ASO Author Reflections: Using Patient-Reported Outcomes to Optimize Care of the Surgical Oncology Patient

Past:

Traditional measures of surgical quality and effectiveness have concentrated on rates of morbidity, mortality, cancer recurrence, disease-specific and overall survival. While these outcomes are quantifiable and easily obtainable, they do not inherently capture the patient’s perspective of their illness and treatment.(1) Patient-reported outcomes (PROs) elicit facets of a patient’s health status and are direct links to the patient’s perception of their care. As measures of healthcare quality increasingly become patient-centered, the patient-provider relationship has evolved to recognize the importance of PROs in improving healthcare delivery and efficiency.(2) Numerous assessment tools have been developed and validated for use in patient care over the last several decades.

Present:

Despite issues with the logistics of widespread implementation, there is now growing appreciation in surgical oncology for incorporating PROs into mainstream clinical practice and using these measures to complement how we assess outcomes for surgical oncology patients.(3) Surgeons are increasingly accepting that PROs offer additional information to help improve the quality of surgical outcomes. Ideally, PROs can also be used to manage symptoms and complications. Currently, issues related to cost, labor intensive data capture, and applicability regarding cancer-specific operations hamper the widespread utilization of PROs. However, the development and implementation of electronic PROs (ePROs) to frequently and actively monitor patients in the perioperative setting are on the horizon.(4) For example, the multicenter Symptom Management Implementation of Patient Reported Outcomes in Oncology (SIMPRO) Research Center is presently evaluating an ePRO reporting and management system centered on symptom control in medical and surgical patients undergoing cancer treatment As ePRO measures become integrated directly into the electronic health record, their incorporation into standard of care practice will likely follow.

Future:

As ePROs expand into everyday practice, new challenges will emerge. The controversies will no longer be centered around the validity, reliability or cost of PROs, but on how to process and store the vast amounts of data generated and protect patient privacy. Payers and policymakers will become increasingly invested in using PROs to measure and profile performance. Furthermore, we must be cautious to not allow socioeconomic, educational and access issues to prevent vulnerable populations from benefitting from these technologic advances. Rural areas with limited telecommunications infrastructure will need to be targeted, and devices made affordable and easy to use. In order to reach a diverse population, assessment tools must be devised in ways that adjust for and minimize the impact of disparities in literacy, physical abilities, and income. Physicians, nurses, information technologists, administrators, support staff and patients will all need to be engaged in order to maximize the capabilities of this technology and positively impact healthcare outcomes.