Management of gastrointestinal symptoms in advanced cancer patients: the rapid learning cancer clinic model.
OBJECTIVE
Gastrointestinal symptoms are prevalent, often persistent, and detrimental to patients' quality of life. This review discusses evaluation of gastrointestinal symptoms as patient-reported outcomes (PROs) and presents an information technology-based system for symptom monitoring and management. The electronic PRO (ePRO) system is then placed within the larger context of rapid learning healthcare, a concept currently under development in which data obtained through both research and clinical care continuously build large datasets for analysis, seed future research, fuel expansion of the evidence base, and support clinical decision-making.


RESULTS
PROs are increasingly recognized as valid measures of symptoms, functional status, and quality of life. They have demonstrated prognostic significance and are being developed as a component of toxicity reporting in clinical trials. Recent studies have validated an information technology-based approach for collecting ePROs in routine clinical care. The system is feasible and acceptable; electronic and paper-based data, collected on validated assessment instruments, are equivalent; ePRO collection supports real-time symptom monitoring and management. The ePRO system represents a first step toward implementing rapid learning healthcare at the clinic level.


CONCLUSIONS
ePROs provide a rich source of information to support monitoring and clinical management of troubling symptoms such as gastrointestinal complaints.
Abernethy
Amy P
AP
Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA. amy.abernethy@duke.edu
Wheeler
Jane L
JL
Zafar
S Yousuf
SY
D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D020407:Internet; D016347:Medical Records Systems, Computerized; D009369:Neoplasms / Q000150:complications*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010358:Patient Participation; D012720:Severity of Illness Index