Weill Cornell Medical College, New York, NY, USA.
J Clin Oncol. 2013 Jul 10;31(20):2580-5. doi: 10.1200/JCO.2012.47.6804. Epub 2013 Jun 3.
Patient-reported outcomes are increasingly used in routine outpatient cancer care to guide clinical decisions and enhance communication. Prior evidence suggests good patient compliance with reporting at scheduled clinic visits, but there is limited evidence about compliance with long-term longitudinal reporting between visits.
Patients receiving chemotherapy for lung, gynecologic, genitourinary, or breast cancer at a tertiary cancer center, with access to a home computer and prior e-mail experience, were asked to self-report seven symptomatic toxicities via the Web between visits. E-mail reminders were sent to participants weekly; patient-reported high-grade toxicities triggered e-mail alerts to nurses; printed reports were provided to oncologists at visits. A priori threshold criteria were set to determine if this data collection approach merited further development based on monthly (≥ 75% participants reporting at least once per month on average) and weekly compliance rates (60% at least once per week).
Between September 2006 and November 2010, 286 patients were enrolled (64% were women; 88% were white; median age, 58 years). Mean follow-up was 34 weeks (range, 2 to 214). On average, monthly compliance was 83%, and weekly compliance was 62%, without attrition until the month before death. Greater compliance was associated with older age and higher education but not with performance status. Compliance was greatest during the initial 12 weeks. Symptomatic illness and technical problems were rarely barriers to compliance.
Monthly compliance with home Web reporting was high, but weekly compliance was lower, warranting strategies to enhance compliance in routine care settings.
患者报告的结果越来越多地用于常规的门诊癌症护理中，以指导临床决策和加强沟通。先前的证据表明，患者在预约的门诊就诊时报告的依从性良好，但关于在就诊之间进行长期纵向报告的依从性的证据有限。
在一家三级癌症中心接受化疗的肺癌、妇科、泌尿生殖系统或乳腺癌患者，能够使用家用电脑并具有电子邮件使用经验，被要求在就诊之间通过网络自行报告七种症状性毒性。每周向参与者发送电子邮件提醒；患者报告的高级别毒性会触发电子邮件提醒护士；在就诊时向肿瘤医生提供打印报告。事先设定了阈值标准，以根据每月（≥ 75%的参与者平均每月至少报告一次）和每周的依从率（至少每周一次为 60%）来确定这种数据收集方法是否值得进一步开发。
在 2006 年 9 月至 2010 年 11 月期间，共纳入 286 名患者（64%为女性；88%为白人；中位年龄为 58 岁）。平均随访时间为 34 周（范围为 2 至 214 周）。平均每月的依从率为 83%，每周的依从率为 62%，直到死亡前一个月才出现数据丢失。较高的依从性与年龄较大和受教育程度较高有关，但与表现状态无关。依从性在最初的 12 周内最高。症状性疾病和技术问题很少成为依从性的障碍。
在家用网络报告方面，每月的依从性很高，但每周的依从性较低，这需要在常规护理环境中采取策略来提高依从性。
