In a single-institution phase III trial reported in the Journal of Clinical Oncology, Absolom et al found that use of the electronic patient self-reporting of adverse events: patient information and advice (eRAPID) system was associated with improvements in patient-reported outcomes vs usual care in patients initiating cancer chemotherapy.
eRAPID is an online e-health system that allows patients to self-report symptoms during cancer treatment. The system provides automated severity-dependent patient advice guiding self-management or medical contact, with reports being displayed in electronic patient records.
Study Details
In the trial, 508 patients with colorectal, breast, or gynecologic cancers starting chemotherapy at Leeds Cancer Centre were randomly assigned between January 2015 and June 2018 to the eRAPID intervention plus usual care (n = 256) or usual care alone (n = 252). The eRAPID group was to perform weekly online symptom reporting for 18 weeks. A total of 55 clinicians participated, with 19 seeing more than 10 eRAPID patients. The primary outcome measure was physical well-being assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) Physical Well-Being subscale (FACT-PWB) at 6, 12, and 18 weeks.
“Real-time monitoring with electronic patient-reported outcomes improved physical well-being (6 and 12 weeks) and self-efficacy (18 weeks) in a patient population predominantly treated with curative intent, without increasing hospital workload.”— Absolom et al
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Key Findings
The eRAPID patient group reported improved physical well-being vs usual care at 6 (P = .028) and 12 (P = .039) weeks, with no significant difference at 18 weeks (P = .69).
Subgroup analysis showed no differences in physical well-being between groups among 191 patients with metastatic disease. Among patients with early-stage disease, eRAPID was associated with a significant benefit at 6 weeks (P = .0426) but not at 12 (P = .0550) or 18 weeks (P = .9955).
Clinically meaningful physical well-being deterioration was reported in the eRAPID vs usual care groups by 47% vs 56% at week 12, with smaller differences at week 6 (43% vs 48%) and 18 (46% vs 48%). Overall, maintained stable physical well-being was reported by 39% vs 32%.
Self-efficacy at 18 weeks, measured by the Self-Efficacy for Managing Chronic Disease scale, was significantly better with eRAPID (P = .0073).
On the EuroQOL-5D (EQ-5D) visual analog scale, patients in the eRAPID group reported better overall health at 18 (P = .0095) and 12 weeks (P = .0302), with no difference at 6 weeks (P = .3773).
No differences between groups were observed in FACT-G and EQ-5D-5L utility scores at 6, 12, or 18 weeks.
EORTC Quality of Life Questionnaire (QLQ)-C30 summary scores showed improved symptom control with eRAPID at 12 weeks (P = .0111), with no significant differences between groups at 6 or 18 weeks.
Average patient compliance with weekly symptom reporting was 64.7%. Patient compliance was associated with clinician data use and improved FACT-PWB at 12 weeks.
The investigators concluded, “Real-time monitoring with electronic patient-reported outcomes improved physical well-being (6 and 12 weeks) and self-efficacy (18 weeks) in a patient population predominantly treated with curative intent, without increasing hospital workload.”
Galina Velikova, MD, PhD, of the Leeds Institute of Medical Research at St James’s, University of Leeds and Leeds Cancer Centre, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Institute for Health Research (NIHR). For full disclosures of the study authors, visit ascopubs.org.
