Electronic symptom monitoring improves cancer care and reduces emergency visits

A pioneering study has revealed that people with metastatic cancer who actively report their symptoms via a home-based electronic monitoring system experience significant improvements in quality of life, clinical outcomes, and overall well-being. Furthermore, these individuals require fewer emergency department visits compared to those who do not engage in symptom reporting. However, overall survival rates remained comparable between both groups. These findings, led by researchers at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center, highlight the potential of electronic symptom monitoring to enhance cancer care by facilitating timely interventions.

The results of this extensive multicentre study were published in Nature Medicine on 7 February.

Bridging the Gap in Symptom Management

“Doctors and nurses are often unaware of symptoms and side effects that can worsen for cancer patients between office visits, leading to complications and unnecessary suffering. The patient-reported outcomes, or PRO, system was developed to enable patients to report their own symptoms and side effects and our study showed that PRO keeps care teams informed so that they can intervene promptly to help patients,” stated Dr Ethan Basch, MD, MSc, lead author of the study, Richard M. Goldberg Distinguished Professor of Medicine, and Chief of Medical Oncology at UNC School of Medicine, as well as Director of the Cancer Outcomes Research Programme at UNC Lineberger.

The PRO-TECT randomised clinical trial, conducted across 52 community oncology practices in 26 states, aimed to assess the real-world impact of electronic PRO symptom monitoring on clinical outcomes in comparison to standard care.

A total of 1,191 patients were enrolled in the study. Participants were randomly assigned into two groups: 593 individuals were placed in the PRO arm, where they could report their symptoms through a web-based programme or an automated telephone system, while 598 participants were assigned to the usual care/control arm.

The demographic breakdown of the study participants revealed that the median age was 63 years, with nearly 17% having never used the internet and approximately 26% receiving treatment at rural oncology practices.

Key Findings: Improved Quality of Life and Fewer Emergency Visits

While the primary outcome—overall survival—remained unchanged between the two groups, the use of electronic PRO reporting demonstrated multiple significant benefits:

• Reduction in Emergency Visits
  • Patients in the PRO group experienced a 6.1% decrease in emergency department visits compared to those in the usual care group.
  • Additionally, individuals in the PRO arm experienced a 16% longer duration before their first emergency visit compared to those in the usual care arm.
• Delayed Deterioration in Physical Function and Symptoms
  • The median time before physical function decline was 12.6 months in the PRO group versus 8.5 months in the control group.
  • Participants in the PRO arm exhibited a 31% delay in the worsening of symptoms, with a median progression time of 12.7 months compared to 9.9 months in the control group.
  • Additionally, PRO use was associated with a 28% improvement in health-related quality of life, with median times of 15.6 months versus 12.2 months in the control group.
• Positive Patient Perceptions and Engagement
  • 77% of participants felt PRO enhanced their discussions with their care team.
  • 84% believed PRO helped them feel more in control of their own care.
  • 91% of participants stated they would recommend the PRO system to other patients.
  • The adherence rate was remarkably high, with 91.5% of patients completing scheduled weekly symptom surveys.

Simplifying Symptom Reporting for Patients and Care Teams

One of the major challenges in cancer care has been the burden of electronic medical recordkeeping, which can be frustrating for both physicians and patients. Dr Basch acknowledged this concern, stating:

“Electronic medical recordkeeping has been a bane for some physicians and patients who find it frustrating to navigate patient portal systems—mitigating those frustrations was a central consideration in configuring the PRO system in this study. PRO largely circumvents physicians and is managed by nurses and/or patient navigators, whose jobs often encompass symptom management and care coordination. The PRO systems have also proven very easy for patients to use, in terms of technical ability.”

Generalisability and Future Research

The PRO-TECT trial was intentionally designed to be generalisable across all cancer types and treatment regimens, ensuring that the results apply broadly across diverse oncology populations. The study’s findings confirmed the effectiveness of PRO monitoring across multiple types of cancer, reinforcing its potential for widespread clinical application.

While these results mark the final stage of the PRO-TECT study, researchers have outlined several areas for further investigation. Planned sub-study analyses will explore:

• Patient, nurse, and doctor interviews to gain deeper insights into the experiences of those involved in the trial.
• Outcome variations based on patient characteristics, including cancer type, race, and geographical location.
• Methodological assessments to refine and improve the PRO technology for future implementations.

Despite the strong evidence supporting PRO in metastatic cancer, Dr Basch emphasised the need for further research into its benefits for earlier-stage cancers, concluding:

“While there have been some studies evaluating the benefits of PRO for patients with earlier stage cancers who get chemotherapy, radiation or surgeries for their cancer, there is less conclusive evidence of benefit for PRO in non-metastatic disease, so we certainly hope researchers will take an interest in establishing more studies to provide evidence of that benefit.”

Conclusion

The findings from this study reinforce the importance of proactive symptom monitoring in cancer care. While overall survival remained unchanged, electronic PRO reporting provided notable quality-of-life benefits, delayed symptom progression, and reduced emergency visits. Additionally, patients felt more engaged in their care and valued the improved communication with their healthcare teams. As researchers continue to explore PRO’s broader applications, its potential to transform cancer care and symptom management remains highly promising.