Radiation therapy (RT) can be associated with toxicity that can impact patient’s quality of life (QOL). Unlike standard toxicity reporting methods, patient reported outcomes (PROs) are reported directly by the patient, without input from clinicians who are known to under-report side effects compared to patients. PROs allow health care providers to assess the impact of cancer and its treatment side effects on patients, facilitate communication between the patient and the health care team, improve quality of life of cancer patients, and evaluate the effectiveness of treatments and interventions. However, there are challenges with traditional capturing of PRO measures, including under-reporting of symptoms by patients, lack of clinician time to view and act upon PROs and patient recall bias.
Several studies have found Radiation Therapist (RTT)-led monitoring of PROs is feasible, safe and improves patient experiences. RTTs are in a unique position within the patient’s circle of care as they interact with the patient daily and thus form a connection with the patient. One study found that the patient-provider relationship has the largest influence on overall patient satisfaction and the patient’s relationship with their RTT had a significant effect on how patients perceived their experience. Another study suggests RTT led treatment reviews is advantageous to patients because they are in close contact with the RTTs, and have built a stronger relationship, allowing easier communication. RTTs collect PROs as standard of care during many points in the patient’s treatment journey: Advanced Practice RTTs collect ESAS scores in review and post-treatment follow up appointments, treatment unit RTTs document side effects of treatment regularly, a clinical trialist RTT is responsible for collecting PROs required for various studies.
Unlike traditional methods of PRO collecting, digital intelligence tools offer unique advantages such as real time data capture, objective and subjective measurements captured simultaneously, reduced transportation cost for the patient, less burden on the caregiver’s time and reliance on patients’ recall. Studies have found that clinical trial follow-up rates for palliative RT were much higher when return visits to clinic for follow up were not required. Prior PRO collection initiatives have not been able to capture patient experiences and outcomes in real-time. There is now widespread capability to collect PROs via online questionnaires external to the medical chart, for example our institution is transitioning away from paper-based ESAS documentation in consultation to an online app. This app allows patients to input ESAS scores, provide a brief history of their current symptoms and list their medications, reducing time spent on this in consultation. The app will allow the RTT to electronically track the side effects of treatment and facilitate communication between the patient and the health care team.
Increasingly novel ‘smart’ technology can also be used to collect patient wellness information in real time. One example of this would be ‘wearable’ devices. This could be as simple as a Fitbit or as complicated as a ‘smart shirt’. A study of this technology is currently underway, utilizing digital patient reporting and real time objective measurements of patients’ symptoms and side effects from palliative RT over the course of a year. This digital outcome measures depends less on active patient or provider participation, which may allow for greater collection consistency, frequency and accuracy. Patients are fitted with wearable technology (HexoSkinTM Smart Shirt) which is capable of measuring vital signs. The patients are given a cell phone with an app to enter symptoms and side effects. The app prompts them to complete quality of life, patient satisfaction and subjective symptom surveys. The RTT involved in the palliative RT team provides follow up of these patients at 30, 90 and 365 days after the last treatment. The RTT is able to monitor the symptoms reported on the app by the patient and follow up with the patients’ health care team as necessary.
PROs are an important means to track symptoms patients are experiencing, evaluate patient outcomes (including treatment efficacy and side effects), and improve the patient experience. On a broader scale, PROs can be used to study population based informatics such as comparing efficacy of various techniques or evaluating the quality of care when aggregated together in cohort analysis. Although there are challenges to initiating RTT-led PRO assessments and follow ups (including delegating time away from clinical duties and training), studies have shown that these assessments can drastically impact the QOL for patients receiving cancer therapy. The increasing use of novel digital intelligence technology may lead to easier real-time monitoring of patients’ symptoms and improved patient experiences while on treatment.