title: Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial.
abstract: OBJECTIVE
  There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited.
  
  
  METHODS
  We randomly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians. Those with home computers received weekly e-mail prompts to report between visits. Treating physicians received symptom printouts at visits, and nurses received e-mail alerts when participants reported severe or worsening symptoms. The primary outcome was change in health-related quality of life (HRQL) at 6 months compared with baseline, measured by the EuroQol EQ-5D Index. Secondary endpoints included emergency room (ER) visits, hospitalizations, and survival.
  
  
  RESULTS
  Among 766 patients allocated, HRQL improved among more participants in the intervention group than usual care (34% v 18%) and worsened among fewer (38% v 53%; P < .001). Overall, mean HRQL declined by less in the intervention group than usual care (1.4- v 7.1-point drop; P < .001). Patients receiving intervention were less frequently admitted to the ER (34% v 41%; P = .02) or hospitalized (45% v 49%; P = .08) and remained on chemotherapy longer (mean, 8.2 v 6.3 months; P = .002). Although 75% of the intervention group was alive at 1 year, 69% with usual care survived the year (P = .05), with differences also seen in quality-adjusted survival (mean of 8.7 v. 8.0 months; P = .004). Benefits were greater for participants lacking prior computer experience. Most patients receiving intervention (63%) reported severe symptoms during the study. Nurses frequently initiated clinical actions in response to e-mail alerts.
  
  
  CONCLUSIONS
  Clinical benefits were associated with symptom self-reporting during cancer care.
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA. ebasch@med.unc.edu.
authors.forename: Ethan
authors.initials: E
authors.lastname: Basch
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Kris
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Howard I
authors.initials: HI
authors.lastname: Scher
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Hudis
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Paul
authors.initials: P
authors.lastname: Sabbatini
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Rogak
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Antonia V
authors.initials: AV
authors.lastname: Bennett
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Amylou C
authors.initials: AC
authors.lastname: Dueck
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Atkinson
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Chou
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Dulko
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Laura
authors.initials: L
authors.lastname: Sit
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Allison
authors.initials: A
authors.lastname: Barz
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Paul
authors.initials: P
authors.lastname: Novotny
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Fruscione
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.affiliation: Ethan Basch, Mark G. Kris, Howard I. Scher, Clifford A. Hudis, Paul Sabbatini, Lauren Rogak, Thomas M. Atkinson, Joanne F. Chou, Dorothy Dulko, Laura Sit, Michael Fruscione, and Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch, Allison M. Deal, and Antonia V. Bennett, University of North Carolina, Chapel Hill, NC; Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ; Allison Barz, Children's Hospital of Philadelphia, Philadelphia, PA; Paul Novotny and Jeff A. Sloan, Mayo Clinic, Rochester, MN; and Deborah Schrag, Dana-Farber/Harvard Cancer Center, Boston, MA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000627:therapeutic use; D034742:Electronic Mail; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D024802:Nurse's Role; D011788:Quality of Life; D057566:Self Report; D015996:Survival Rate; D063189:Symptom Assessment
chemical_list: D000970:Antineoplastic Agents