March 2016 Edition Vol.11, Issue 3

Using Patient-Reported Outcomes (PRO) to Improve the Quality of Cancer Care

Using Patient-Reported Outcomes (PRO) to Improve the Quality of Cancer Care (continued)

Integrating PRO into EHRs

Collette Pitzen, RN, BSN, CPHQ, MN Community Measurement, Minneapolis, Minnesota, presented several examples of PRO-based tools developed by MN Community Measurement, and how these might be integrated into EHRs. MN Community Measurement, a non-profit organization, collects HIPAA compliant, patient-level data from 1,600 clinics in the state.

One PRO tool that is being developed addresses symptom control during chemotherapy. Ms. Pitzen notes that medical groups are currently being recruited to pilot test this tool.11 This tool is currently being developed for patients with newly diagnosed cancer at the first round of chemotherapy, with an assessment during days 5 to 15 of the first 3 cycles of chemotherapy. This appears to be the proper window for assessment of chemotherapy-related outcomes. The PRO tool is an excerpt of the NCI PRO-CTCAE. The PRO-CTCAE tool has 81 items, but since each was evaluated independently, questions can be selected for a shorter tool. The tool was designed to generate useful data. Symptoms of pain, nausea, and constipation are considered to be under control if the severity is rated as none or mild or <2 (Figure 3).

Ms. Pitzen said that in developing tools, they prefer those in the public domain so they don’t need permission for use. The intent of the use of the PRO tool is two-fold: 1) data from the tool will be collected to calculate retrospective measures of symptom control (e.g., nausea is rated as none or mild), and 2) the tool will be used to assess the patients symptoms in real time during the process of providing chemotherapy care, with the expectation that when symptoms are not in good control, the providers will intervene. However, this intervention is not a part of the data collection strategy or measurement.

Looking Ahead

Arlene E. Chung, MD, MHA, MMCi, University of North Carolina at Chapel Hill School of Medicine, North Carolina, gave a presentation on the use of capturing patient-generated health data, including PRO associated with chemotherapy, via the use of wearables and tethered portals. These data could be collected on an on-going basis from large numbers of patients using current technology, e.g., smart phones and wristbands, and eventually using newer technology such as smart garments, contact lenses with sensors, implantable or ingestible chips, or tattoos. “There will be an acceptability issue with some of these,” Dr. Chung noted.

She said that new changes in CMS reimbursement, such as monthly payments for remote monitoring of chronic conditions using digitally stored and/or transmitted data should encourage data collection. However, questions remain, such as how to manage the data and make it useful for patients and providers. Just because data can be collected 24 hours a day does not mean that someone is monitoring abnormal results in real time.

Session Chair Ethan M. Basch MD, MSc, Cancer Outcomes Research Program, University of North Carolina, Chapel Hill, North Carolina, said, “We should come away from this discussion excited and frightened.” He added that PRO are likely to be required in clinical practice in the future and that ASCO wants to lead the way in oncology. Key challenges include patient logistics, e.g., how to get patients to participate and what happens if they miss reporting; and how to integrate PRO data into electronic health records as well as retrieve data for use.

The 2017 ASCO Quality Care Symposium will further explore quality measurement and improvement in oncology care, and will include looking at the use and experience with electronic tools to measure and report the patient experience.


  1. Basch E, Snyder C, McNiff K. et al. Patient-reported outcome performance measures in oncology. J Oncol Practice. Published online April 22, 2014. DOI:10.1200/JOP.2014.001423.
  2. Institute of Medicine: Delivering high-quality cancer care: charting a new course for a system in crisis. Washington, DC. National Academies Press; 2013.
  3. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol. 2016;34:557-565.
  4. Gravis G, Marino P, Joly D, et al. Eur J Cancer. 2014;50:953-963.
  5. Laugsand EA, Sprangers MAG, Bjordal K et al. Health care providers underestimate symptom intensities of cancer patients: a multicenter European study. Health Qual Life Outcomes. 2010;8:104-117.
  8. Hawley ST, Janz N, Jagsi R, et al. Recurrence risk perception and quality of life after treatment of breast cancer. J Clin Oncol. 34, 2016 (suppl 7S; abstr 175).
  9. Jagsi R, Hawley ST, Griffith KA, et al. Contralateral prophylactic mastectomy decision-making in the population-based iCanCare study of early-stage breast cancer patients. J Clin Oncol. 34, 2016 (suppl 7S; abstr 177).
  10. Jensen RE, Snyder CF, Abernethy AP, et al. Review of electronic patient-reported outcomes systems used in cancer clinical care. J Oncol Practice. 2013;10:e215-e222.

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