Highlights
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Weekly ePROMs after radiotherapy make patients feel better supported.
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ePROMs are effective in identifying patients needing intervention.
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ePROMs are a well-suited digital solution for personalised follow-up.
Keywords: Personalised Follow-up, Radiotherapy, Electronic Patient-Reported Outcome Measures, Lung Cancer, Head and Neck Cancer
Abstract
Background
There is an unmet need in patient monitoring between the end of radiotherapy and the first follow-up appointment during which patients may experience severe side effects. Personalised follow-up has the potential to tailor healthcare to individual needs. ePROMs enable remote monitoring and identification of those needing earlier intervention.
Purpose
To assess the feasibility of integrating ePROMs into personalised follow-up of patients after radiotherapy.
Materials and Methods
Patients with lung or head and neck (HN) cancer were enrolled. ePROMs questionnaires, comprising EQ-5D-5L and 14 lung or 19 HN cancer-specific questions adapted from CTCAE v5.0, were sent to patients at eight timepoints: pre-radiotherapy, mid-radiotherapy, end of radiotherapy, weekly for four weeks post-treatment, and first face-to-face follow-up appointment. Upon completion, automated advice was provided based on responses. Grade 2 or above symptoms were escalated to clinicians. Patient feedback was obtained through structured interviews.
Results
Over two months, 19 eligible patients (10 lung, 9 HN) were recruited: 13 received concurrent chemoradiotherapy, and six received radiotherapy alone. ePROMs completion rate was 69.1%, ranging from 47.4% to 89.5% at each timepoint. Three patients reported grade 3 or above symptoms on 5 instances during and after radiotherapy. Fourteen patients participated in the interviews: all 14 reported ePROMs were easy to complete, took an acceptable amount of time, and made them feel better supported.
Conclusion
Integrating ePROMs into personalised follow-up is feasible and acceptable to patients. ePROMs provide insights into patients’ symptoms during and after radiotherapy, highlighting the need for a tailored approach.
Introduction
Radiotherapy is the most common non-surgical cancer treatment, received by over half of patients with cancer [1,2]. Radiotherapy techniques have significantly improved, allowing more precise tumour targeting and less damage to normal tissue. Despite these improvements, side effects still occur [3] and can greatly impact patients’ quality of life [4], highlighting the need for appropriate support for those undergoing radiotherapy.
Early radiotherapy side effects typically occur within days to weeks from the treatment initiation and improve a few weeks after treatment completion [5]. However, the first follow-up appointments are scheduled 4–12 weeks post-treatment, depending on tumour site and local guidance [[6], [7], [8]]. This monitoring gap may leave early side effects unmanaged, potentially leading to hospital admission or long-term side effects [9]. Shortening follow-up intervals is not a straightforward solution as it can be unnecessary for some patients and resource-intensive [10]. Therefore, alternative means of follow-up personalised to individual needs are desirable.
Personalised follow-up refers to care that is tailored to each patient’s needs [11]. This approach ensures patients can access care as needed rather than adhering to a one-size-fits-all follow-up scheme. One component of this approach is digital solutions for remote monitoring, where patients can report issues to clinicians and seek advice [12].
Electronic patient-reported outcome measures (ePROMs) are used to collect health information, such as functional status, treatment side effects, and quality of life, from patients via online questionnaires. Multiple clinical trials have reported the benefits of ePROMs, including improved symptom control, reduced emergency admission, and improved survival [[13], [14], [15], [16], [17]]. These benefits are especially noted when ePROMs include clinician alerts and self-management advice [18]. Therefore, ePROMs are a well-suited digital solution for personalised follow-up.
There is growing interest in embedding ePROMs into radiotherapy care. Several initiatives have demonstrated the feasibility of implementing ePROMs during treatment, when patients are typically reviewed on a weekly basis [[19], [20], [21], [22]]. However, evidence supporting their use in the post-radiotherapy period remains limited, despite it being a time when early side effects may occur, and clinical contact is often markedly reduced. This highlights a significant gap in the current care model.
To address this, we implemented an ePROMs-driven personalised follow-up system to identify patients needing earlier intervention post-radiotherapy. As part of a broader initiative to personalise radiotherapy care, we designed a feasibility study to: 1) assess the acceptability of the service, 2) evaluate recruitment feasibility, and 3) determine the effectiveness of ePROMs in monitoring patients after radiotherapy.
Materials and Methods
This service improvement project was conducted at The Christie NHS Foundation Trust, a large cancer centre in the United Kingdom, where the MyChristie-MyHealth ePROMs service was integrated into routine outpatient services since 2019 [17].
The project focused on incorporating ePROMs into the post-radiotherapy care of patients with lung or head and neck cancers. In addition, structured interviews were conducted to evaluate patient experiences with this new approach. This service evaluation was approved by The Christie NHS Foundation Trust Governance Panel.
Patient Recruitment
Patient recruitment occurred between March and April 2023. The eligibility criteria included individuals aged over 18 years who could provide verbal consent. Patients with either limited-stage small cell lung cancer, stage III non-small cell lung cancer or head and neck cancer undergoing 4–6 weeks of radiotherapy with or without concurrent chemotherapy were included. This study excluded individuals with no access to mobile phones or computers and those unable to read or understand English without translation.
Consecutive eligible patients were identified using lists of patients scheduled for radiotherapy or new patient clinic lists. They were approached and recruited via telephone with verbal consent. Upon obtaining consent, ePROMs were scheduled to align with patients’ treatment.
Service Design
During radiotherapy, patients with head and neck cancer received weekly face-to-face reviews, while patients with lung cancer were weekly monitored either virtually or face-to-face. In addition, patients could raise concerns during daily radiotherapy treatment or contact the 24-hour hotline. Once treatment was complete, patients were scheduled for the first face-to-face radiotherapy follow-up appointment approximately 4–6 weeks post-treatment.
As part of standard care, all patients received pre-treatment ePROMs and ePROMs at their follow-up appointments via text and/or email. Recruited patients were invited to complete ePROMs at six additional timepoints: mid-radiotherapy, end-radiotherapy, and weekly for four weeks post-treatment. Fig. 1 illustrates the integration of ePROMs into the radiotherapy pathway.
Fig. 1.
Integration of ePROMs into the radiotherapy pathway. Abbreviation: RT, Radiotherapy. ePROM, Electronic Patient-Reported Outcome Measure.
The ePROM questionnaires comprised EQ-5D-5L as well as 14 lung- or 19 head-and-neck-cancer-specific symptom questions (Supplementary Items 1 and 2). The symptom questions were adapted from the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 using lay language. Exceptions included the dysphagia question in the head and neck questionnaire, adapted from the International Dysphagia Diet Standardisation Initiative (IDDSI) framework [23], with a reverse scoring system where higher scores indicate a reduced ability to swallow regular diet. The questionnaires were developed based on prior studies involving patients and well-received by both patients and clinicians at our centre [[24], [25], [26]]. Importantly, they were designed as pragmatic tools for use in routine clinical practice, rather than for clinical trial settings. A formal validation of these questionnaires, including cognitive interviews and psychometric analyses in line with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations [27,28], is currently underway.
Upon completion, patients received automated advice based on symptom severity. This ranged from guidance on self-care to contacting clinicians within one week or seeking immediate medical attention. Clinicians set the advice thresholds based on symptom severity. All ePROMs were automatically uploaded onto the electronic health record. A designated team member reviewed the responses and escalated cases where patients reported symptoms graded two or above. The responsible clinicians then contacted patients to provide support.
Structured Patient Interviews
Those patients who had completed at least one ePROM were invited to participate in a structured telephone interview. The interviews were guided by a ten-question questionnaire to evaluate patient experience (Supplementary Item 3). At the end of the interview, patients were asked for suggestions on how the service could be improved. These interviews were conducted by P.A.N.K. with no audio recordings or transcripts.
Interview responses were summarised based on the structured questionnaire. Additional suggestions were captured using contemporaneous notes taken during the interviews. Although no formal qualitative analysis method was applied, the interviewer reviewed the responses to identify recurring themes in patient experience.
Data Collection and Statistical Analysis
Patient demographic and clinical data were collected from structured forms in the electronic health record at the time of consent. ePROM data were retrieved after the study period and stored in a Microsoft Excel file.
Descriptive statistics were used to analyse quantitative and categorical data in line with our objectives. To evaluate the recruitment feasibility, we summarised the number of patients assessed for eligibility, approached, and recruited. Monthly recruitment was calculated to determine whether enrolling 120 patients over 18 months (seven per month) would be achievable in a subsequent study. To evaluate acceptability, we analysed structured interview responses using frequencies and percentages. The ePROMs completion rates were also calculated to assess patient engagement. Lastly, to assess the utility of ePROMs in monitoring patients post-radiotherapy, we visualised symptom severity over time by plotting pre-selected symptoms and EQ-5D-5L domains using heatmaps.
Results
Patient Recruitment
Over two months, 64 patients were assessed for eligibility, with 30 meeting the inclusion criteria. The reasons for ineligibility included ten patients without a treatment plan, four treated with chemotherapy alone, 11 undergone radiotherapy for a duration outside the eligible range, and nine with disease stage outside the eligibility criteria.
Of the 30 eligible patients, 19 gave verbal consent to participate, resulting in a monthly recruitment rate of nine patients. Five patients declined, citing treatment-related anxiety (two patients) and lack of interest (three patients). Six patients did not respond to the recruitment calls. Supplementary Fig. 1 shows patient recruitment flow.
Patient Characteristics
Patient characteristics are summarised in Table 1. All clinical data were complete, with no missing values. Ten patients had lung cancer and nine had head and neck cancer. In the lung cancer group, the median age was 67 [46–73] years. Eight out of ten patients with lung cancer were female, ten had an ECOG performance status of 0–1, and nine received concurrent chemoradiotherapy. For head and neck cancer, the median age was 58 [50–76]. Three out of nine patients were female, seven had an ECOG performance status of 0–1, and four underwent concurrent chemoradiotherapy.
Table 1.
Baseline Patient Characteristics.
| Lung (n = 10) |
Head and Neck (n = 9) |
All (n = 19) |
|
|---|---|---|---|
| Age in years, median (range) | 67 (46–73) | 58 (50–76) | 66 (46–76) |
| Sex at birth, n (%) | |||
| Female | 8 (80.0) | 3 (33.3) | 11 (58.9) |
| Male | 2 (20.0) | 6 (66.7) | 8 (41.1) |
| Staging, n (%) | |||
| I | 0 (0) | 0 (0) | 0 (0) |
| II | 0 (0) | 3 (33.3) | 3 (15.8) |
| III | 8 (80.0) | 2 (22.2) | 10 (52.6) |
| IV | 0 (0) | 4 (44.4) | 4 (21.1) |
| Limited (Small cell) | 2 (20.0) | − | 2 (10.6) |
| Extensive (Small cell) | 0 (0) | − | 0 (0) |
| ECOG performance status, n (%) | |||
| ECOG PS 0 | 1 (10.0) | 4 (44.4) | 5 (26.3) |
| ECOG PS 1 | 9 (90.0) | 3 (33.3) | 12 (63.2) |
| ECOG PS 2 | 0 (0) | 2 (22.2) | 2 (10.5) |
| Clinical frailty scale, n (%) | |||
| 2 (Well) | 5 (50.0) | 4 (44.4) | 9 (47.4) |
| 3 (Manging well) | 4 (40.0) | 4 (44.4) | 8 (42.1) |
| 4 (Vulnerable) | 1 (10.0) | 1 (11.1) | 2 (10.5) |
| Adult comorbidity evaluation-27, n (%) | |||
| 0 (None) | 2 (20.0) | 2 (22.2) | 4 (21.1) |
| 1 (Mild) | 7 (70.0) | 5 (55.6) | 12 (63.2) |
| 2 (Moderate) | 1 (10.0) | 1 (1.11) | 2 (10.5) |
| 3 (Severe) | 0 (0) | 1 (1.11) | 1 (5.3) |
| Smoking history, n (%) | |||
| Current smoker | 4 (40.0) | 0 (0) | 4 (21.1) |
| Ex-smoker | 5 (50.0) | 7 (77.8) | 12 (63.2) |
| Non-smoker | 1 (10.0) | 2 (22.2) | 3 (15.8) |
| Treatment, n (%) | |||
| Radiotherapy alone | 0 (0) | 5 (55.6) | 6 (31.6) |
| Sequential Chemoradiotherapy | 1 (10.0) | 0 (0) | 0 (0) |
| Concurrent Chemoradiotherapy | 9 (90.0) | 4 (44.4) | 13 (68.4) |
Abbreviation: ECOG PS, Eastern Cooperative Oncology Group Performance Status.
ePROMs Completion Rates
Of 19 patients, 17 (nine lung and eight head and neck) completed at least one ePROM. Among 152 ePROMs sent to patients at eight timepoints, 105 were completed, indicating an overall completion rate of 69.1 %. The completion rate for the lung cancer group was 75.3 % (61 out of 80), ranging from 60.0 % to 90.0 % across timepoints. For head and neck cancer, the completion rate was 61.1 % (44 out of 72), ranging from 33.3 % to 88.9 %. Fig. 2 shows the percentage of ePROMs completed at each timepoint.
Fig. 2.
The number and percentage of completed ePROMs at each timepoint per disease group. Abbreviation: RT, Radiotherapy.
Reported Symptoms and Quality of Life
Fig. 3 presents the severity of six symptoms (pain, dyspnoea, cough, dysphagia, anorexia, and fatigue) reported by lung patients at each timepoint. Fig. 4 shows the severity of six symptoms (replacing cough with dry mouth) reported by head and neck patients. Additionally, EQ-5D anxiety scores are reported to provide a more comprehensive understanding of patient experience beyond physical symptoms.
Fig. 3.
Symptoms and anxiety levels reported by individual patients with lung cancer at each timepoint. Abbreviation: RT, Radiotherapy. ECOG PS, Eastern Cooperative Oncology Group Performance Status. ACE-27, Adult Comorbidity Evaluation-27. SCLC, Small Cell Lung Cancer. NSCLC, Non-Small Cell Lung Cancer.
Fig. 4.
Symptoms and anxiety levels reported by individual patients with head and neck cancer at each timepoint. Abbreviation: RT, Radiotherapy. ECOG PS, Eastern Cooperative Oncology Group Performance Status. ACE-27, Adult Comorbidity Evaluation-27.
In the lung cancer cohort, there were three instances where patients reported new symptoms graded three or above. All three events occurred at week 1 or week 2 post-radiotherapy, with two events leading to hospitalisation (both due to anorexia). Similarly, patients with head and neck reported new symptoms graded three or above on two occasions. These events occurred during treatment and at week 3 post-radiotherapy, both requiring hospitalisation (one due to dry mouth, dysphagia, and anorexia, whilst another primarily due to anorexia). Symptom severity at the first face-to-face follow-up appointment was similar to or less severe than those reported during or shortly after radiotherapy.
Increased anxiety levels were noted during radiotherapy and shortly after treatment completion. Anxiety levels either remained at the same level or reduced before the first follow-up appointment in both groups.
Patient Experience
Seventeen patients who had completed ePROMs at least once were invited for a telephone interview; 14 (seven lung and seven head and neck) agreed to participate. Three declined due to poor health post-hospitalisation, and one provided no reason.
The interview responses are summarised in Table 2. Regarding ePROMs usability, all 14 patients agreed that the questionnaire was easy to understand and took an acceptable amount of time to complete. While 12 patients (85.7 %) found the included questions relevant to their experience, six (42.9 %) reported that the questionnaire did not fully capture their symptoms and psychological needs. Regarding the impact on patient care, all patients found the advice provided upon completion helpful. Among eight patients who experienced side effects and required support, all knew whom to contact and received the support promptly. All patients felt that ePROMs enhanced their sense of support during and after radiotherapy.
Table 2.
Patient Experiences.
| Lung (n = 7) |
Head and Neck (n = 7) |
All (n = 14) |
|
|---|---|---|---|
| The questionnaire was easy to understand | |||
| Strongly Agree | 7 (100 %) | 7 (100 %) | 14 (100 %) |
| Agree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Strongly Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| The questionnaire took an acceptable amount of time to complete | |||
| Strongly Agree | 5 (71.4 %) | 4 (57.1 %) | 9 (64.3 %) |
| Agree | 2 (28.6 %) | 3 (42.9 %) | 5 (35.7 %) |
| Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Strongly Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| The questions were relevant to me | |||
| Strongly Agree | 5 (71.4 %) | 6 (85.7 %) | 11 (78.6 %) |
| Agree | 1 (14.3 %) | 0 (0 %) | 1 (7.1 %) |
| Disagree | 1 (14.3 %) | 1 (14.3 %) | 2 (14.3 %) |
| Strongly Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| The questions covered all my symptoms and psychological needs | |||
| Strongly Agree | 2 (28.6 %) | 4 (57.1 %) | 6 (42.9 %) |
| Agree | 1 (14.3 %) | 1 (14.3 %) | 2 (14.3 %) |
| Disagree | 4 (57.1 %) | 2 (28.6 %) | 6 (42.9 %) |
| Strongly Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Did you experience side effects during and/or after your radiotherapy treatment? | |||
| Yes | 5 (71.4 %) | 3 (42.9 %) | 8 (57.1 %) |
| No | 2 (28.6 %) | 4 (57.1 %) | 6 (42.9 %) |
| If you experience side effects, did you know who to contact within The Christie clinical team? | |||
| Yes | 5 (100 %) | 3 (100 %) | 8 (100 %) |
| No | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Not Applicable | 2 | 4 | 6 |
| If you required help, did you receive the input needed within an acceptable time? | |||
| Yes | 5 (100 %) | 3 (100 %) | 8 (100 %) |
| No | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Not Applicable | 2 | 4 | 6 |
| Completing questionnaires during radiotherapy made me feel better supported | |||
| Strongly Agree | 3 (42.9 %) | 5 (71.4 %) | 8 (57.1 %) |
| Agree | 4 (57.1 %) | 2 (28.6 %) | 6 (42.9 %) |
| Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Strongly Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Completing questionnaires after radiotherapy made me feel better supported | |||
| Strongly Agree | 5 (71.4 %) | 6 (85.7 %) | 11(78.6 %) |
| Agree | 2 (28.6 %) | 1 (14.3 %) | 3 (21.4 %) |
| Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Strongly Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| If you received self-care messages after completing the questionnaire, did you find it helpful? | |||
| Strongly Agree | 6 (85.7 %) | 7 (100 %) | 13 (92.9 %) |
| Agree | 1 (14.3 %) | 0 (0 %) | 1 (7.1 %) |
| Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
| Strongly Disagree | 0 (0 %) | 0 (0 %) | 0 (0 %) |
When asked for improvement suggestions, 11 patients suggested adding a free-text box to the questionnaires, so they could elaborate on specific concerns. One patient specifically suggested placing a free-text box after the treatment-related question to share their personal experience. Two had no suggestions.
Discussion
This feasibility study provides valuable insights into establishing ePROMs-driven personalised follow-up for post-radiotherapy care, an area that remains underexplored. Recruitment feasibility was assessed against a predefined target of 7 patients per month. Patient acceptability of the service was evaluated through structured interviews and ePROMs completion rates. Furthermore, the feasibility of using ePROMs to monitor patients after radiotherapy was explored.
Recruitment Feasibility
This study demonstrates the feasibility of recruiting at least seven patients per month, with an average monthly recruitment of nine patients. These findings suggest recruiting at least 120 patients over 18 months is achievable.
Six out of 30 eligible patients could not be contacted by telephone; however, this would unlikely be a concern in practice, as patient recruitment would typically occur face-to-face during clinics. Of those who declined to participate, two cited treatment-related anxiety, leaving only three uninterested patients (12.5 % of eligible participants). Participation rates were comparable to those observed in a similar-sized study implementing weekly ePROMs. For example, in the initial phase of ePROM implementation at a cancer centre in Alabama, United States, 87 % of 23 approached patients participated in a six-week ePROMs programme [29]. However, this was in a different context of patients treated with systemic therapy.
Acceptability of The Service
Patient acceptability was assessed through structured interviews and ePROMs completion rates. The overall completion rate across eight timepoints was 69.1 %, which is lower than other ePROMs initiatives. Rocque et al. and Hauth et al. reported that 70 % of 23 recruited patients and 81 % of 21 recruited patients reported, respectively [21,29]. However, these studies involved different patient populations. In addition, in our study, six patients were admitted hospital on nine occasions, which may affect completion rates.
Interviews revealed high service satisfaction. All patients found ePROMs user-friendly and reported feeling better supported during and after radiotherapy. While 87.5 % of patients found questions relevant, 42.9 % reported that not all relevant symptoms were covered by the questionnaire. A majority suggested adding a free-text box to allow them to elaborate on their responses, a recommendation consistent with feedback from our prior service evaluation [30]. There is limited evidence related to the inclusion of a free-text box in routine settings, and ESMO recommendations on ePROMs only suggest it as an optional feature [31]. We subsequently decided to include the free-text box in the lung questionnaire to assess its safety and usefulness.
Effectiveness of ePROMs in Monitoring Patients after Radiotherapy
This study highlights the potential of ePROMs in monitoring patients after radiotherapy. Symptoms were captured as clinically expected, with early radiotherapy side effects emerging shortly after treatment initiation and improving within weeks post-treatment [3,5]. This timeframe coincided with a gap in follow-up care and a need for support, with some patients requiring hospital admission. Despite the study’s small sample size, these findings reinforce the need to reconsider the standard 4-to-6-week post-treatment follow-up, as symptoms often occur earlier. Integrating ePROMs into follow-up care allows clinicians to identify patients requiring earlier intervention, while prompting patients to seek timely medical attention rather than waiting for follow-up appointments.
In this study, a designated team member was assigned to monitor completed ePROMs and escalate concerns to responsible clinicians. Although no safety issues occurred, service expansion would benefit from a dedicated patient-facing role, especially when limited time for ePROMs implementation and review is frequently cited as a barrier [32,33]. Several studies highlighted the role of nurse navigators in onboarding patients and managing ePROM alerts [29,34,35]. Franzoi et al. reported that a single nurse navigator could manage up to 200 patients within their system. Introducing a similar role in our service is being considered; alternatively, the responsibility of ePROMs monitoring should be carefully integrated into existing job plans. Importantly, securing funding is essential to support staff or recruit dedicated roles.
Limitations
Several limitations were identified in this study. Firstly, the recruited cohort does not fully represent the broader patient population, with disparities in gender distribution, and the median age compared to previous analyses of lung and head and neck patients treated at our institution. In addition, we were unable to compare the demographics of participants and non-participants, as demographic data of non-participants were not collected. This limits the assessment of generalisability, particularly given the likelihood that patients more comfortable with technology or more actively engaged in their care were more likely to participate.
Secondly, the approach to patient interviews introduced limitations that may have reduced the robustness of the findings. All interviews were conducted over the phone, limiting the ability to capture physical and non-verbal cues and potentially influencing the results. Furthermore, no audio recordings or transcripts were made; responses were instead summarised from interview notes without applying formal qualitative methods, limiting the analytical rigour. Also, 8 out of 14 patients who participated in the structured interviews and reported experiencing side effects indicated that they knew who to contact for assistance; it was unclear whether this stemmed from the advice provided through the ePROMs service or from standard communication pathways.
Thirdly, although this workflow proved manageable in a small-scale pilot with 19 patients, significant developments would be required to scale it effectively for routine clinical practice with larger patient volumes. We also recognise the need to explore the use of digital triage algorithms and automated alerts to prioritise responses and reduce manual workload. Adjusting escalation thresholds or developing tiered alerts may further enhance scalability and ensure clinical resources are used efficiently. These considerations will inform the design of our larger-scale study and future service development.
Lastly, despite high satisfaction, reasons for not completing ePROMs were not explored. Notably, completion rates declined post-radiotherapy, particularly among head and neck patients. Although this could be explained by hospitalisation, exploring barriers to ePROM completion would help improve the service.
Future Directions
This feasibility study has established a foundation for ePROMs-driven personalised follow-up in patients undergoing radiotherapy. While the findings highlight strong patient acceptability and demonstrate the ability of ePROMs to support symptom monitoring after radiotherapy, the study did not assess the broader clinical impact of the intervention. Our planned subsequent study, involving larger cohorts and additional tumour sites, will focus on assessing clinical effectiveness and service impact, such as healthcare utilisation, timeliness of interventions, and improvements in symptom control.
In addition, while this study focused on early side effects, future work should extend to late side effects, where standardised approaches for timely identification and management are lacking. Finally, future efforts should focus on improving patient engagement with ePROMs, key to the service’s success.
Conclusion
In summary, our study demonstrates the feasibility of integrating ePROMs into a personalised follow-up strategy post-radiotherapy, based on recruitment feasibility, patient acceptability, and the ability of ePROMs in monitoring patients after treatment. Further research should focus on the impact of such intervention on clinical outcomes and service delivery.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement
This work uses data provided by patients and collected by the NHS as part of their care and support. The Christie ePROMs service ‘MyChristie-MyHealth’ is funded by The Christie Charity, The Manchester Cancer Research Centre, and The University of Manchester. C. Faivre-Finn is supported by the NIHR Biomedical Research Centre.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.tipsro.2025.100333.
Appendix A. Supplementary Data
The following are the Supplementary data to this article:
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