Photo Credit: Nuttawan Jayawan

A recent systematic review and meta-analysis found that incorporating PROMs into cancer care is associated with lengthened overall survival and improved QOL.

Incorporating patient-reported outcome measures, or PROMs, into cancer care is associated with lengthened overall survival and improved patient QOL, according to findings from a recent systematic review and meta-analysis published in JAMA Network Open.

The lead author of the study explained that symptoms in people with cancer can often go unnoticed by their care providers. The last systematic review of PROMs in oncology care was in 2014, and it did not include a meta-analysis because of the variability of the studies. Since then, the researchers went on to say that PROMs have become more important in the care of patients with cancer.

“It’s important to know that there is a discrepancy between what a patient reports as their symptoms, and what a clinician reports or documents, and often clinicians underestimate the frequency and severity of the patients’ symptoms,” study author Amaris K. Balitsky, MD, MSc, told Physician’s Weekly (PW). “This has been documented in multiple studies, which is all the more reason we should be asking patients directly to report their symptoms and QOL.”

Dr. Balitsky and colleagues searched for randomized clinical trials of adults with active cancer who received some form of anti-cancer treatment. To be included, trials needed to use PROMs as an intervention. The primary outcomes of the review and meta-analysis were HRQOL measures, hospital utilization, and overall mortality. Researchers used random-effects analyses to determine the potential impact of any PROMs that appeared as an intervention in at least two eligible studies. 

The review included 45 randomized controlled trials, which included a total of 13,661 patients. All eligible articles were published between 1996 and 2022. 

Effect of PROMs in Clinical Trials

The researchers reported that adding a PROM was associated with a reduced risk for overall mortality (HR=0.84, 95% CI, 0.72-0.98, moderate certainty). Integration of PROMs also appeared to be linked with improved health-related quality of life as measured at 12 weeks (mean difference, 2.45; 95% CI, 0.42-4.48; moderate certainty).

Improvements in HRQOL were not significant at the 24-week mark, they added (mean difference, 1.87, 95% CI, −1.21 to 4.96, low certainty). At 48 weeks, they continued, there was no association between PROMs as an intervention and HRQOL.

Further, the researchers noted that including PROMs in clinical trials did not appear to be associated with reduced healthcare resource use. The use of PROMs in these studies was not linked with reduced ED visits (OR=0.74, 95% CI, 0.54-1.02; I²=53.2%; P=0.09) or with reduced hospital admissions (OR=0.86, 95% CI, 0.73-1.02; I²=0%, P=0.79).

However, the researchers also noted the potential impact of digital health tools. Multiple studies in the review obtained PROMs electronically, a strategy that “lends itself to the potential for the integration of digital health tools into oncology care,” Dr. Balitsky and colleagues reported.

Further, they noted that using patient-reported symptoms and other PROMs is integral to remote patient monitoring, including checking vital signs. Remote patient monitoring coupled with interactive clinician care “could help anticipate and reduce toxic effects and therapy-related sequelae, improve patient well-being, and potentially reduce hospital resource utilization and treatment burden.” 

Additional Questions and Future Research

Researchers acknowledged several questions the meta-analysis could not answer. These included questions about the specific mechanisms and exactly when and how these metrics should be used in the clinic. The study also did not discern which individual PROMs were important in the reviewed trials, partly because these outcomes are measured with various tools.

“A few questions come out of this,” Dr. Balitsky explained. “One question is: What is the mechanism of why PROMs work, and when are they appropriate to use? Is it a proactive measure or more of a supportive care measure? Is it working well because it improves communication between the patient and the clinician? Is it improving care because it improves patient self-reflection? We don’t fully understand that yet, and that can be its own set of questions and its own study.”