Purpose
Utilization of patient-reported outcome measures (PROMs) to guide symptom management during radiation therapy has shown to be more sensitive to changes in health status and might detect the exact onset of the toxic effects of radiotherapy more accurately than clinician-reported outcomes. The Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) is a validated 16-item, diseasespecific PROM that targets the unique needs of men with prostate cancer (PCa) and evaluates the five HRQOL domains of urinary incontinence, urinary irritation/obstruction, bowel related symptoms, sexual dysfunction and hormonal symptoms. At our radiotherapy treatment units, there is currently no standardized method in place to record disease specific PROMs from baseline until end of treatment for patients who undergo radical PCa radiotherapy. There are also inconsistencies in how and at what point in a PCa patient’s treatment course should questionnaires be given to obtain PROMs. While EPIC-CP has been shown to provide a short yet effective method to measure outcomes, little is known about how to implement widespread dissemination of EPIC-CP and at what fraction in a PCa patient’s treatment course should questionnaires be given to obtain accurate PROMs. Strategies for implementation and dissemination of EPIC-CP deserve investigation, as does the identification of barriers to routine administration, and the assessment of EPIC-CP use on patient outcome/satisfaction and clinician workflow. The aim of this Quality Improvement project is to evaluate the feasibility of administering EPIC-CP at regular intervals during hypofractionated radiotherapy in PCa patients. EPIC-CP’s acceptability and role in customizing care from the perspective of patients and Radiation Therapists (RTs) will also be assessed.
Methods
Eligible patients for this prospective feasibility project are those being treated with hypofractionated schemes (≥3Gy/fraction) for radical PCa treatments at our institution between January 2020 to April 2020. The first EPIC-CP questionnaire was given to patients in paper format on their first day of treatment during their new patient education to gather baseline information. The same questionnaire was then given twice a week until the end of treatment. RTs documented answers to every EPIC-CP questionnaire into the patient’s electronic medical record. Satisfaction, practicality and usefulness of the tool in facilitating discussions regarding treatment side effects were to be evaluated from the patient’s perspective through a Patient Experience Survey (PES). Qualitative focus group interviews were to be conducted with RTs who provide consent to capture how they used the tool in their practice, their perspectives on its value and barriers encountered. This was to be audiotaped, transcribed verbatim and then thematically analyzed. Standard deviations, means, paired t-test and chi-square tests was to be used according to data characteristics of the EPIC-CP and PES.
Results
Due to COVID-19 pandemic, all research and access to data collection was terminated. RT’s feedback was collected though an online survey which resulted in a low response rate with only three completed surveys submitted. Survey feedback showed low compliance of RTs administrating EPIC-CP twice a week to patients. High workload and inability to manage time with other urgent RT tasks was the largest barrier for EPIC-CP implementation. EPIC-CP surveys and PES could not be analyzed and therefore was not included in the results section.
Conclusion
Organisations implementing PROMs need to invest time and resources in designing the PROMs strategy and preparing the organisation to use PROMs. Focusing on these earlier stages is critical in eliminating patient confusion, clinician workload strain and an overall fluid collection process of PROMs to better manage treatment outcomes.