Takvorian Samuel U, Anderson Ryan T, Gabriel Peter E, Poznyak Dmitriy, Lee Sooin, Simon Sam, Barrett Kirsten, Shulman Lawrence N
Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
JCO Oncol Pract. 2022 Sep;18(9):e1454-e1465. doi: 10.1200/OP.21.00855. Epub 2022 Jun 8.
Routine collection of patient-reported outcomes (PROs) for patients with advanced solid malignancies is an evidence-based practice and critical component of high-quality cancer care, but real-world adherence is poorly characterized. We sought to describe real-world adherence to PRO monitoring and its potential predictors.
We conducted a retrospective cross-sectional study using deidentified electronic health record data from a National Cancer Institute Cancer Center, encompassing one academic and two community sites. Participants included individuals with lung cancer receiving systemic therapy from January 1 to December 31, 2019. The primary outcome was patient-level adherence, defined as the proportion of treatment visits during which a PRO questionnaire (spanning symptoms, functional status, and global quality-of-life domains) was completed within 30 days. Practice-level performance was calculated as unadjusted mean patient-level adherence. We modeled patient-level adherence using multivariable ordinary least squares regression and identified covariates associated with adherence using a significance threshold of < .05.
In 2019, there were 18,604 encounters for 1,105 patients with lung cancer (mean [standard deviation] age 65.8 [10.2] years; 621 [56.2%] female; 216 [19.6%] Black) receiving systemic therapy. The mean patient-level PRO adherence ranged from 27.2% to 70.0% across sites and was 49.4% overall. Advanced age (≥ 65 years) and Black or African American race were negatively associated with PRO adherence ( < .01).
Across this real-world cohort of patients undergoing treatment for lung cancer, adherence to PRO monitoring lagged that achieved in seminal clinical trials, with potential age- and race-based disparities, demonstrating an implementation gap that could be addressed with standardized reporting of an adherence-based quality metric.
对于晚期实体恶性肿瘤患者，常规收集患者报告结局（PROs）是一种基于证据的实践，也是高质量癌症护理的关键组成部分，但实际应用中的依从性特征尚不明确。我们旨在描述PRO监测的实际应用依从性及其潜在预测因素。
我们进行了一项回顾性横断面研究，使用来自美国国立癌症研究所癌症中心（包括一个学术机构和两个社区机构）的去识别化电子健康记录数据。参与者包括在2019年1月1日至12月31日期间接受全身治疗的肺癌患者。主要结局是患者层面的依从性，定义为在30天内完成PRO问卷（涵盖症状、功能状态和总体生活质量领域）的治疗就诊比例。实践层面的表现以未调整的平均患者层面依从性计算。我们使用多变量普通最小二乘法回归对患者层面的依从性进行建模，并使用显著性阈值<0.05识别与依从性相关的协变量。
2019年，1105例接受全身治疗的肺癌患者有18604次就诊（平均[标准差]年龄65.8[10.2]岁；621例[56.2%]为女性；216例[19.6%]为黑人）。各机构的平均患者层面PRO依从性在27.2%至70.0%之间，总体为49.4%。高龄（≥65岁）以及黑人或非裔美国人种族与PRO依从性呈负相关（<0.01）。
在这个接受肺癌治疗的真实世界队列中，PRO监测的依从性低于开创性临床试验中的水平，存在潜在的年龄和种族差异，表明存在一个实施差距，可通过基于依从性的质量指标的标准化报告来解决。
