Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lung Cancer. 2021 Dec;162:1-8. doi: 10.1016/j.lungcan.2021.09.020. Epub 2021 Sep 30.
Patients with lung cancer have high symptom burden and diminished quality of life. Electronic patient-reported outcome (PRO) platforms deliver repeated longitudinal surveys via web or telephone to patients and alert clinicians about concerning symptoms. This study aims to determine feasibility of electronic PRO monitoring in lung cancer patients receiving treatment in community settings.
Adults receiving treatment for advanced or metastatic lung cancer at 26 community sites were invited to participate in a prospective trial of weekly electronic PRO symptom monitoring for 12 months (NCT03249090). Surveys assessing patients' satisfaction with the electronic PRO system were administered at 3 months. Descriptive statistics were generated for demographics, survey completion rates, symptom occurrence, and provider PRO alert management approaches. Pairwise relationships between symptom items were evaluated using intra-individual repeated-measures correlation coefficients.
Lung cancer patients (n = 118) participating in electronic PROs were older (mean 64.4 vs 61.9 years, p = 0.03), had worse performance status (p = 0.002), more comorbidities (p = 0.02), and less technology experience than patients with other cancers. Of delivered weekly PRO surveys over 12 months, 91% were completed. Nearly all (97%) patients reported concerning (i.e., severe or worsening) symptoms during participation, with 33% of surveys including concerning symptoms. Pain was the most frequent and longest lasting symptom and was associated with reduced activity level. More than half of alerts to clinicians for concerning symptoms led to intervention. The majority (87%) would recommend using electronic PRO monitoring to other lung cancer patients.
Remote longitudinal weekly monitoring of patients with lung cancer using validated electronic PRO surveys was feasible in a multicenter, community-based pragmatic study. A high symptom burden specific to lung cancer was detected and clinician outreach in response to alerts was frequent, suggesting electronic PROs may be a beneficial strategy for identifying actionable symptoms and allow opportunities to optimize well-being in this population.
肺癌患者的症状负担高，生活质量下降。电子患者报告结局（PRO）平台通过网络或电话向患者提供重复的纵向调查，并向临床医生发出有关症状的警报。本研究旨在确定在社区环境中接受治疗的肺癌患者中电子 PRO 监测的可行性。
邀请 26 个社区站点接受晚期或转移性肺癌治疗的成年人参加一项为期 12 个月的每周电子 PRO 症状监测前瞻性试验（NCT03249090）。在 3 个月时进行电子 PRO 系统满意度调查。对人口统计学数据、调查完成率、症状发生情况以及提供者 PRO 警报管理方法进行描述性统计分析。使用个体内重复测量相关系数评估症状项目之间的两两关系。
参与电子 PRO 的肺癌患者（n=118）年龄较大（平均 64.4 岁比 61.9 岁，p=0.03），功能状态较差（p=0.002），合并症更多（p=0.02），技术经验较少比其他癌症患者。在 12 个月的每周 PRO 调查中，完成了 91%的调查。近 100%（97%）的患者在参与期间报告了令人担忧（即严重或恶化）的症状，其中 33%的调查包括令人担忧的症状。疼痛是最常见和持续时间最长的症状，与活动水平降低有关。超过一半的临床医生对令人担忧的症状发出警报后进行了干预。大多数（87%）患者会向其他肺癌患者推荐使用电子 PRO 监测。
在一项多中心、基于社区的实用研究中，使用经过验证的电子 PRO 调查对肺癌患者进行远程纵向每周监测是可行的。检测到肺癌特有的高症状负担，并且针对警报进行的临床医生外展非常频繁，这表明电子 PRO 可能是识别可操作症状的有益策略，并为改善该人群的幸福感提供机会。
