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Analysis of a Remote Monitoring Program for Symptoms Among Adults With Cancer Receiving Antineoplastic Therapy
Electronic patient-reported outcomes (ePROs) may have the potential to improve cancer care delivery by enhancing patient quality of life, reducing acute care visits, and extending overall survival. However, the optimal cadence of ePRO assessments is unknown. To determine patient response preferences...
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| Published in: | JAMA network open 2022-03, Vol.5 (3), p.e221078-e221078 |
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| creator | Daly, Bobby Nicholas, Kevin Flynn, Jessica Silva, Nicholas Panageas, Katherine Mao, Jun J Gazit, Lior Gorenshteyn, Dmitriy Sokolowski, Stefania Newman, Tiffanny Perry, Claire Wagner, Isaac Zervoudakis, Alice Salvaggio, Rori Holland, Jessie Chiu, Yeneat O Kuperman, Gilad J Simon, Brett A Reidy-Lagunes, Diane L Perchick, Wendy |
| description | Electronic patient-reported outcomes (ePROs) may have the potential to improve cancer care delivery by enhancing patient quality of life, reducing acute care visits, and extending overall survival. However, the optimal cadence of ePRO assessments is unknown.
To determine patient response preferences and the clinical value associated with a daily cadence for ePROs for patients receiving antineoplastic treatment.
This quality improvement study of adult patients undergoing antineoplastic treatment assessed a remote monitoring program using ePROs that was developed to manage cancer therapy-related symptoms. ePRO data submitted between October 16, 2018 to February 29, 2020, from a single regional site within the Memorial Sloan Kettering Cancer Center network were included. Data were analyzed from April 2020 to January 2022.
While undergoing active treatment, patients received a daily ePRO assessment that, based on patient responses, generated yellow (moderate) or red (severe) symptom alerts that were sent to clinicians.
The main outcomes assessed included patient response rate, symptom alert frequency, and an analysis of the clinical value of daily ePROs.
A total of 217 patients (median [range] age, 66 [31-92] years; 103 [47.5%] women and 114 [52.5%] men) initiating antineoplastic therapy at high risk for symptoms were monitored for a median (range) of 91 (2-369) days. Most patients had thoracic (59 patients [27.2%]), head and neck (48 patients [22.1%]), or gastrointestinal (43 patients [19.8%]) malignant neoplasms. Of 14 603 unique symptom assessments completed, 7349 (50.3%) generated red or yellow symptom alerts. Symptoms commonly generating alerts included pain (665 assessments [23.0%]) and functional status (465 assessments [16.1%]). Most assessments (8438 assessments [57.8%]) were completed at home during regular clinic hours (ie, 9 am-5 pm), with higher response rates on weekdays (58.4%; 95% CI, 57.5%-59.5%) than on weekend days (51.3%; 95% CI, 49.5%-53.1%). Importantly, 284 of 630 unique red alerts (45.1%) surfaced without a prior yellow alert for the same symptom within the prior 7 days; symptom severity fluctuated over the course of a week, and symptom assessments generating a red alert were followed by an acute care visit within 7 days 8.7% of the time compared with 2.9% for assessments without a red alert.
These findings suggest that daily ePRO assessments were associated with increased insight into symptom management in patients undergoing antineopl |
| doi_str_mv | 10.1001/jamanetworkopen.2022.1078 |
| format | article |
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To determine patient response preferences and the clinical value associated with a daily cadence for ePROs for patients receiving antineoplastic treatment.
This quality improvement study of adult patients undergoing antineoplastic treatment assessed a remote monitoring program using ePROs that was developed to manage cancer therapy-related symptoms. ePRO data submitted between October 16, 2018 to February 29, 2020, from a single regional site within the Memorial Sloan Kettering Cancer Center network were included. Data were analyzed from April 2020 to January 2022.
While undergoing active treatment, patients received a daily ePRO assessment that, based on patient responses, generated yellow (moderate) or red (severe) symptom alerts that were sent to clinicians.
The main outcomes assessed included patient response rate, symptom alert frequency, and an analysis of the clinical value of daily ePROs.
A total of 217 patients (median [range] age, 66 [31-92] years; 103 [47.5%] women and 114 [52.5%] men) initiating antineoplastic therapy at high risk for symptoms were monitored for a median (range) of 91 (2-369) days. Most patients had thoracic (59 patients [27.2%]), head and neck (48 patients [22.1%]), or gastrointestinal (43 patients [19.8%]) malignant neoplasms. Of 14 603 unique symptom assessments completed, 7349 (50.3%) generated red or yellow symptom alerts. Symptoms commonly generating alerts included pain (665 assessments [23.0%]) and functional status (465 assessments [16.1%]). Most assessments (8438 assessments [57.8%]) were completed at home during regular clinic hours (ie, 9 am-5 pm), with higher response rates on weekdays (58.4%; 95% CI, 57.5%-59.5%) than on weekend days (51.3%; 95% CI, 49.5%-53.1%). Importantly, 284 of 630 unique red alerts (45.1%) surfaced without a prior yellow alert for the same symptom within the prior 7 days; symptom severity fluctuated over the course of a week, and symptom assessments generating a red alert were followed by an acute care visit within 7 days 8.7% of the time compared with 2.9% for assessments without a red alert.
These findings suggest that daily ePRO assessments were associated with increased insight into symptom management in patients undergoing antineoplastic treatment and symptom alerts were associated with risk of acute care.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2022.1078</identifier><identifier>PMID: 35244701</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adult ; Aged ; Antineoplastic Agents - adverse effects ; Cancer ; Female ; Head & neck cancer ; Humans ; Male ; Neoplasms - drug therapy ; Oncology ; Online Only ; Original Investigation ; Patient Reported Outcome Measures ; Patients ; Quality of Life ; Self report ; Symptom Assessment</subject><ispartof>JAMA network open, 2022-03, Vol.5 (3), p.e221078-e221078</ispartof><rights>2022. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2022 Daly B et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a470t-bd96e5e64febc99fedd435a025c0c661e543c9c801e7b265a4884e63fc914f3e3</citedby><cites>FETCH-LOGICAL-a470t-bd96e5e64febc99fedd435a025c0c661e543c9c801e7b265a4884e63fc914f3e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2665608000?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,315,786,790,891,25783,27957,27958,37047,37048,44625</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35244701$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Daly, Bobby</creatorcontrib><creatorcontrib>Nicholas, Kevin</creatorcontrib><creatorcontrib>Flynn, Jessica</creatorcontrib><creatorcontrib>Silva, Nicholas</creatorcontrib><creatorcontrib>Panageas, Katherine</creatorcontrib><creatorcontrib>Mao, Jun J</creatorcontrib><creatorcontrib>Gazit, Lior</creatorcontrib><creatorcontrib>Gorenshteyn, Dmitriy</creatorcontrib><creatorcontrib>Sokolowski, Stefania</creatorcontrib><creatorcontrib>Newman, Tiffanny</creatorcontrib><creatorcontrib>Perry, Claire</creatorcontrib><creatorcontrib>Wagner, Isaac</creatorcontrib><creatorcontrib>Zervoudakis, Alice</creatorcontrib><creatorcontrib>Salvaggio, Rori</creatorcontrib><creatorcontrib>Holland, Jessie</creatorcontrib><creatorcontrib>Chiu, Yeneat O</creatorcontrib><creatorcontrib>Kuperman, Gilad J</creatorcontrib><creatorcontrib>Simon, Brett A</creatorcontrib><creatorcontrib>Reidy-Lagunes, Diane L</creatorcontrib><creatorcontrib>Perchick, Wendy</creatorcontrib><title>Analysis of a Remote Monitoring Program for Symptoms Among Adults With Cancer Receiving Antineoplastic Therapy</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Electronic patient-reported outcomes (ePROs) may have the potential to improve cancer care delivery by enhancing patient quality of life, reducing acute care visits, and extending overall survival. However, the optimal cadence of ePRO assessments is unknown.
To determine patient response preferences and the clinical value associated with a daily cadence for ePROs for patients receiving antineoplastic treatment.
This quality improvement study of adult patients undergoing antineoplastic treatment assessed a remote monitoring program using ePROs that was developed to manage cancer therapy-related symptoms. ePRO data submitted between October 16, 2018 to February 29, 2020, from a single regional site within the Memorial Sloan Kettering Cancer Center network were included. Data were analyzed from April 2020 to January 2022.
While undergoing active treatment, patients received a daily ePRO assessment that, based on patient responses, generated yellow (moderate) or red (severe) symptom alerts that were sent to clinicians.
The main outcomes assessed included patient response rate, symptom alert frequency, and an analysis of the clinical value of daily ePROs.
A total of 217 patients (median [range] age, 66 [31-92] years; 103 [47.5%] women and 114 [52.5%] men) initiating antineoplastic therapy at high risk for symptoms were monitored for a median (range) of 91 (2-369) days. Most patients had thoracic (59 patients [27.2%]), head and neck (48 patients [22.1%]), or gastrointestinal (43 patients [19.8%]) malignant neoplasms. Of 14 603 unique symptom assessments completed, 7349 (50.3%) generated red or yellow symptom alerts. Symptoms commonly generating alerts included pain (665 assessments [23.0%]) and functional status (465 assessments [16.1%]). Most assessments (8438 assessments [57.8%]) were completed at home during regular clinic hours (ie, 9 am-5 pm), with higher response rates on weekdays (58.4%; 95% CI, 57.5%-59.5%) than on weekend days (51.3%; 95% CI, 49.5%-53.1%). Importantly, 284 of 630 unique red alerts (45.1%) surfaced without a prior yellow alert for the same symptom within the prior 7 days; symptom severity fluctuated over the course of a week, and symptom assessments generating a red alert were followed by an acute care visit within 7 days 8.7% of the time compared with 2.9% for assessments without a red alert.
These findings suggest that daily ePRO assessments were associated with increased insight into symptom management in patients undergoing antineoplastic treatment and symptom alerts were associated with risk of acute care.</description><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Agents - adverse effects</subject><subject>Cancer</subject><subject>Female</subject><subject>Head & neck cancer</subject><subject>Humans</subject><subject>Male</subject><subject>Neoplasms - drug therapy</subject><subject>Oncology</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Patient Reported Outcome Measures</subject><subject>Patients</subject><subject>Quality of Life</subject><subject>Self report</subject><subject>Symptom Assessment</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNpdUV1rFDEUDaLYsvYvSMQXX7Ymk4_JvAjDUm2homjFx5DN3NnNOpOMSaay_94MraX26V44H9x7DkJvKDmnhND3BzMaD_lPiL_CBP68IlVVkFo9Q6eVqPmaKSKeP9pP0FlKB0JIRShrpHiJTpioOK8JPUW-9WY4Jpdw6LHB32AMGfDn4F0O0fkd_hrDLpoR9yHi78dxymFMuB1DgdpuHnLCP13e443xFmLRW3C3i6712XkI02BSdhbf7CGa6fgKvejNkODsfq7Qj48XN5vL9fWXT1eb9nptyll5ve0aCQIk72Frm6aHruNMGFIJS6yUFARntrGKUKi3lRSGK8VBst42lPcM2Ap9uPOd5u0InQWfoxn0FN1o4lEH4_T_iHd7vQu3Wqmmrov7Cr27N4jh9wwp69ElC8NQsg9z0pVkknLFFSvUt0-ohzDHEuvCkkISVbIvrOaOZWNIKUL_cAwleilWPylWL8Xqpdiiff34mwflvxrZX8vmpmo</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Daly, Bobby</creator><creator>Nicholas, Kevin</creator><creator>Flynn, Jessica</creator><creator>Silva, Nicholas</creator><creator>Panageas, Katherine</creator><creator>Mao, Jun J</creator><creator>Gazit, Lior</creator><creator>Gorenshteyn, Dmitriy</creator><creator>Sokolowski, Stefania</creator><creator>Newman, Tiffanny</creator><creator>Perry, Claire</creator><creator>Wagner, Isaac</creator><creator>Zervoudakis, Alice</creator><creator>Salvaggio, Rori</creator><creator>Holland, Jessie</creator><creator>Chiu, Yeneat O</creator><creator>Kuperman, Gilad J</creator><creator>Simon, Brett A</creator><creator>Reidy-Lagunes, Diane L</creator><creator>Perchick, Wendy</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220301</creationdate><title>Analysis of a Remote Monitoring Program for Symptoms Among Adults With Cancer Receiving Antineoplastic Therapy</title><author>Daly, Bobby ; Nicholas, Kevin ; Flynn, Jessica ; Silva, Nicholas ; Panageas, Katherine ; Mao, Jun J ; Gazit, Lior ; Gorenshteyn, Dmitriy ; Sokolowski, Stefania ; Newman, Tiffanny ; Perry, Claire ; Wagner, Isaac ; Zervoudakis, Alice ; Salvaggio, Rori ; Holland, Jessie ; Chiu, Yeneat O ; Kuperman, Gilad J ; Simon, Brett A ; Reidy-Lagunes, Diane L ; Perchick, Wendy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a470t-bd96e5e64febc99fedd435a025c0c661e543c9c801e7b265a4884e63fc914f3e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic Agents - adverse effects</topic><topic>Cancer</topic><topic>Female</topic><topic>Head & neck cancer</topic><topic>Humans</topic><topic>Male</topic><topic>Neoplasms - drug therapy</topic><topic>Oncology</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Patient Reported Outcome Measures</topic><topic>Patients</topic><topic>Quality of Life</topic><topic>Self report</topic><topic>Symptom Assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Daly, Bobby</creatorcontrib><creatorcontrib>Nicholas, Kevin</creatorcontrib><creatorcontrib>Flynn, Jessica</creatorcontrib><creatorcontrib>Silva, Nicholas</creatorcontrib><creatorcontrib>Panageas, Katherine</creatorcontrib><creatorcontrib>Mao, Jun J</creatorcontrib><creatorcontrib>Gazit, Lior</creatorcontrib><creatorcontrib>Gorenshteyn, Dmitriy</creatorcontrib><creatorcontrib>Sokolowski, Stefania</creatorcontrib><creatorcontrib>Newman, Tiffanny</creatorcontrib><creatorcontrib>Perry, Claire</creatorcontrib><creatorcontrib>Wagner, Isaac</creatorcontrib><creatorcontrib>Zervoudakis, Alice</creatorcontrib><creatorcontrib>Salvaggio, Rori</creatorcontrib><creatorcontrib>Holland, Jessie</creatorcontrib><creatorcontrib>Chiu, Yeneat O</creatorcontrib><creatorcontrib>Kuperman, Gilad J</creatorcontrib><creatorcontrib>Simon, Brett A</creatorcontrib><creatorcontrib>Reidy-Lagunes, Diane L</creatorcontrib><creatorcontrib>Perchick, Wendy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest - Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Daly, Bobby</au><au>Nicholas, Kevin</au><au>Flynn, Jessica</au><au>Silva, Nicholas</au><au>Panageas, Katherine</au><au>Mao, Jun J</au><au>Gazit, Lior</au><au>Gorenshteyn, Dmitriy</au><au>Sokolowski, Stefania</au><au>Newman, Tiffanny</au><au>Perry, Claire</au><au>Wagner, Isaac</au><au>Zervoudakis, Alice</au><au>Salvaggio, Rori</au><au>Holland, Jessie</au><au>Chiu, Yeneat O</au><au>Kuperman, Gilad J</au><au>Simon, Brett A</au><au>Reidy-Lagunes, Diane L</au><au>Perchick, Wendy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of a Remote Monitoring Program for Symptoms Among Adults With Cancer Receiving Antineoplastic Therapy</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>5</volume><issue>3</issue><spage>e221078</spage><epage>e221078</epage><pages>e221078-e221078</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Electronic patient-reported outcomes (ePROs) may have the potential to improve cancer care delivery by enhancing patient quality of life, reducing acute care visits, and extending overall survival. However, the optimal cadence of ePRO assessments is unknown.
To determine patient response preferences and the clinical value associated with a daily cadence for ePROs for patients receiving antineoplastic treatment.
This quality improvement study of adult patients undergoing antineoplastic treatment assessed a remote monitoring program using ePROs that was developed to manage cancer therapy-related symptoms. ePRO data submitted between October 16, 2018 to February 29, 2020, from a single regional site within the Memorial Sloan Kettering Cancer Center network were included. Data were analyzed from April 2020 to January 2022.
While undergoing active treatment, patients received a daily ePRO assessment that, based on patient responses, generated yellow (moderate) or red (severe) symptom alerts that were sent to clinicians.
The main outcomes assessed included patient response rate, symptom alert frequency, and an analysis of the clinical value of daily ePROs.
A total of 217 patients (median [range] age, 66 [31-92] years; 103 [47.5%] women and 114 [52.5%] men) initiating antineoplastic therapy at high risk for symptoms were monitored for a median (range) of 91 (2-369) days. Most patients had thoracic (59 patients [27.2%]), head and neck (48 patients [22.1%]), or gastrointestinal (43 patients [19.8%]) malignant neoplasms. Of 14 603 unique symptom assessments completed, 7349 (50.3%) generated red or yellow symptom alerts. Symptoms commonly generating alerts included pain (665 assessments [23.0%]) and functional status (465 assessments [16.1%]). Most assessments (8438 assessments [57.8%]) were completed at home during regular clinic hours (ie, 9 am-5 pm), with higher response rates on weekdays (58.4%; 95% CI, 57.5%-59.5%) than on weekend days (51.3%; 95% CI, 49.5%-53.1%). Importantly, 284 of 630 unique red alerts (45.1%) surfaced without a prior yellow alert for the same symptom within the prior 7 days; symptom severity fluctuated over the course of a week, and symptom assessments generating a red alert were followed by an acute care visit within 7 days 8.7% of the time compared with 2.9% for assessments without a red alert.
These findings suggest that daily ePRO assessments were associated with increased insight into symptom management in patients undergoing antineoplastic treatment and symptom alerts were associated with risk of acute care.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>35244701</pmid><doi>10.1001/jamanetworkopen.2022.1078</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | JAMA network open, 2022-03, Vol.5 (3), p.e221078-e221078 |
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| subjects | Adult Aged Antineoplastic Agents - adverse effects Cancer Female Head & neck cancer Humans Male Neoplasms - drug therapy Oncology Online Only Original Investigation Patient Reported Outcome Measures Patients Quality of Life Self report Symptom Assessment |
| title | Analysis of a Remote Monitoring Program for Symptoms Among Adults With Cancer Receiving Antineoplastic Therapy |
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