Routinely measuring aspects of health status from the oncology patient’s point of view and using these measures in care improves selected outcomes, according to Grigorios Kotronoulas, Ph.D., and his associates.
The report was published online April 7 in Journal of Clinical Oncology.
For a systematic review, Dr. Kotronoulas and his associates searched five electronic databases through May 2012 to identify controlled trials (whether randomized or not) that tested patient-reported outcome measure (PROM) interventions among adults receiving active anticancer treatment or supportive care, irrespective of type of cancer or stage. The trials had to provide PROM-generated feedback to health care professionals or patients in an effort to improve the quality of care.
The investigators assessed potential impact of the routine PROM use in three broad areas: patient outcomes (e.g., symptom burden, health-related quality of life), processes of care (patient adherence and satisfaction, patient–health professional communication, referrals), and health service outcomes (patient safety, cost-effectiveness).
The search identified 26 articles that reported on 24 unique controlled trials having a total of 6,279 patients and 713 health professionals, reported Dr. Kotronoulas of University of Surrey, Guildford, England, and his colleagues.
The trials had a wide range of designs and used diverse interventions (J. Clin. Oncol. 2014 April 7 [doi:10.1200/JCO.2013.53.5948]). In addition, the outcomes evaluated and cancer- and modality-specific context varied considerably. Although 87.5% of trials reported on patient outcomes and 79.2% reported on processes of care, only 20.8% reported any health service outcomes as endpoints.
Analyses showed that overall, there were few statistically significant associations between routine use of PROMs and a variety of outcomes. Additionally, the intervention effect sizes were generally small to moderate.
Routine use of PROMs did increase the frequency of discussion of patient outcomes during consultations. Interventions had the greatest impact in the context of palliative chemotherapy, where they improved discussion of dyspnea; social functioning and fatigue; and sleep problems, constipation, diarrhea, and cognitive functioning.
Seven trials found that PROMs were associated with improved symptom control, positive effects seen in terms of reduced prevalence or severity of physical symptoms, and reduced prevalence, severity, or impact of psychological symptoms, the investigators reported.
Some trials found PROMs to be associated with increased supportive care measures and greater patient satisfaction.
"More research is necessary on the effects of PROM interventions on health outcomes across different types of cancers and treatment modalities," the researchers wrote.
"Additional effort is required to ensure patient adherence, as well as additional support to clinicians who will respond to patient concerns and issues, with clear system guidelines in place to guide their responses. More research is required to support PROM cost-benefit in terms of patient safety, clinician burden, and health," they added.
Dr. Kotronoulas reported no disclosures. Dr. Nora Kearney, a coauthor, disclosed that she received funding from Philips HealthCare. The other authors disclosed no conflicts of interest.