Department of Oncology and Radiotherapy, Oulu University Hospital and MRC Oulu, P.B. 22, 90029, Oulu, Finland.
Department of Oncology and Radiotherapy, Vaasa Central Hospital, Vaasa, Finland.
J Cancer Res Clin Oncol. 2023 Aug;149(10):6875-6882. doi: 10.1007/s00432-023-04622-4. Epub 2023 Feb 21.
Electronic (e) patient-reported outcomes (PROs) have been shown to improve the quality of life and survival in chemotherapy treated advanced cancer patients. We hypothesized that multidimensional ePRO centered approach could improve symptom management, streamline patient flow, and optimize the use of healthcare resources.
In this multicenter trial (NCT04081558), colorectal cancer (CRC) patients receiving oxaliplatin-based chemotherapy as adjuvant or in the first- or second-line setting in advanced disease were included in the prospective ePRO cohort, while a comparative retrospective cohort was collected from the same institutes. The investigated tool consisted of a weekly e-symptom questionnaire integrated to an urgency algorithm and laboratory value interface, which generated semi-automated decision support for chemotherapy cycle prescription and individualized symptom management.
Recruitment to the ePRO cohort occurred 1/2019-1/2021 (n = 43). The comparator group (n = 194) consisted of patients treated in the same institutes 1-7/2017. The analysis was limited to adjuvant treated (n = 36 and n = 35). The feasibility of the ePRO follow-up was good with 98% reporting easy usage and 86% improved care, while health care personnel valued the easy use and logical workflow. In the ePRO cohort, 42% needed a phone call before planned chemotherapy cycles, while this was 100% in the retrospective cohort (p = 1.4e-8). Peripheral sensory neuropathy was detected significantly earlier with ePRO followed (p = 1e-5) but did not translate to earlier dose reduction, delays, or unplanned therapy termination compared to the retrospective cohort.
The results suggest that the investigated approach is feasible and streamlines workflow. Earlier symptom detection may improve the quality in cancer care.
电子(e)患者报告的结局(PROs)已被证明可以改善接受化疗的晚期癌症患者的生活质量和生存率。我们假设多维 ePRO 为中心的方法可以改善症状管理,简化患者流程,并优化医疗资源的利用。
在这项多中心试验(NCT04081558)中,接受奥沙利铂为基础的化疗作为辅助或晚期疾病一线或二线治疗的结直肠癌(CRC)患者被纳入前瞻性 ePRO 队列,而来自同一机构的比较回顾性队列则被收集。研究工具包括每周电子症状问卷与紧急算法和实验室值界面的集成,为化疗周期处方和个体化症状管理提供半自动决策支持。
ePRO 队列的招募时间为 2019 年 1 月至 2021 年 1 月(n=43)。对照组(n=194)由同一机构于 2017 年 1-7 月治疗的患者组成。分析仅限于接受辅助治疗的患者(n=36 和 n=35)。ePRO 随访的可行性良好,98%的患者报告易于使用,86%的患者报告改善了护理,而医疗保健人员则重视易用性和逻辑工作流程。在 ePRO 队列中,42%的患者在计划化疗周期前需要打电话,而在回顾性队列中这一比例为 100%(p=1.4e-8)。使用 ePRO 可以更早地发现周围感觉神经病变(p=1e-5),但与回顾性队列相比,这并未导致更早的剂量减少、延迟或计划外治疗终止。
结果表明,所研究的方法是可行的,并简化了工作流程。更早的症状检测可能会提高癌症护理的质量。