Patient-Reported Outcomes Improve Adherence and Symptom Management for Cancer Patients

Posted in Feature Articles

Patient-reported outcomes (PROs) are becoming an important measure of high-quality healthcare. They are a competitive differentiator for patients who are evaluating providers based on patient satisfaction and clinical outcomes. PROs also help organizations identify improvement opportunities and to succeed in value-based care arrangements.

The Impact of PROs in Cancer Care

Researchers are now beginning to recognize additional emerging benefits of PROs: improved adherence and outcomes. Evidence is growing that patients who regularly report how they’re feeling are more likely to take their medications as prescribed and experience better outcomes. In one study, Dr. Ethan Basch and his associates evaluated the impact of a simple web-based tool that enables cancer patients to report their symptoms in real time and alerts the care team when intervention is needed. This randomized clinical trial of 766 patients resulted in major benefits including longer survival. Patients with metastatic cancer who regularly used the tool to report symptoms while receiving chemotherapy lived a median of 5 months longer than those who did not use the tool. This simple intervention had a survival benefit greater than that seen with some new targeted therapies.

This same group previously reported that the use of the tool was also associated with better quality of life, the ability to tolerate chemotherapy longer, and fewer visits to the emergency room and subsequent hospitalizations. Compared to patients who received usual care, 75% of the patients who used the reporting tools received interventions from the oncology team compared to only 25% who were treated in the standard fashion. The timing and frequency of intervention suggests that the tools not only provide useful information, but that acting on that information can change a patient’s care trajectory.

In a different study Dr. Fabrice Denis and colleagues used a randomized trial to compare the use of a web enabled symptom reporting tool to standard care in patients with lung cancer. Data from the reporting tool was routed to the oncologist and the interventions were predetermined. This trial also demonstrated a significant survival improvement using what it termed “Web-application-guided follow-up.” Use of the tool was associated with better Performance Status at relapse, earlier supportive care, and a reduction in routine imaging.

These and other studies demonstrate that collecting PROs in clinical care improves patient-clinician communication, clinician awareness of symptoms, symptom management, patient satisfaction, quality of life, and overall survival. In the absence of a strategy to connect with patients between encounters, the body of evidence validates that clinicians miss about half of their cancer patients’ symptoms during treatment. The consequences of inadequate communication are costly to the health system and the patient in terms of admissions or ED visits, pain, fatigue, and other poorly controlled symptoms.

PROs clearly improve outcomes for patients undergoing cancer treatment. Patients can better manage side effects before they become severe and get assistance with adherence, psychosocial support, and social services. Physicians are more connected to patients in real time so they are aware of issues as soon as they arise and can address them immediately. Patients stay on therapy longer, experience better outcomes, and report real world experiences to help inform drug development.

Patient Engagement Tools Enable Holistic Care at Scale

Treating cancer has evolved into much more than a chemotherapy regimen. Providing comprehensive patient-centered care improves the patient’s cancer treatment journey and now encompasses things like symptom management, medication adherence, psychological and financial support, nutrition guidance, and transportation and logistic coordination.

The realities of today’s healthcare environment prohibit a personnel-driven approach to high-touch care. Organizations must harness the power of technology to automate patient outreach. A digital patient engagement tool can deliver gentle nudges, education, coaching, assessment forms, and emotional support to reduce administrative burden on clinical staff. Alerts and notifications can be configured to notify the care team when patients don’t respond, or when responses fall outside expected parameters, focusing their time on patients that require additional support.

Leaders are wise to look for flexible tools that support the configuration of communication protocols that are specific to the diagnosis and treatment plan, enabling a highly patient-centric experience. Optional two-way communication can also be a great tool in helping providers identify patients that require intervention.

Finally, accessibility is a key requirement in overcoming health equity issues related to age, technology savvy, geographic location, and more. Secure text messaging is the most widely accessible and adopted technology and will garner the highest engagement rates for oncology patients. Furthermore, the asynchronous nature of secure messaging enables care teams to respond to non-urgent needs at times that are convenient, rather than interrupting other clinical processes.

Give every patient high quality, comprehensive care to not only improve the patient experience, but also help them realize the best outcome possible.

The Tate Chronicles: Thomas Elbert, SVP & General Manager of Data at Health Catalyst (HealthcareNOW Radio Podcast Network)

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