Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study). Background: E-health based patient-reported outcome measures (PROMs) have the potential to automate early identification of both nutrition status and distress status in cancer patients while facilitating treatment and encouraging patient participation. This cross-sectional study assessed the acceptability, accuracy, and clinical utility of PROMs collected via E-Health tools among patients undergoing treatment for stomach, colorectal, and pancreatic tumors. Results: Eight-nine percent mostly, or completely, agreed that PROMs via tablets should be integrated in routine clinical care. Men were significantly more likely to require help completing the questionnaires than women (inv.OR = 0.51, 95% CI = (0.27, 0.95), p = 0.035). The level of help needed increased by 3% with each 1-year increase in age (inv. OR = 1.03, 95% CI = (1.01, 1.06), p = 0.013). On average, a patient tended to declare weight which was 0.84 kg inferior to their true weight (Bland and Altman 95 % CI = (–3.9, 5.6); SD: 2.41) and a height which was 0.95 cm superior to their true height (Bland and Altman 95 % CI = (−5, 3.1); SD 2.08). Patient-reported nutrition status was significantly associated with the professionally generated assessment (95% CI = (2.27, 4.15), p < 0.001). As nutrition status declined, the distress score increased (95%CI = (0.88, 1.68), p < 0.001). Of the patients, 48.8% who were both distressed and malnourished requested supportive care to address their problems. Conclusion: Patient-reported assessments utilizing E-health tools are an accurate and efficient method to encourage patient participation in cancer care while simultaneously ensuring that regular assessment of psycho-social and nutritional aspects of care are efficiently integrated in the daily clinical routine.
Abstract from Erickson N, Schinkoethe T, Eckhardt C, et al.: Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study). Support Care Cancer. 2021; doi: 10.1007/s00520–021–06351–1.
Knowledge Transfer of Susana Couto Irving (Porto)
People living with cancer are among the most malnourished, with the biggest risk of unintentional weight loss being experienced by those undergoing multimodal therapy. Despite the broadly acknowledged insidious impact on outcomes and overall quality of life, too many oncology patients, particularly outpatients, do not undergo nutritional screening in a timely and consistent manner and remain at further risk of nutritional deterioration.
The interest in patient-reported outcomes (PROMs) has been gaining momentum, and patient participation seems to help bridge gaps in cancer care.
Erickson et al. report on the findings of the PaCC Study which aimed to assess the clinical utility and accuracy of PROMs collected via eHealth tools among cancer outpatients.
Through a cross-sectional design, and by recruiting participants in two locations, the authors explored the general acceptability of using tablet-based questionnaires and then, through continued patient participation, the feasibility of tablet-based self-reporting, by making available the eHealth version of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) which is recognized as one of the most robust tools for nutrition screening and assessment in oncology (another supportive care dimension was also assessed but is beyond the scope of this commentary).
The patient reports (PR) were then compared to dietitian-led nutrition risk assessments (using the Nutrition Risk Score-NRS-2002) and anthropometric measurements (weight and height).
Results were evident, with 89% (n = 152) being in agreement (mostly or completely) that PROMs via tablets do have a place within routine care. However, age remains an important consideration, with younger patients agreeing more with tablet-based approaches, and older patients finding the tablets harder to handle. Of particular interest, this study shows that PR weight and height are closely associated with professional measurements. Likewise, PR nutritional status is significantly associated with the dietitian’s risk stratification. Other encouraging results, showing support for such initiatives, were that 38.2% of the participants requested same-day supportive care, namely nutrition interventions, after completing the tablet-based screening.
The recurrent lack of standardization and consensus in approaching malnutrition identification in oncology outpatients hinders the implementation and routine operationalization of screening processes. However, such a step remains critical and key for the establishment of pertinent nutritional care plans and has been endorsed by most international societies.
Other well-described barriers delaying nutrition referrals are well known to every practicing nutrition/oncology professional; these include lack of administrative capacity, HCP competing time constraints, shortage of nutrition specialized staff, and non-standardized processes.
Therefore, strategies to better embed malnutrition risk screening must be pursued. Approaches that ease the assessment burden by encouraging routine patient participation should be particularly welcomed because they might facilitate adherence and upscaling throughout the cancer care continuum and can harness a great potential through the leverage of data – i.e., aggregates and reports might be used to further inform on malnutrition prevalence, care consistency/optimization, cost-benefit appraisals, and to better deploy specialized resources alongside real-time patient needs.