Patient-Reported Outcomes and New Technologies

Chicago, IL—Patient-reported outcomes (PROs) have not been around for long, but they have been involved in nearly every aspect of oncology. Monitoring PROs has the potential to improve clinical benefit, more accurately capture toxicity, and provide better cost data. In addition, new technologies can facilitate the collection of PROs and other patient-generated data, said Heather S. Jim, PhD, Associate Member, Moffitt Cancer Center, Tampa, FL, at the 2017 ASCO annual meeting practice management sessions.

“Monitoring and intervening early in PROs can help patients stay on treatment for longer. PROs can also be used to accurately define toxicity of new regimens and to model the cost of care for toxicity, which is an important part of the value equation,” said Dr Jim.

Symptom Management

Despite their wide influence, PROs may be most effective in disease symptomatology, given physicians’ tendency to underestimate symptom severity. Data from a comparison of PROs versus provider ratings of symptom severity in nearly 2000 patient–provider dyads showed that patients reported a far greater prevalence of moderate-to-severe symptoms than their providers.

“This speaks to the fact that provider and patient ratings are complementary to one another. The providers have the medical expertise to put symptomatology in context to explain its likely causes, whereas the patients are really the experts in their own day-to-day experience,” said Dr Jim.

Recent data also suggest that monitoring and treating PROs can improve clinical benefits, reported Dr Jim. A study of 766 patients who started chemotherapy were randomized to clinic-based symptom monitoring or standard care. Patients who received clinic-based symptom monitoring had significantly less decline in quality of life in a 6-month period compared with standard care; patients in the intervention group also demonstrated improved 1-year survival, longer time receiving treatment, and fewer visits to the emergency department, which is a proxy for grade 3 or 4 adverse events.

“These studies demonstrate how important it is for the provider to be actively involved in providing symptom management. It’s not enough just to trigger an alert. There needs to be an active intervention in terms of symptom management,” said Dr Jim.

PROs can also be used to enhance provider understanding of the toxicities of newer regimens, she said.

“Accurate estimates of toxicity using both provider and patient ratings can offer more accurate evaluations of value, but they can also help prescribers in the community identify and manage toxicity early,” said Dr Jim.

In addition, PROs can be used to better estimate the cost of care, said Dr Jim. A study from the Moffitt Cancer Center of patients receiving immune checkpoint inhibitors used billing data to estimate the frequency of different symptomatic toxicities. The researchers then used a publicly available database to estimate the cost of treating those toxicities, and found that the cost of managing toxicities related to immune checkpoint inhibitors added 6% to the cost of treatment with ipilimumab (Yervoy), 17.6% to the cost of nivolumab (Opdivo) therapy, and 16% to the cost of pembrolizumab (Keytruda) therapy.

New Technologies

The utilization of PROs has been facilitated by advancements in technology, because monitoring parameters can be easily adapted for computer, tablet, or smartphone. Overall, 67% of patients aged ≥65 years currently use the Internet, 51% own a smartphone, and 32% own a tablet, reported Dr Jim.

“The gap is rapidly closing in terms of patients who have access to this type of technology. Increasingly, sophisticated accelerometers can now pair with Bluetooth devices, heart rate monitors, scales and blood pressure monitors, and can transmit data wirelessly without action by the patient at home,” she observed.

“We’ve come a long way in a relatively short period of time, but this is just the beginning,” she concluded.

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