A multi-state study conducted at over 50 community cancer clinics has revealed that people with advanced cancer who track their symptoms weekly using an electronic survey had about a one-third better physical function and over a 15 percent better control of their symptoms compared to those who were evaluated less frequently via in-person clinical visits. The Patient Reported Outcomes To Enhance Cancer Treatment (PRO-TECT) trial was led by researchers at the University of North Carolina Lineberger Comprehensive Cancer Center. The findings of the study were published online in the Journal of the American Medical Association on Sunday and simultaneously presented at the 2022 American Society of Clinical Oncology annual meeting in Chicago.
According to the researchers, an estimated 50 percent of cancer-related symptoms go undetected and unreported. The scientists claim that the electronic systems that facilitate patient-reported outcome (PRO) surveys may identify symptoms early and prompt clinicians to intervene before the symptoms become more complicated.
During the trial, 1,191 participants were enrolled and nearly half of them were randomly assigned to complete a weekly internet-based or automated telephone system survey that included questions about common symptoms, performance status, and falls. Meanwhile, the other half were assigned to a usual delivery of care group, which often meant waiting until their next regularly scheduled clinic visit to report any symptoms.
During the trial the scientists found that the most common symptoms reported on the electronic survey were fatigue, nausea, insomnia, appetite loss, diarrhea, pain, difficulty breathing and constipation. Moreover, alerts were sent to nurses if a patient’s reported symptoms were severe or worsening.
“We had very high engagement with patients and their care teams in this study, with patients completing more than ninety percent of their symptom surveys, and nurses frequently reaching out to patients when severe or worsening symptoms were electronically reported. This likely reflects how accustomed many patients and providers have become to telehealth and electronic communications,” UNC Lineberger’s Ethan Basch, MD, MSc, the paper’s lead author.
The researchers also found that while the improvements were robust after three months of telehealth reporting, the improvements dissipated after one year. According to Basch, some of the fall off could be attributed to patients having resolved any needs they had but also possibly due to the decreased number of study participants after a year due to the limited life expectancies of people with advanced cancers.
“PRO-TECT is a way to bring patients together with their care team and aids in identifying those who are at greatest risk. And because we had equal success at all 52 practices in 25 states, it shows that there’s a wide acceptance for this kind of intervention,” Basch said.
The researchers are planning to determine the best models for widespread implementation and how to make the intervention more efficient for practices.