Discussant of the abstract on electronic symptom management, Therese M. Mulvey, MD, FASCO, Director of Breast Oncology at the Massachusetts General Hospital North Shore Cancer Center, Boston, said the SIMPRO study showed that electronic patient-reported outcomes can be implemented into real-world clinics across a diverse group of practices.
Therese M. Mulvey, MD, FASCO
“The single most important thing the authors showed us is that electronic patient-reported outcomes are feasible and open to scale,” said Dr. Mulvey. “However, when fewer than half of patients complete the questionnaire, questions of reliability remain.”
Dr. Mulvey also underscored the need for multidisciplinary supportive care when managing symptoms identified in electronic patient-reported outcomes. “Most symptoms cannot be managed with medication or a simple intervention,” she said. “Symptoms like fatigue, for example, are not quick fixes.” According to Dr. Mulvey, however, the SIMPRO study did not indicate who managed the symptoms in the real world or whether the interventions were successful. This information may be needed to overcome the physician perception of increased burden for care of patients, she said.
Dr. Mulvey also noted the clusters of symptoms may influence interventions in both the curative and noncurative settings. It would be useful to know how many of these patients were being treated for cure and how many were not, she said. “Whether the outcome is appropriate for patients with curative intent depends on the therapy. Patients who are being treated for cure will tolerate a lot more toxicity than people in the third and fourth round of therapy.”
Finally, Dr. Mulvey noted several questions about patient-reported outcomes, including whether they address predictive or prognostic outcomes. “Do patient-reported outcomes decrease ED [emergency department] visits? Can they predict who will show up in the emergency room? Can they predict who will be admitted to the hospital? Can they predict patients who have a diagnosis of adult failure to thrive or those who will die sooner? We need to start thinking about these questions.”
DISCLOSURE: Dr. Mulvey reported no conflicts of interest.
