ePRO Tool Improves Symptom Management in an Outpatient Gynecologic Cancer Clinic

Electronic patient-reported outcome (ePRO) tools are feasible and accepted by patients with gynecologic cancer as helpful in identifying severe symptoms and obtaining clinician support. These results were published in Gynecologic Oncology.

The Patient-Reported Outcomes Measurement Information System (PROMIS) Network, funded by the National Institutes of Health (NIH), was developed to be a collaborative effort to advance and standardize measurement of health-related quality of life (HRQOL) in clinical practice. PROMIS uses state-of-the-art psychometric and computer adaptive tests. In addition, a publicly available repository bank of standardized patient-reported outcome (PRO) measures, validated for patients with cancer and available as either paper or electronic tools (ePROs), has been established by the PROMIS Network.  

In this study, the investigators sought to assess implementation of selected PROMIS PROs to screen for severe cancer symptomatology in gynecologic oncology outpatients, evaluate patient acceptability of administering PROMIS ePROs, and identify if PROMIS can effectively increase referral of severely symptomatic patients to ancillary support services.

A composite ePRO instrument was created for patients with gynecologic cancer that was composed of PROMIS PROs focused on a number of different symptom domains, including physical function, pain interference, fatigue, depression, anxiety, and sexual function. This composite ePRO measure was completed by patients using iPads in clinic waiting areas.

Patient demographic and clinicopathologic characteristics were abstracted from medical records and compared with ePRO responses across different symptom domains. Those patients considered to have severe symptoms were offered referral to ancillary support services.

Most patients offered study participation accepted (336 from an initial pool of 370 patients). Mean age for this cohort was 65 years, and only 47% of patients self-identified as white. Gynecologic oncology diagnoses were uterine cancer (59%), ovarian cancer (23%), cervical cancer (14%), vulvar cancer (2%), and vaginal cancer (1%). Approximately one-third of patients had stage III or IV disease, approximately two-thirds of patients were in disease remission, and 35% of patients were receiving active treatment.

With respect to study outcomes, the percentages of patients in the study cohort found to have moderate to severe symptoms in specific domains were as follows: physical dysfunction (60%), pain (36%), fatigue (28%), anxiety (9%), depression (8%), and sexual dysfunction (32%). On multivariate analysis, only active disease and type of gynecologic cancer were associated with the presence of severe symptoms.

All 59 patients (18%) with responses consistent with severe symptoms in at least one domain were contacted. More than three-quarters of the 36 patients with severe symptoms who completed follow-up surveys identified the ePRO tool as helpful, and nearly all in this subgroup described it as easy-to-use. Thirty-nine patients (12% of the overall cohort) were referred to ancillary support services.

The study authors suggest conducting further mixed-methods studies and longitudinal assessments to determine what barriers patients face in the referral process, if PROMIS ePRO scores improve after successful referral, and if use of these instruments is cost-effective.

Reference

Gressel GM, Dioun SM, Richley M, et al. Utilizing the Patient Reported Outcomes Measurement Information System (PROMIS®) to increase referral to ancillary support services for severely symptomatic patients with gynecologic cancer. Gynecol Oncol. 2019;152(3):509-513.