The discussion began with a presentation by Ethan Basch, MD, MSc, director of the Cancer Outcomes Research Program at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center, Division Head of Oncology and chief medical officer at NC Cancer Hospital, and professor of health policy and management at UNC Gillings School of Global Public Health. The panel also included Nadia Still, DNP, RN, senior director of customer services at Carevive Systems, Inc; Madelyn Trupkin Herzfeld, co-founder and vice-president of Carevive; and Bruno Lempernesse, Managing Director of Carevive.
“One of the pillars of quality cancer care is symptom management. It’s at the heart of what we do because cancer is so symptomatic, and our treatments are also very symptomatic, ”said Basch. “And early in my career, I started to observe that unfortunately we often miss the symptoms that patients can experience that appear later. We realized that in reality they were showing up much earlier, but they escaped our notice. “
This realization led him and his research group to conduct preliminary studies to determine whether simultaneous use of PROs and clinician reports would reveal gaps in reported symptoms. They found significant differences between the incidence of symptoms reported by patients compared to clinicians, with symptoms underreported by clinicians compared to PRO. “This is a missed opportunity to detect symptoms early to intervene and to improve the patient experience and potentially avoid downstream complications,” said Basch.
Basch highlighted PRO electronic systems (ePRO) as a way to implement patient reporting and symptom management. Patients self-report their symptoms with the system, whether through a web interface, smartphone or automated telephone questionnaire. He noted that a traditional telephone system is the most accessible to patients, especially in community practices and rural areas. The system can automatically respond with information on how to self-manage symptoms while transmitting the information to providers and electronic health records.
Providing multiple interface options for patients and predefined reminders for them to enter their inquiries are 2 key best practices to help ensure patient side buy-in, said Basch.
A randomized controlled trial by Basch’s research group found that compared to standard care, patients using ePRO were 7% less likely to visit the emergency room.1 Median survival was also 5.2 months longer in patients in the self-report group of the study. “In this and other studies, patients were able to stay on chemotherapy longer using this type of ePRO intervention,” added Basch. Better quality of life and improved functionality have also been observed in these patients.
Basch noted that patients generally reported satisfaction with ePRO systems, as did nurses. He warned that these systems increase nurses’ initial workload, but will save labor down the line if fewer patients have hospital visits. Therefore, workflow adaptation should be planned and clinics should be prepared before starting to use ePRO systems.
Introducing ePRO systems to patients can be quick, Still explained in his presentation. In the case of Carevive PROmpt, for example, a physician could introduce the concept to patients before a patient navigator explains the system to the patient in more depth. By next week, patients should be comfortable taking weekly surveys from their homes.
Based on the survey responses, the system responds with a self-management plan that includes evidence-based methods to manage their symptoms. Regarding supplier notifications, practitioners can set the threshold to avoid getting bogged down in alerts.
Herzfeld discussed reimbursement, highlighting reimbursement codes that were created specifically to deal with the rise of telehealth during the pandemic. Some examples she provided were codes for electronic visits, which are set up by providers to deal with situations where a clinic visit is not necessary; codes for patient initiated virtual recordings; the Principal Care Management code, which concerns the overall management of a single high-risk disease lasting more than 3 months; and reimbursement for remote monitoring with an FDA approved device such as a fitness tracker.
RSM could be included as an enhanced service required for patients in the upcoming Oncology Care First model, which is expected to begin in July 2022, Herzfeld pointed out. For physicians planning to participate, it would be a good idea to get used to using ePROs in advance, she said.
Finally, Lempernesse mentioned the importance of data on patient experience, which includes symptoms of the disease, impact on quality of life, experience of treatments, comments on the most important outcomes for patients. patients and the relative importance of a given problem for each patient. Using ePROs provides a complete picture of the patient experience, he said.
“So if we look at the implications for the future of cancer care with this data, what do we see? Well today [there are] already have several applications and advantages to using this type of data in cancer care, ”said Lempernesse. “This data enables patients to become active stakeholders, with increased engagement in their treatment and disease. From a clinician’s perspective, using patient-reported data and outcomes improves patient-provider communication, informs treatment and symptom pathways, increases alertness and real-time actions with alerts, and finally , supports personalized care.
1. Basch E, Deal AM, Dueck AC, al. Overall survival results from a trial evaluating patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017; 318 (2): 197-198. doi: 10.1001 / jama.2017.7156