PRO Survey Easily Integrated Into Standard Oncology Practice

Patient-reported outcomes (PROs) can be introduced to both general and academic oncology practices through the use of standardized reporting tools, such as the revised Edmonton Symptom Assessment Scale (ESAS-r), according to a study published in Journal of Oncology Practice (published online February 14, 2017; doi:10.1200/JOP.2016.018390).

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PROs have emerged as a tool to improve both the quality of care patients receive and the value of care, through the identification of potentially harmful or intolerable treatment-related adverse events. Many doctors are eager to integrate PROs into their practice; however, little agreement exists regarding the optimal methods for doing so.

The ESAS-r is a validated tool designed to assess the symptom burden of patients with cancer. Emily Mackler, PharmD, BCOP, clinical pharmacist and senior project manager at Michigan Oncology Quality Consortium and adjunct clinical associate professor at University of Michigan College of Pharmacy (Ann Arbor, MI), and colleagues sought to determine whether the ESAS-r could be seamlessly integrated into eight oncology practices in the state of Michigan.

Prior to scheduled outpatient visits, patients taking oral oncolytic therapies were asked to complete the ESAS-r, which is comprised of 13 questions pertaining to mental and physical symptoms associated with cancer treatment. The survey ranks symptoms as mild (score of 0-3), moderate (score of 4-6), or severe (score of 7-10).

Patients completed a total of 1235 ESAS-r surveys, representing 29 unique oral anticancer drugs. The majority of reported symptoms (82.5%) were mild; moderate symptoms accounted for 11.9% reported, and severe symptoms accounted for 5.9%.

Survey domains in which patients more frequently reported moderate or severe symptoms included overall well-being (34%), fatigue (35%), and pain (20%). Twenty-three percent of surveys (n = 286) included four or more domains identified as moderate or severe.

Based on survey responses, the researchers identified potentially actionable symptoms in 55.5% of assessments, which met the study’s predefined threshold.

“This initiative was one of the first steps toward facilitating standard processes … to address the care of patients receiving oral oncolytics,” Dr Mackler and colleagues wrote. “Since our initial pilot, several additional practices have joined the Oral Oncolytic Collaborative and successfully used the modified ESAS-r tool as part of routine patient care.”—Cameron Kelsall