TOPLINE

While remote electronic symptom monitoring using patient-reported outcomes (PROs) improved symptom control and physical function among all patients with metastatic cancer receiving systemic therapy, the benefits were most pronounced in younger patients, women, Black patients, and individuals with lower educational attainment. In contrast to previous research, Black participants reported more than double the improvement in symptom control compared with White participants in an exploratory subgroup analysis of the PRO-TECT trial.

METHODOLOGY

• Researchers aimed to identify subgroups that benefited most from electronic symptom monitoring based on demographic characteristics. Remote symptom monitoring using PROs has been shown to improve symptom control and physical function among patients with advanced cancer, but it remains unclear whether these benefits are similar across demographic groups.
• Previous studies have demonstrated that disparities exist between Black and White oncology patients in symptom experience and management, with Black patients experiencing greater physical symptoms, treatment side effects, and psychological distress while reporting that their symptoms went unaddressed.
• PRO-TECT was a cluster randomized trial conducted across 52 US community oncology practices, enrolling 1191 adult patients with metastatic solid tumors receiving systemic therapy (593 in the PRO arm and 598 in usual care).
• Participants in the PRO arm completed weekly symptom surveys for up to 1 year, including the PRO version of the Common Terminology Criteria for Adverse Events, with alerts sent to care teams for severe or worsening symptoms.
• Patients chose to complete surveys online via computer/handheld device or through telephone interactive voice response, a system using a recorded voice to administer questions with numerical responses, not requiring Internet access.
• Outcome measures included the European Organisation for Research and Treatment of Cancer QLQ-C30 symptom control and physical function scales assessed at baseline and 1, 3, 6, 9, and 12 months after enrollment.
• Subgroup analyses examined differences by race (Black vs White), age (< 65 vs ≥ 65 years), sex (male vs female), and educational attainment, using general linear mixed models with fixed effects for study arm, timepoint, and arm-by-visit interaction.

TAKEAWAY

• From baseline to 3 months, PRO participants showed greater improvements in symptom control (+2.37 vs -0.20; P = .002) and physical function (+1.54 vs -0.93; P = .02) than participants receiving usual care.
• Black participants in the PRO arm experienced substantial improvements in symptom control (+4.84 vs -0.16; P = .03) and physical function (+4.70 vs +1.00; P = .18), with the symptom control improvement putting them on par with White participants at 3 months.
• Among younger participants (< 65 years), those in the PRO arm had greater improvements in symptom control (+2.95 vs -0.92; P < .001) and physical function (+2.20 vs -0.76; P = .03) than those in the usual care arm, while no significant differences were observed in older participants.
• Female participants in the PRO arm showed greater improvements in symptom control (+3.36 vs -0.57; P < .001) and physical function (+3.13 vs -0.49; P = .009) at 3 months, whereas male participants showed no significant differences between arms.

IN PRACTICE

“Remote symptom monitoring has the potential to reduce disparities in patient-provider communication and symptom management. Broad implementation of these systems may represent an effective strategy to advance health equity,” wrote the authors of the study.

SOURCE

The study was led by Allison M. Deal, MS, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, and Victoria S. Blinder, MD, MSc, of Memorial Sloan Kettering Cancer Center, New York City. It was published online on May 12 in JCO Oncology Practice.

LIMITATIONS

The study sample only included patients with metastatic cancer, which limits generalizability to other cancer populations. The race-stratified subgroups were not well-balanced, with fewer than 200 Black participants included despite recruitment efforts, and too few participants of other races were included to permit subgroup analysis. Although feedback survey completion exceeded 80%, nonresponse bias cannot be ruled out and may have resulted in overrepresentation of positive experiences. The use of dichotomized variables such as age and education to define subgroups may have obscured additional or alternative patterns of difference that different thresholds could have revealed. The trial was not powered for testing interaction effects or subgroup analyses, so these exploratory subgroup findings should be interpreted with caution.

DISCLOSURES

The study received support from Alliance Foundation Trials and the Patient-Centered Outcomes Research Institute (PCORI IHS-1511-33392) and utilized technology systems provided by the Patient-Reported Outcomes Core at the Lineberger Comprehensive Cancer Center of the University of North Carolina, which is funded by National Cancer Institute Cancer Center Core Support Grant No. 5-P30-CA016086 and the University Cancer Research Fund of North Carolina. Yashasvini Sampathkumar, MD, was supported by the National Cancer Institute research training grant (T32CA275764). Deal and the other authors disclosed having no relevant conflicts of interest. 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.