Why ePRO-based Monitoring is Good for the Patient

Oncologists and oncology providers want the best for their patients, recognizing that being diagnosed with cancer is devastating, treatment is hard, and bad things can happen despite best efforts. They also understand patient expectations, doing everything possible to deliver an easier journey, the highest quality of life, and the best outcomes. Innovation is expected in oncology, with physicians and providers driving support for clinical trials and new treatment options, including the advancement of health technologies. As a result, we are now at a point where the evolution of the care delivery model, including the use of remote patient monitoring via electronic patient-reported outcomes (ePROs), needs to occur.

A New Precedent for Patient Engagement

The COVID-19 pandemic brought major challenges for both patients and oncologists—cancer screenings were delayed, timely surgery was almost impossible, and being in the clinic or hospital for treatment was dicey. While we won’t know the full impact of COVID-19 on oncology care for some time, we did learn that patients are willing to engage with their care teams using technology. Prior to the pandemic, the use of telehealth was limited, often because of discomfort with the technology needed for telehealth visits and skepticism about the value of virtual care. But when patients and oncologists faced the hurdles (and even risk) of in-person visits, these obstacles were rapidly overcome and telehealth utilization soared. In fact, telehealth adoption grew by 79x at the peak of the COVID-19 pandemic and stabilized at 38x. As a result, patients expect a new standard for engaging with care teams, both at their convenience and on their terms.

While the COVID-19 pandemic revealed that patients will engage with doctors outside the walls of the clinic, research on ePRO-based remote patient monitoring has been ongoing. The modern era of ePRO-based monitoring dates to a 2016 report by Ethan Basch, MD, MSc, then a faculty member at Sloan Kettering. Dr. Basch theorized that remotely monitoring and promptly managing symptoms between office visits for treatment would improve health outcomes. He randomized 766 patients on treatment to either standard of care or weekly remote engagement. The findings? Patients randomized to the remote engagement cohort experienced significantly better outcomes: improved health-related quality of life (HRQOL), fewer ER visits and hospitalizations, and increased treatment time and overall survival. [JCO, 2016]  [JAMA, 2017] 

Earlier Recognition of Treatment Toxicity Keeps a Small Problem from Becoming a Big Problem

Why did the remote engagement cohort experience better outcomes? Earlier recognition of treatment toxicity keeps a small problem from becoming a big problem. Also, patients may have other medical problems that can interfere with therapy continuation. Effectively managing diabetes or a COPD exacerbation might be just as important as controlling diarrhea.

So why isn’t the current standard of care adequate? The answer may seem obvious to practicing oncologists and providers—the care journey isn’t patient-centric. Office visits are based on a patient’s treatment schedule or a physician’s convenience. Published evidence suggests that patients not only experience symptoms in between office visits, but these symptoms can lead to avoidable hospital visits, with few patients calling the practice before heading to the emergency department. Patients often avoid calling because of the complexity of phone trees and long hold times. When patients do have the opportunity to report symptoms during office visits, they often minimize symptom severity or avoid disclosing symptoms for worry of bothering the doctor. Interestingly, this hesitancy was overcome during the pandemic using telemedicine and in Basch’s trial using remote patient reporting.

Can outcomes from these clinical studies be replicated in the real world? Early results from Basch’s PRO-TECT trial with community oncology sites show high patient engagement and treatment persistence, improved HRQOL, with impact on survival pending. [JCO, 2020] Debra Patt, MD, PhD, MBA, and colleagues at Texas Oncology have also reported on the implementation of an ePRO solution in a very large, multi-site practice [JCO, 2021], and finally—as reported at ASCO in 2021 and 2022—recent real-world data from oncology practices working with Canopy show [JCO, 2022] [ASCO, 2022] [ASCO, 2022]:

Results from Clinical Trials and Real-world Data Suggest that ePRO-based Monitoring Can Improve Patient Outcomes

High patient engagement and retention on ePRO-based health tools—coupled with the COVID-19 acceleration of telehealth adoption—suggest that patients are ready to use remote reporting to get closer to their care teams. Even government programs, like the Enhancing Oncology Model (EOM), from the Center for Medicare and Medicaid Innovation (CMMI), have embraced ePROs as a building block of outcomes-based care. Although questions remain regarding staffing models and effects on efficiency, ePRO-based monitoring has moved from “nice to have” to “need to have” for practices wanting to optimize patient experiences and outcomes. And as oncology moves toward alternative payment models and value-based contracting, embracing ePRO-based monitoring will be a key component of care delivery.

Learn More

Want to learn more about ePRO-based monitoring and how to optimize your practice for continuous care delivery? Schedule a demo with the Canopy team.

1. Cherny, N. I., Parrinello, C. M., Kwiatkowsky, L., Hunnicutt, J., Beck, T., Schaefer, E., Thurow, T., & Kolodziej, M. (2022). Feasibility of Large-Scale Implementation of an Electronic Patient-Reported Outcome Remote Monitoring System for Patients on Active Treatment at a Community Cancer Center. JCO Oncology Practice, 18(12), e1918-e1926. DOI: 10.1200/OP.22.00180

2. Kolodziej, M. A., Kwiatkowsky, L., Parrinello, C., Thurow, T., Schaefer, E. S., Beck, J. T., Cherny, N., & Blau, S. (2022). ePRO-based digital symptom monitoring in a community oncology practice to reduce emergency room and inpatient utilization. Journal of Clinical Oncology, 40(16_suppl), 1508.

Authors observed a 22 percent lower rate of adverse clinical events, specifically emergency room and hospital admission.

3. Parrinello, C., Calkins, G., Kwiatkowsky, L., Schaefer, E. S., Beck, J. T., Ellis, A. R., Blau, S., Telivala, B. P., & Kolodziej, M. A. (2022). Time on treatment is prolonged in patients utilizing an ePRO based digital symptom monitoring platform in the community setting. Journal of Clinical Oncology, 40(16_suppl), 1528. DOI: 10.1200/JCO.2022.40.16_suppl.1528