ePROs Effect on Patient Health Outcomes

Michael Kolodziej, MD, Senior Advisor, ADVI, began his 2022 Oncology Clinical Pathways Congress presentation, “Improving Health Outcomes with ePROs,” by asking the audience a very simple question.

“Why do we use pathways? What’s the pot of gold at the end of this rainbow?”

When pathway development was in its nascent stages, the goals were to ensure patients get the best evidence-based treatment, and to promote value-based prescribing.

“We have not changed a whit since 2005 and that’s a sad statement,” Dr Kolodziej told the assembly. “We could chant this as our pathways mantra: evidence-toxicity-cause. Of course, the evidence is based on the best clinical trial evidence. And if you follow this recipe, you get value-based prescribing and ideally you get optimal outcomes. But … pathways aren’t perfect. They are a population-based treatment construct.”

As an example, Dr Kolodziej presented a slide featuring more than a dozen patients on one side, and barely a half-dozen on the other side. One side represented the entire population of patients with a particular cancer. The other, less-populated side represented those who went into clinical trials.

“They’re not representatives of everybody,” Dr Kolodziej said of the clinical trial population. “This has been published a million times. Patients who go on clinical trials are younger, whiter, smarter, more educated, wealthier, and healthier. They are not the people sitting in front of you in the office.”

Keeping this in mind, Dr Kolodziej continued, “we have to determine the most realistic outcomes that our patients can achieve using clinical trials as the starting point. We need to identify processes of care that allow us to achieve those outcomes. Patients treated in a clinical trial are treated differently than patients treated in a routine practice, there’s no question about that. And based on what we learn, we must modify pathways to reflect the legitimate value of the various treatment options.”

Maintaining patient engagement is significant in treatment success. Cancer patients usually have dynamic symptoms, and their treatments may cause toxicities and multiple side effects, which usually leads to patient distress, frequent emergency department (ED) visits, and even treatment discontinuation. The fact that patients are only seen roughly every 2 to 3 weeks with little contact or support between appointments just exacerbates these challenges.

Dr Kolodziej pointed to a Journal of Clinical Oncology study that compared patients receiving standard of care with those who received enhanced patient reporting.

A randomized clinical trial of patients with solid tumors treated at Sloane Kettering over the 5-year span of the trial were randomized to routine office care or to a weekly intervention in which the patient received an email and responded with their symptoms, and if they reported significant symptoms, they were contacted for follow-up.

“The results were astounding,” Dr Kolodziej said. Using electronic patient-reported outcomes (ePROs) significantly improved results. There was a 16% increase in patient health-related quality of life, 17% reduction in ED visits, 8% reduction in hospitalizations, 30% increase in time on chemotherapy, and 20% increase in overall survival.

ePRO is a solid approach, Dr Kolodziej continued. The ePRO Digital Symptom Monitoring (DSM) platform is a modular, cloud-based communication system that incorporates integrated interfaces for patients and clinical staff. Other studies are showing similar results to the Journal of Clinical Oncology study: ePROs lead to high patient engagement and retention.

“We’ve heard a million times that it can’t be done. So I’m here to tell you, it can be done,” he said.

ePROs are here to stay, Dr Kolodziej concluded. Covid showed that patients are just fine if they communicate electronically with their care team. Some preferred it, and all cancer patients like being more in touch with their care team.

“I think ePROs are ultimately going to be proven to show to improve health outcomes, reducing (ED) and inpatient hospitalizations, prompting extended time of therapy, and they may improve survival,” Dr Kolodziej concluded. “ePROs are going to help us understand what individual patient experience is, and if we take that information and build on it, we will ultimately understand how the patient in front of us fits in the universe of patients on the trial and not on the trial.

“We need to evolve. We can’t be talking about the same old stuff we’ve been doing for the last 16 years. We need to start thinking about, what’s the right treatment for the patient sitting in front of us.”