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Study: Automated Surveys Can Boost Engagement, Outcomes for Cancer Patients

Analysis  |  By Eric Wicklund  
   June 08, 2022

Research by the University of North Carolina finds that patient-reported outcomes collected through a digital health platform can help healthcare providers monitor their patients living with cancer at home, improving engagement, quality of life and outcomes.

A new study finds that patient-reported outcomes (PROs) delivered by phone as well as online helped health systems improve care management for people living with advanced cancer.

The study, conducted by the University of North Carolina and recently published in the Journal of the American Medical Association (JAMA), sheds light on the value of an automated survey platform that allows care providers to track patient symptoms at home. The platform reduces stressful travel to and from a doctor's office or clinic and allows providers to monitor patients weekly and intervene when they detect a health concern.

“We had very high engagement with patients and their care teams in this study, with patients completing more than 90% of their symptom surveys, and nurses frequently reaching out to patients when severe or worsening symptoms were electronically reported,” Ethan Basch, MD, MSc, a researcher at UNC's Lineberger Comprehensive Cancer Center and the paper’s lead author, said in a press release. “This likely reflects how accustomed many patients and providers have become to telehealth and electronic communications.”

Supported by the Patient Centered Outcomes Research Institute (PCORI), the PRO-TECT (Patient Reported Outcomes To Enhance Cancer Treatment) trial tracked 1,191 patients receiving care at 52 community cancer clinics between October 2017 and March 2020. Roughly half of the patients were asked to complete a weekly survey, offered online as well as by phone, for as long as a year, while the rest received traditional care, often in he form of scheduled visits to the clinic or doctor's office.

The project enabled participants to report typical symptoms of cancer treatment, including fatigue, nausea, insomnia, appetite loss, diarrhea, pain, difficulty breathing, and constipation. If those symptoms appeared to be worsening or increasing, the digital health platform sent an alert to the patient's care team to follow up immediately.

According to the study, those using the online or phone survey platform experienced roughly 35% better physical function that their counterparts who reported their symptoms during office visits, and they also reported more than 16% better control over their symptoms and more than 40% better health-related quality of life.

The research adds to a growing library of data that virtual care can stand in for in-person care in certain circumstances, and can even help providers improve clinical outcomes. The platform saw increased use during the pandemic, when many health systems turned to telehealth to substitute for in-person care at a time when the risk of infection was high.

The platform also offers crucial value to people living with cancer, with studies suggesting half of cancer-related symptoms are undetected and unreported. Healthcare providers fear that people are skipping appointments or check-ups, in part because of COVID-19 fears, so they aren't keeping their doctors up to date on symptoms.

"Symptom monitoring using electronic systems that facilitate patient-reported outcome (PRO) surveys via the internet, mobile applications, or automated telephone interfaces have been shown to be feasible for identifying symptoms that can be treated by clinicians," Basch and his colleagues wrote in the study. "Prior studies have reported improved outcomes for physical function, symptom control, health-related quality of life (HRQOL), hospitalizations, and survival when such electronic systems are used by patients receiving cancer treatment. Integrating symptom monitoring into routine treatment of cancer may improve outcomes with an opportunity for reimbursement by payers."

The study also proves the value of offering multiple ways of accessing the survey, to take into account barriers that some patients may face in accessing the Internet. Roughly one-third of the participants in the study reported their symptoms via telephone.

It also points out that launching a digital health program comes with challenges.

"Despite prior evidence of the benefits and feasibility of electronic symptom monitoring with PROs, there has not been widespread adoption in treatment for cancer," the study noted. "Implementation requires technology, patient engagement, staff effort, and modification of information flow. A prior analysis of user feedback from this trial found high levels of enthusiasm from patients and clinicians. However, nurses reported that alerts could be burdensome unless there is dedicated time to address the alerts. Despite cost savings associated with PRO monitoring for insurance companies, currently funding is not available to sustain additional costs to clinics of technology and staffing in the US."

"The Centers for Medicare & Medicaid Services has suggested including PROs in a proposed oncology payment model," Basch and his colleagues wrote. "Expansion of current billing codes for remote monitoring to include PROs in oncology would facilitate greater use of the intervention. Future work could delineate the relationship of PRO monitoring with patient navigation. Work is needed to refine algorithms for communicating alerts to assess whether the number of notifications can be safely reduced."

Basch says the project now needs to be expanded, to improve efficiency and determine the best models for widespread use.

“PRO-TECT is a way to bring patients together with their care team and aids in identifying those who are at greatest risk,” he said in the press release. “And because we had equal success at all 52 practices in 25 states, it shows that there’s a wide acceptance for this kind of intervention.”

Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.


Roughly 50 percent of patients living with cancer aren't reporting their symptoms on a regular basis to their care team, putting them at a high risk of serious health concerns and death.

Healthcare providers who use a digital health platform to collect patient-reported outcomes on a weekly basis stand a better chance of catching health concerns before they become serious, while also boosting engagement and improving the patient's fitness and quality of life.

While the platform is becoming popular, particularly in the wake of the pandemic, support from the Centers for Medicare & Medicaid Services is crucial.

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