Oncology and Informatics – Editorial

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Electronic Patient-Reported Outcomes: A New Standard of Care?

Putora P.M.a,b

Author affiliations

aDepartment of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
bDepartment of Radiation Oncology, University of Bern, Bern, Switzerland

Corresponding Author

Dr. Paul Martin Putora

Department of Radiation Oncology, Kantonsspital St. Gallen

Rorschacherstrasse 95

CH–9007 St. Gallen (Switzerland)

E-Mail paul.putora@kssg.ch

Related Articles for ""

Oncology 2020;98:327–328

The paper in this issue by Giordano [1] describes the current state of mobile health in oncology, a big part of which are electronic patient-reported outcomes. The most impressive results are reported in two prospective randomized trials by Basch et al. [2] and Denis et al. [3] demonstrating a survival benefit with electronic patient-reported outcome measures (ePROMs).

Two other examples of recent significant trials in lung cancer include the IMPOWER 133 trial [4] and the PACIFIC trial [5], both introducing immunotherapeutic agents to lung cancer. For many, these trials are shaping new standards of care. The IMPOWER 133 trial demonstrated an improvement in overall survival from 10.3 months to 12.3 months with the addition of atezolizumab to chemotherapy in stage IV small-cell lung cancer. The PACIFIC trial demonstrated an overall survival benefit with durvalumab in patients with stage III, unresectable non-small-cell lung cancer without disease progression after concurrent chemotherapy. The placebo arm had a median overall survival (mOS) of 28.7 months, while the mOS for the durvalumab arm has not yet been reached: 34.7 months or more (95% confidence interval) [6].

The survival benefit from the ePROM trials is no less impressive, with an increase in mOS from 26 to 31.2 months when used for adverse event monitoring during chemotherapy [2] and an increase from 12 to 19 months when used in follow-up [3]. Does this make ePROMs standard of care? While it is simple to argue that the advantage of the ePROM arms may stem from insufficient care in the control arm, these control arms represent reality. We can always improve patient communication and optimize follow-up independently of the use of ePROMs; however, these interventions have demonstrated a meaningful impact on patients’ lives. Additionally, we can guess which interventions might win in cost-efficiency analyses.

Whether we are ready to declare the use of ePROMs a standard of care is up for debate – several barriers and limitations are addressed in the paper by Giordano [1]. Going forward, we will need to learn how to apply this new modality and understand how to compare and combine approaches. Guideline committees will need to broaden their searches and future guidelines will be incomplete if these aspects are ignored.

The paper by Giordano [1] describes the current state of ePROMs and the results from the positive ePROM trials underline their importance.

Disclosure Statement

The author has no conflicts of interest to declare.



References

  1. Giordano FA, Welzel G, Siefert V, Jahnke L, Ganslandt T, Wenz F, et al. Digital Follow-up and the Perspective of Patient-Centered Care in Oncology: What’s the PROblem? Oncology. 2018, DOI: 10.1159/000495294.
  2. Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, et al. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. JAMA. 2017 Jul;318(2):197–8.
  3. Denis F, Lethrosne C, Pourel N, Molinier O, Pointreau Y, Domont J, et al. Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients. J Natl Cancer Inst. 2017 Sep;109(9):109.
  4. Horn L, Mansfield AS, Szczęsna A, Havel L, Krzakowski M, Hochmair MJ, et al.; IMpower133 Study Group. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer. N Engl J Med. 2018 Sep;NEJMoa1809064.
  5. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, et al.; PACIFIC Investigators. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med. 2017 Nov;377(20):1919–29.
  6. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, et al.; PACIFIC Investigators. Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC. N Engl J Med. 2018 Sep;NEJMoa1809697.

Author Contacts

Dr. Paul Martin Putora

Department of Radiation Oncology, Kantonsspital St. Gallen

Rorschacherstrasse 95

CH–9007 St. Gallen (Switzerland)

E-Mail paul.putora@kssg.ch


Article / Publication Details

Received: October 29, 2018
Accepted: October 29, 2018
Published online: December 12, 2018
Issue release date: June 2020

Number of Print Pages: 2
Number of Figures: 0
Number of Tables: 0

ISSN: 0030-2414 (Print)
eISSN: 1423-0232 (Online)

For additional information: https://beta.karger.com/OCL


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References

  1. Giordano FA, Welzel G, Siefert V, Jahnke L, Ganslandt T, Wenz F, et al. Digital Follow-up and the Perspective of Patient-Centered Care in Oncology: What’s the PROblem? Oncology. 2018, DOI: 10.1159/000495294.
  2. Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, et al. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. JAMA. 2017 Jul;318(2):197–8.
  3. Denis F, Lethrosne C, Pourel N, Molinier O, Pointreau Y, Domont J, et al. Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients. J Natl Cancer Inst. 2017 Sep;109(9):109.
  4. Horn L, Mansfield AS, Szczęsna A, Havel L, Krzakowski M, Hochmair MJ, et al.; IMpower133 Study Group. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer. N Engl J Med. 2018 Sep;NEJMoa1809064.
  5. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, et al.; PACIFIC Investigators. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med. 2017 Nov;377(20):1919–29.
  6. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, et al.; PACIFIC Investigators. Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC. N Engl J Med. 2018 Sep;NEJMoa1809697.
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