronic Patient-Reported Outcomes in Clinical Cancer Populations

Gabrielle B Rocque  1   2   3 , Jeffrey A Franks  1 , Luqin Deng  3 , Nicole E Caston  4 , Courtney P Williams  3   5 , Andres Azuero  5   6 , D'Ambra Dent  1 , Bradford E Jackson  4 , Chelsea McGowan  7 , Nicole L Henderson  1   3 , Chao-Hui Sylvia Huang  2 , Stacey Ingram  1 , J Nicholas Odom  5   6 , Noon Eltoum  1 , Bryan Weiner  8 , Doris Howell  9 , Angela M Stover  4   10 , Jennifer Young Pierce  7 , Ethan M Basch  4
Affiliations

Remote Symptom Monitoring With Electronic Patient-Reported Outcomes in Clinical Cancer Populations

Gabrielle B Rocque et al. JAMA Netw Open. .

Abstract

Importance: Value-based health care increasingly requires electronic patient-reported outcome-based remote symptom monitoring (RSM) to improve health care utilization in patients with cancer. However, data on the impact of RSM in clinical practice are lacking.

Objective: To evaluate the association of RSM with 3- and 6-month health care utilization among patients receiving systemic cancer treatment.

Design, setting, and participants: This nonrandomized controlled trial used a hybrid, type 2 implementation-effectiveness design. Participants were patients with cancer at 2 Alabama-based academic institutions receiving chemotherapy, targeted therapy, or immunotherapy; the exposure group received standard-of-care delivered RSM from 2021 to 2024, and historical controls were patients who received cancer treatment prior to RSM implementation from 2017 to 2021. Data were analyzed from May to October 2024.

Exposure: RSM using electronic patient-reported outcomes.

Main outcomes and measures: Health care utilization at 3 and 6 months after RSM enrollment (intensive care unit [ICU] admissions, hospitalizations, emergency department [ED] visits). Adjusted modified Poisson models estimated the relative risk (RR) and 95% CI of health care utilization overall. Penalized logistic regression was used for stratified analyses by patient race, residence, neighborhood deprivation, insurance type, and comorbid conditions.

Results: A total of 5949 patients were assessed. From May 2021 to May 2024, 1392 patients (median [IQR] age at index date, 61 [51-69] years; 933 [67%] female) were enrolled in RSM, including 378 Black patients (27%) and 922 White patients (66%), with 262 patients (19%) living in rural areas and 372 patients (27%) living in areas with high neighborhood disadvantage; RSM patients were compared with 4557 controls (median [IQR] age at index date, 62 [53-69] years; 2654 [58%] female), including 1177 Black patients (26%) and 3151 White patients (69%), with 1012 patients (22%) living in rural areas, and 1281 patients (28%) living in areas with high neighborhood disadvantage. Compared with historical controls, hospitalizations among patients receiving RSM were 19% lower at 3 months (RR, 0.81; 95% CI, 0.73-0.91) and 13% lower at 6 months (RR, 0.87; 95% CI, 0.80-0.96). ICU admissions were not significantly different among the RSM populations compared with controls (3 months: RR, 0.82; 95% CI, 0.59-1.13; 6 months: RR, 0.83; 95% CI, 0.65-1.06). ED visits were similar for both groups (3 months: RR, 1.02; 95% CI, 0.89-1.16; 6 months: RR, 1.03; 95% CI, 0.92-1.15). Subset analyses showed similar patterns in 3- and 6-month RR for hospitalizations, ED visits, and ICU admissions.

Conclusions and relevance: In this nonrandomized controlled trial, RSM implementation was associated with reduced risk of hospitalizations for patients with cancer, supporting the need to expand implementation nationally.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rocque reported receiving grants from Pfizer and Daichi Sankyo, personal fees from Gilead, and being employed by Atlas Oncology Partners outside the submitted work. Dr Eltoum reported receiving grants from Agency for Healthcare Research and Quality during the conduct of the study. Dr Stover reported receiving grants from University of North Carolina at Chapel Hill (subcontract from University of Alabama at Birmingham) during the conduct of the study and grants and personal fees from Pfizer outside the submitted work. Dr Basch reported personal fees from Navigating Cancer, Savor Health, Verily, Thyme Care, and Resilience Health outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Unadjusted Frequency and Adjusted Relative Risk (RR) of Health Care Utilization at 3 and 6 Months
ED indicates emergency department; ICU, intensive care unit; and RSM, remote symptom monitoring.
Figure 2.
Figure 2.. Comparison of Health Care Utilization Among Patients Receiving Remote Symptom Monitoring vs Control Patients by Subset
ADI indicates Area Deprivation Index; ED indicates emergency department; ICU, intensive care unit; and RUCA, Rural-Urban Commuting Area.
See this image and copyright information in PMC

References

    1. Kline RMBM, Brown M, Buescher N, et al. . The Centers for Medicare & Medicaid Services Oncology Care Model halfway through: perspectives from diverse participants. J Natl Cancer Inst. 2019;111(8):764-771. doi:10.1093/jnci/djz072 - DOI - PMC - PubMed
    1. Rocque GB, Pisu M, Jackson BE, et al. ; Patient Care Connect Group . Resource use and Medicare costs during lay navigation for geriatric patients with cancer. JAMA Oncol. 2017;3(6):817-825. doi:10.1001/jamaoncol.2016.6307 - DOI - PMC - PubMed
    1. Waters TM, Kaplan CM, Graetz I, Price MM, Stevens LA, McAneny BL. Patient-centered medical homes in community oncology practices: changes in spending and care quality associated with the COME HOME experience. J Oncol Pract. 2019;15(1):e56-e64. doi:10.1200/JOP.18.00479 - DOI - PubMed
    1. Keating NL, Jhatakia S, Brooks GA, et al. ; Oncology Care Model Evaluation Team . Association of participation in the Oncology Care Model with Medicare payments, utilization, care delivery, and quality outcomes. JAMA. 2021;326(18):1829-1839. doi:10.1001/jama.2021.17642 - DOI - PMC - PubMed
    1. Kline RM, Blau S, Buescher NR, et al. . Secret sauce—how diverse practices succeed in Centers for Medicare & Medicaid Services Oncology Care Model. JCO Oncol Pract. 2021;17(12):734-743. doi:10.1200/OP.21.00165 - DOI - PubMed

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