eRAPID: Electronic Monitoring of Patient-reported Symptoms in Patients With a Diagnosis of Thoracic Cancer Managed at Leeds Cancer Centre

Background: Lung cancer is a leading cause of cancer-related morbidity and mortality. There are 2 main categories of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC accounts for approximately 85% of lung cancer diagnoses, almost 70% of NSCLC cases are diagnosed in the advanced/metastatic stages (IIIB-IV) of the disease. Pleural mesothelioma is another rare form of lung cancer, the average incidence across European countries is 20 cases per million people. Historically, patients with NSCLC were treated with the same algorithm, without consideration of their histological sub-type or their molecular profile. More recently, personalised therapies based on histology and/or molecular pathology have become the standard of care. The stage of NSCLC determines treatment options, with surgery being the mainstay of treatment for patients in early stages of the disease (stages I-IIIA). Additionally, those with localised disease spread (stages II and IIIA) may receive adjuvant therapy [11]. In patients with advanced/metastatic disease (stages IIIB-IV) and a performance status (PS) score of 0-2, the first line treatment options include chemotherapy regimens with or without immunotherapy or targeted biological therapy.

Patient reported outcome measures (PROMs) encompass data self-reported by patients about how they feel and function and include symptoms, physical function, emotional distress and health-related quality of life (HRQoL). PROMs are becoming important for patient care, as they provide the means of recording the experience of the patient in a structured format readily available to relevant clinical staff. Recently a randomised control trial (RCT) in advanced lung cancer using web-mediated follow-up showed overall survival benefit of 7-9 months compared to usual care, whilst maintaining cost-effectiveness. The relapses were detected earlier in patients in the intervention arm facilitating earlier and appropriate treatment initiation compared to patients in the control arm.

Study aims: This study will systematically capture patient reported disease-related symptoms, treatment-related side effects and HRQoL in a cohort of patients treated with systemic anti-cancer therapy (SACT) for thoracic cancer. The objectives are:

1. To compare disease-related symptoms and HRQoL across groups of patients stratified by patient and clinical characteristics.
2. To compare treatment-related side effects of patients prescribed chemotherapy, tyrosine kinase inhibitors (TKIs) or checkpoint inhibitors.
3. To compare outcomes, such as healthcare resource utilisation (HCRU), in patients systematically self-reporting symptoms
4. To examine patient acceptance, feasibility of this approach and optimal means of engaging with patients in the systematic PROMs reporting in a real world setting.
5. To assess the utility of PROMs reported by patients to their healthcare professionals.

Study design: This is an interventional, prospective study conducted at a single cancer centre. Patients with a diagnosis of thoracic cancer prescribed SACT will be enrolled in the study at oncology clinic visits. The intervention is an electronic patient self-report of disease-related symptoms, treatment-related side effects and HRQoL. This design allows the assessment of the utility to clinicians of PROMs reporting in the real world setting and provides an opportunity to study customised patient interventions based on PROMs reporting.