Can PROMs Enhance Cancer Outcomes?

TOPLINE:

Integrating patient-reported outcome measures (PROMs) into cancer care was associated with improved overall survival and health-related quality-of-life (QoL) in the short-term, though not emergency department visits or hospitalizations, a recent meta-analysis found. 

METHODOLOGY:

• A growing body of evidence suggests that incorporating PROMs — patients’ assessments of their own symptom burden and health-related quality of life (QoL) — into cancer care can improve QoL and survival.
• To better understand the potential value of PROMs for patient outcomes, researchers performed an updated systematic review of studies evaluating the impact of PROMs on outcomes among patients undergoing active cancer treatment.
• The literature search included MEDLINE, Embase, PsychINFO, CENTRAL, and CINAHL databases from January 2012 to September 26, 2022, as well as trials from a previous systematic review published in 2014.
• The analysis included 45 randomized clinical trials, with 13,661 participants, that assessed the association of PROMs with a range of outcomes important to patients, including survival, health-related QoL, emergency department visits, and hospitalizations.
• Among the 45 randomized controlled trials, 25 measured health-related QoL using a range of different questionnaires, five looked at hospitalizations, four at emergency department visits, and only three measured overall mortality.

TAKEAWAY:

• Integrating PROMs into cancer care “likely” reduced the risk for all-cause mortality (hazard ratio, 0.84; 95% CI, 0.72-0.98; moderate certainty), according to the authors, and was associated with improved health-related QoL at 12 weeks (mean difference [MD], 2.45; 95% CI, 0.42-4.48; moderate certainty).
• However, at 24 weeks, improvements in health-related QoL were no longer significant (MD, 1.87; 95% CI, -1.21 to 4.96; low certainty) and, by 48 weeks, there was no association between the use of a PROM and health-related QoL.
• Researchers also found no association between PROMs and reduced emergency department visits (odds ratio [OR], 0.74; 95% CI, 0.54-1.02; low certainty) or hospital admissions (OR, 0.86; 95% CI, 0.73-1.02; low certainty).

IN PRACTICE:

“The findings of this study suggest that the integration of PROMs into cancer care may improve overall survival and quality of life” in the short-term, the study authors wrote. 

The analysis provides further support that “PROMs should be used routinely in oncology practice,” according to the authors of an accompanying editorial. However, while “multiple studies have demonstrated that PROMs improve outcomes in a variety of clinical settings, some results were not statistically significant highlighting that there is much uncertainty about what makes an intervention effective.”

SOURCE:

The study, led by Amaris K. Balitsky, MD, MSc, Department of Oncology, McMaster University in Hamilton, Ontario, Canada, and the accompanying editorial were published online on August 13 in JAMA Network Open.

LIMITATIONS:

A major limitation of the available data was the small number of studies that evaluate PROM and survival and hospital use. Given the heterogeneity of PROM interventions used, the study does not provide evidence on the optimal strategy to collect PROMs in active oncology care.

DISCLOSURES:

Hira Mian, MD, disclosed receiving grants from Janssen, Pfizer, and Takeda outside the submitted work. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.