Dr. Basch directs the Cancer Outcomes Research Program at Chapel Hill-based University of North Carolina’s Lineberger Comprehensive Cancer Center, chief of medical oncology and the Richard M. Goldberg distinguished professor of medicine at UNC School of Medicine.
He recently led a study, published Feb. 7 in Nature Medicine, that assessed the effect of electronic patient-reported symptom management among cancer patients at 52 oncology practices across 26 states.
He told Becker’s the impetus behind the national trial was multiple smaller studies that found providers miss about half of the symptoms and side effects experienced by cancer patients, whether during treatment, clinical trials or drug development.
“If we’re missing people’s symptoms and side effects, we can’t intervene,” Dr. Basch said. “Those things will then get worse, leading to unnecessary, preventable suffering and also to downstream complications, like people missing their treatments, missing their appointments, going to the emergency room, being hospitalized or even catastrophic medical outcomes.”
To analyze the effect patient-reported outcomes might have during the multicenter national trial, patients were randomly chosen to either complete a weekly online symptom questionnaire or receive standard care. Cancer care teams were electronically notified when patients in the questionnaire group reported severe or worsening symptoms.
Patients were enrolled for up to a year and were all undergoing treatment for metastatic or advanced stage cancers. These patients accrue high costs for health systems as they are often admitted to the hospital or emergency room, Dr. Basch said.
“We found that there were highly significant and clinically meaningful improvements in patient symptom control, quality of life and physical functioning,” he said. “We also saw a substantial decrease in emergency department visits, but we did not see any difference in overall survival.”
A key factor in the success of an electronic patient reported outcome initiative is a facility’s existing culture of quality, the study found.
“There needs to be either a quality officer or a value-based care officer who can run programs effectively and there needs to be enough staffing that they can handle these patient problems that are coming in,” Dr. Basch said. “The biggest [program implementation] barrier we found among our 52 practices was a highly variable state of readiness.”
Dr. Basch is currently working on a new initiative, OncoPRO, with the American Society of Clinical Oncology. Together, and in partnership with major EHR vendors, they are running co-learning collaboratives to support remote symptom monitoring and management programs. He encourages interested health systems and cancer centers to join OncoPro, which is working with EHR vendors Epic, Cerner, iKnowMed and OncoEMR.
“These programs can be difficult to roll out. It requires new technology, staff training, patient engagement and continuous program monitoring. Once these programs get rolling, they do great,” Dr. Basch said. “It is a mid- to long-term investment in improving outcomes with an intervention that actually makes communication with your patients better. To me, it’s a win.”