Feasibility of Electronic Patient-Reported Outcomes in Older Cancer Patients

Medicine Environmental and Public Health Oncology
electronic patient-reported outcomes older patients cancer care remote monitoring quality of life technological barriers

Multicenter Prospective Study: Feasibility of Electronic Patient-Reported Outcomes (ePROs) in Elderly Cancer Patients

Research Background

In recent years, telemedicine has developed rapidly, especially during the COVID-19 pandemic, and is considered a solution to the problem of medical personnel shortages. Electronic patient-reported outcomes (ePROs) have been proven to improve overall survival (OS) and quality of life in cancer care. However, prospective data specific to remote ePRO monitoring for elderly cancer patients aged 75 and above are scarce. This population represents a significant proportion of total cancer patients, making the feasibility study of ePROs in this group an urgent issue to address.

The guidelines from the European Society for Medical Oncology (ESMO) on PROs do not provide specific data for patients aged 75 and above. Furthermore, according to the World Health Organization (WHO), the number of elderly people aged 80 and above is expected to triple by 2050 compared to 2020. Thus, exploring the feasibility of ePROs in this group is necessary to improve the quality of cancer care.

Research Sources

This paper was completed by Dr. Mathilde Cancel, MSc Carine Sauger, Dr. Julie Biogeau, Dr. Véronique Dardaine-Giraud, Dr. Thierry Lecomte, Dr. David Solub, Dr. Pierre Combe, Dr. Rémy Wilmet, MSc Eugénie Aubard, and BSc Amandine Deloigne. The study was published in the Journal of Clinical Oncology on May 6, 2024.

Research Design and Methods

Study Process

This study is a prospective multicenter study conducted from February 2021 to April 2022 in six cancer centers in the Loire Valley, France. Subjects included patients aged 75 and above who were undergoing anticancer treatment (chemotherapy, immunotherapy, endocrine therapy, and targeted therapy). Excluded were patients already using connection applications to monitor symptoms, those with severe cognitive impairment, and long-term inpatients.

The study used a web-based application, ANA, developed by ANA-Health and compliant with European Class I medical device standards. The application is designed to collect and report patient-reported outcome data and supports access through any connected device, such as computers, smartphones, or tablets.

Process Details

Patient Screening and Recruitment

Out of 492 screened patients, 19 were excluded for not meeting the criteria, leading to a total of 473 patients participating in the study. Initially, patients’ basic information was recorded, and assistance was provided for creating login credentials and training on using ANA.

Acceptance and Feasibility Evaluation

  1. Patients who declined to test were categorized as the “Primary Failure” group, and the reasons were recorded.
  2. The remaining patients were included in the “Intention to Test” (ITT) group and monitored for ePRO use within 3 months.
  3. Active participants were defined as patients who completed at least one form, whereas non-users were deemed non-active participants.
  4. Follow-up was planned for 3 months, and a satisfaction survey was conducted at the end of the study to evaluate patient feedback.

Data Collection

The primary endpoint was to assess the feasibility of remote ePRO reporting in elderly cancer patients. Secondary endpoints included: 1. Evaluating the feasibility of each protocol. 2. Estimating the proportion of active participants in the ITT population. 3. Identifying factors influencing the use of ANA and assessing patient satisfaction.

Statistical analysis was performed using SPSS software, with all tests being two-sided. Differences were considered statistically significant if the p-value was less than 0.05.

Research Results

Patient Data

A total of 492 patients were screened, with 473 enrolled. The median age of patients was 79 years (interquartile range 77-82), with the majority living at home (460⁄473, 97.2%) and receiving in-hospital treatment (84.1%). The main cancer types included digestive system cancer (29.6%), gynecological cancer (24.1%), and hematologic malignancies (20.5%).

Feasibility of ePRO Monitoring

Among all enrolled patients, 39% (185⁄473) were willing to test ePRO. Active users of ePRO were 122 patients, with the feasibility in the ITT analysis being 26%, and the feasibility for each protocol reaching 66%. Active participants completed a median of 6 questionnaires (interquartile range 3-10), with 41% of patients continuing to use the application after the study follow-up.

Analysis of Influencing Factors

The study found that: 1. Primary Failure Group Analysis: High social occupational category and self-assessed good health status significantly influenced patients’ willingness to test ePRO. 2. Active Participants Analysis: In the ITT population, the proportion of active participants self-assessing good health status was significantly higher than non-active participants. Factors such as age, residence area, social occupational status, having caregivers, and treatment location showed no significant differences.

Satisfaction Survey

Among ITT patients, 57% were satisfied with the application, with an active user satisfaction rate of 71%. Most dissatisfied users considered the software unsuitable for their use.

Conclusion and Significance

In summary, this study suggests that the overall feasibility of remote ePRO monitoring in elderly cancer patients is limited (26%), but the proportion is higher among those willing to test (66%). The main barrier is technological access, primarily internet connectivity. The study highlights high social occupational category and good health status as important factors influencing ePRO use.

Given the significant impact of ePRO on improving cancer patient survival quality and overall survival, overcoming technological barriers and enhancing the user experience for elderly patients is urgently needed to improve cancer care quality.

This study’s first exploration in the elderly patient population provides valuable data for future remote ePRO monitoring studies in elderly cancer patients and points to directions for technological improvements and education training.

These research findings were presented at the 2023 ASCO Annual Meeting on June 4 and the Société Francophone d’Oncogériatrie Annual Meeting on November 24, 2022, and published by the research team in the Journal of Clinical Oncology.