Areej El-Jawahri, MD, on the Significance of Patient-Reported Outcomes in Gastrointestinal Cancers

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The invited discussant of this study on patient-reported outcomes, Areej El-Jawahri, MD, Associate Director of Cancer Outcomes Research and Education Program and Director of Bone Marrow Transplant Survivorship Program at Massachusetts General Hospital, said these findings underscore the importance of patient-reported outcomes for patients and their families.

“Patient-reported outcomes are often the outcomes of interest in supportive care studies, and it’s been shown that monitoring patient-reported outcomes in the outpatient setting can improve survival in randomized clinical trials,” said Dr. El-Jawahri. “Now, we are hearing that patient-reported outcomes could be early markers of tumor progression.”

“Symptom burden and quality of life were not only associated with treatment response and survival outcomes in patients with gastrointestinal cancers in this study, but the association between patient-reported outcomes and clinical benefit may actually be stronger than what we see with even tumor markers,” she added.

Areej El-Jawahri, MD

Areej El-Jawahri, MD

Study Strengths and Limitations

According to Dr. El-Jawahri, the strengths of this investigation include the longitudinal assessment of patient-reported outcomes over time and the use of validated patient-reported outcomes, which are easy to administer, scale, and incorporate into practice. The high enrollment rate and low missing data rate were also considered strengths, as was the inclusion of tumor markers in addition to patient-reported outcomes.

Conversely, study limitations include the use of a single institution and limited sociodemographic diversity, which could limit generalizability. In addition, said Dr. El-Jawahri, there was probably some heterogeneity in the timing of patient-reported outcomes administration relative to chemotherapy administration.

“We know that when patients receive chemotherapy, they may have side effects, and the timing of when patient-reported outcomes were measured relative to that chemotherapy administration may be important,” she explained. “Tumor burden may also be a potential effect modifier or moderator of this relationship.”

Clinical Implications

Despite those study limitations, the research could have many implications, including the integration of patient-reported outcomes into routine clinical practice and the outpatient setting. Clinicians should consider, however, whether patient-reported outcomes are prognostic or predictive markers.

“Are patient-reported outcomes telling us that something bad is going to happen, or can we tailor our therapy relative to what we’re seeing in terms of changes in patient-reported outcomes?” Dr. El-Jawahri asked. “The other question is, which patient-reported outcomes? And why?”

According to Dr. El-Jawahri, quality of life and symptom burden are effective metrics of how patients feel, and it makes intuitive sense that patients might experience fewer symptoms as their tumors shrink. However, there may be a biologic mechanism that can better explain the association between patient-reported outcomes and clinical outcomes.

Next Steps

Finally, future research should examine the relationship between patient-reported outcomes and tumor progression in populations beyond gastrointestinal cancer, said Dr. El-Jawahri. Researchers also should consider other tumor factors that could affect this relationship.

“Obviously, we need validation across more diverse populations and multiple institutions,” she concluded. “And we need to integrate patient-reported outcomes in clinical practice in a scalable and disseminable way.” 

DISCLOSURE: Dr. El-Jawahri has served as a consultant or advisor to AIM ­Specialty Health, GSK, and Novartis.


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