Proactive Symptom Self-Reporting Extends Survival in Patients with Metastatic Cancer
Chicago, IL—The use of an online tool to self-report symptoms during treatment for metastatic cancer extended survival by 5 months compared with usual care according to a study presented at ASCO 2017. In addition, online self-reporting of symptoms improved quality of life (QOL) and reduced emergency department visits and hospitalizations versus usual care.
“If a drug had a survival advantage of this magnitude, it would be priced at $100,000, and we would ask, ‘How do we get this into our practice?’” stated Harold J. Burstein, MD, PhD, FASCO, Medical Oncologist, Dana-Farber Cancer Institute, Boston, at a press conference at the meeting. “This is an exciting and compelling study showing that patient-focused, team-based care can improve survival, reduce emergency room visits, improve quality of life, and, incredibly, improve overall survival,” he said.
“Patient-reported outcomes should be considered for inclusion in standard symptom management as a component of high-quality care,” said lead investigator, Ethan M. Basch, MD, MSc, FASCO, Director, Cancer Outcomes Research Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, formerly affiliated with Memorial Sloan Kettering Cancer Center (MSKCC), where the study was conducted.
“Up to half of symptoms are not reported to clinicians,” said Dr Basch. “Between visits, patients are often hesitant to call the office, and even at clinic visits, symptoms are not always fully communicated. Our current approach is reactive and inhibits our ability to act quickly. We have identified a communication gap,” he added. The study was simultaneously published online to coincide with the ASCO meeting (Basch E, et al. JAMA. 2017 Jun 4. Epub ahead of print).
The study enrolled 766 patients with cancer who were receiving chemotherapy for metastatic solid tumors between September 2007 and January 2011 at MSKCC. Patients were randomized to the web-based intervention or to usual care. Patients were sent weekly e-reminders to complete the web-based symptom monitoring tool, which assessed 12 common symptoms. The system automatically triggered e-alerts to nurses for worsening symptoms. Nurses printed the self-reports for the oncologist to use during the patient visit.
Patients of all ages self-reported symptoms 73% of the time when prompted. Nurses responded to e-alerts for symptom worsening 77% of the time.
At 6 months, compared with baseline, 31% more patients in the intervention group reported improved QOL versus patients in the standard care arm; the intervention group patients also had 7% fewer emergency department visits and 4% fewer hospitalizations.
At 5 years, the median overall survival was 31.2 months in the intervention arm versus 26 months in the standard arm, a difference of 8% (P = .03). The intervention group received 2 extra months of chemotherapy versus the standard care group (8.2 months vs 6.3 months; P = .002).
“This approach should be included as part of standard symptom management. Future efforts should focus on implementing strategies to incorporate self-reporting symptoms into electronic health records,” stated Dr Basch. “We plan to do a national study across the US to validate these results,” he added.
The self-reporting instrument was adapted from the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (www.nci.gov), which can be adapted for any practice.