A groundbreaking cluster-randomized trial has revealed that implementing electronic patient-reported outcome (PRO) monitoring systems in cancer care significantly improves clinical outcomes and patient experience, despite showing no impact on overall survival rates.
The study, registered under ClinicalTrials.gov (NCT03249090), involved 52 oncology practices and 1,191 patients with metastatic cancer. Practices were randomly assigned to either implement PRO monitoring or continue with usual care protocols.
Impact on Emergency Care and Clinical Outcomes
The implementation of PRO monitoring demonstrated substantial benefits in reducing emergency care utilization. Patients in PRO-monitored practices experienced a significant delay in time to first emergency visit (Hazard Ratio 0.84, 95% CI, 0.71-0.98; P = 0.03). This translated to a 6.1% reduction in cumulative emergency visits, with PRO patients averaging 1.02 visits compared to 1.30 visits in usual care at 12 months.
Quality of Life and Physical Function Benefits
The study revealed remarkable improvements in patient quality of life metrics. PRO monitoring significantly delayed the deterioration of physical function, with median times of 12.6 months versus 8.5 months in usual care (HR 0.73; P = 0.002). Similarly, symptom deterioration was delayed by nearly three months (12.7 versus 9.9 months, HR 0.69; P < 0.001), and health-related quality of life showed improvement with a median of 15.6 months compared to 12.2 months in usual care (HR 0.72; P = 0.001).
Patient Engagement and Satisfaction
The PRO system demonstrated exceptional patient engagement, with participants completing 91.5% (20,565/22,486) of weekly symptom surveys. Patient satisfaction metrics were equally impressive:
- 84.0% reported feeling more in control of their care
- 77.0% noted improved discussions with their care team
- 91.4% would recommend the system to other patients
System Implementation and Monitoring
Under the PRO protocol, patients completed weekly symptom surveys, with automated alerts generated for the care team when severe or worsening symptoms were reported. This proactive approach to symptom monitoring allowed for earlier intervention and better symptom management.
While the study showed no significant difference in overall survival rates (HR 0.99, 95% CI, 0.83-1.17; P = 0.86), the substantial improvements in quality of life and healthcare utilization suggest that PRO systems should become a standard component of quality cancer care. The findings indicate that future studies of PRO implementations should focus on these quality-of-life metrics rather than mortality as primary endpoints.
