Abstract Topic: 35. Quality of life and palliative care
Background: Medical care is shifting from a disease-centered approach to a more personalized one. Patient-reported outcome measurement(PROM)are reports of health status or quality of life (QoL) directly provided by patients. They are routinely captured within clinical trials and are slowly being incorporated in the daily standard of care in patients with hematological diseases. “E-Res” is a value-based healthcare program implemented in a four-public hospitals network in Spain that aims to improve process management and patient journey giving voice to patients by collecting individual and aggregated data.
Aims: The hypothesis of this prospective multi-center study was that the implementation of an electronic PRO measurement(ePROM)program in patients with lymphoma receiving intravenous(iv)chemotherapy in the outpatient setting may improve self-perception of health,allow a better use of resources, and have positive impact on survival.
Methods: Patients with diagnosis of any type of lymphoma in the need of iv therapy between January 1st, 2020, and June 30th, 2022, in a four-public hospitals network were included in the study. Those patients rejecting participation were considered the control arm. All participating patients were registered in the hospital patient portal app. PRO-CTCAE™ questionnaire was electronically sent through the app at 3 points (after 1st, 3rd and 6th course of therapy). Those patients reporting symptoms of low intensity were to receive recommendations automatically through the app. Those reporting symptoms of high intensity were to receive a teleconsultation call by a specialized nurse.
Results: Among the 244 patients included in the study, 121 (49.6%) reported outcomes in the ePROM program. Despite patients were not randomized, baseline characteristic (age, sex, ECOG, diagnosis, treatment and previous lines of therapy) were balanced. Low grade of agreement was met between adverse events (AE) reported by physicians at electronic medical records (EMR) and those reported by patients. The only categories where no differences were found (p>0.05) were gastrointestinal (63% vs. 68%), neurological (29% vs. 31%) and respiratory (12% vs. 17%). Cutaneous, oral and sleep disorders were reported by more than 50% of patients but only at 26, 22 and 19% of EMR (p<0.05).
Despite showing tendency, no statistical difference was found between the percentage of patients reporting high grade AE at the 3 different moments. In terms of clinical benefits, those who were adherent to the program had fewer number of visits to the Emergency Room (33.3% vs. 55.7%; p<0.01) and showed a tendency to require fewer unscheduled hospital admissions (21.5% vs. 32.0%; p=0.075). More patients among those included in the ePROM program were able to complete the full initially planned treatment (94.2% vs. 83.6%; p<0.05). Finally, after a median follow-up of 18.8 months (IQR 11.3-23.2), median overall survival (OS) was not reached in either group, but it was significantly longer among patients included in “E-Res Salud” program than among those who were not (88.2% vs. 79.7% after 18 months of follow up; stratified hazard ratio, 2.25; 95% confidence interval [CI], 1.23 to 4.13;p=0.007 by a two-sided log-rank test)(Figure 1).
Summary/Conclusion: Better understanding of patient-reported symptoms could aid physicians to develop an individualized treatment plan and having an early feed-back seems to improve self-perception of health. The inclusion in the program and the reduction of ER visits has an impact in survival and both direct and indirect costs. Further follow-up and larger sample size will allow us to increase the level of detail and will lead to a decision-making process by integrating patient voice into healthcare decision.
Keywords: Lymphoma, Quality of life