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. Author manuscript; available in PMC: 2021 Dec 1.
Published in final edited form as: Ann Surg Oncol. 2019 Nov 18;27(Suppl 3):725–726. doi: 10.1245/s10434-019-07920-9

ASO Author Reflections: Patient-Reported Outcomes—Bench to Bedside

Srinivas Joga Ivatury 1,2, Sandra L Wong 1,2, Deborah Schrag 3
PMCID: PMC7231622  NIHMSID: NIHMS1543816  PMID: 31741111

Past:

Historically, oncology trials have focused on quantitative parameters: mortality, recurrence, and short-term morbidity. In recent years, there has been a trend towards obtaining patient perspective through systematic tracking of electronic patient reported outcomes. PRO-CTCAE, a companion to CTCAE that measures symptomatic toxicity from the patient perspective, has been developed and validated and is publicly available for use in multiple languages.1,2 Recent oncology clinical trials that have utilized PROs have demonstrated reduced acute care utilization, and symptom burden, as well as improved survival. It has now become imperative to translate and integrate PROs into everyday oncology clinical practice.

Present:

Our educational review provides the framework of factors to consider when integrating PROs into everyday oncology clinical practice.3 There are number of clinical, logistical, and organizational factors that clinicians must take into account in order to integrate PROs into everyday practice. The rapid dissemination of smartphones and the ability to track patients’ symptoms between visits has created great potential for decreasing potentially avoidable clinic visits, emergency department visits, and unplanned hospitalizations. Studies have found that patients are willing to report their symptoms through this approach4 - establishing its value. We must also be cognizant that these studies have been largely conducted at tertiary academic medical centers, where the minority of oncology care is performed worldwide.

Future:

We must find the most effective strategies for implementation of PROs more consistently into clinical practice in order to maximize what is most important to the patient. On one hand, proliferation of multiple freestanding apps and symptom trackers creates chaos for clinicians. On the other, accessibility of PRO data alongside clinical data and visit histories augments the potential for actionability of PROs. Integration of PROs into existing patient portals is an important goal. Systems that engage both patients and clinicians in proactive symptom management without overburdening or pestering either party will likely have the largest impact. Several large trials currently underway including the PRO-TECT study5 and trials from the NCI’s IMPACT Consortium6 will generate data on how PRO implementation affects a variety of outcomes. We must evaluate implementation of PROs across a range of patient populations and across diverse health care delivery systems. Learning the barriers and facilitators to broad uptake of PROs will optimize oncology care delivery via true translation efforts.

Acknowledgments

Funding: Funded by NIH UM1 CA233080-1.

Disclosures: Dr. Schrag has received research funding from Pfizer. She has also received remuneration from GRAIL and from JAMA for editorial services Dr. Ivatury and Dr. Wong report no conflicts of interest.

Footnotes

Publisher's Disclaimer: This Author Accepted Manuscript is a PDF file of an unedited peer-reviewed manuscript that has been accepted for publication but has not been copyedited or corrected. The official version of record that is published in the journal is kept up to date and so may therefore differ from this version.

ASO Author Reflections is a brief invited commentary on the article, “Translation of Patient-Reported Outcomes in Oncology Clinical Trials to Everyday Practice,” Ann Surg Oncol. (2019). https://doi.org/10.1245/s10434-019-07749-2

References

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