2) Our expert author is Thomas LeBlanc, MD @tomleblancMD, patient experience & cancer outcomes researcher @DukeCancer. Thanks for joining! pic.twitter.com/9lga8yCj76
— @onc_ce (@onc_ce) February 15, 2023
4) #PRO in #mNSCLC were a hot topic at #ESMO22. In prior discussions of the #POSEIDON trial, PRO data favored a triple combo of immunotherapy + chemotherapy over chemo alone, supporting the previously reported efficacy findings (🔓https://t.co/aFOpRBCSrJ). pic.twitter.com/xVAJzmpqIF
— @onc_ce (@onc_ce) February 15, 2023
6a) Patients are the experts on their own experiences. That’s why we’re talking today about “#PROs,” short for “patient-reported outcome measures” (sometimes abbreviated as #PROMs).
— @onc_ce (@onc_ce) February 15, 2023
See https://t.co/dOqAE8i8HY. pic.twitter.com/PwhqpzFzIi
7) Strictly defined, PROs are: “direct reports of patient experience that are usually collected via validated questionnaires without amendment or interpretation of the patient’s response”
— @onc_ce (@onc_ce) February 15, 2023
See 🔓 https://t.co/FPNxi8EMvv from @HHSGov and @US_FDA.
9a) It comes as a surprise to some clinicians that subjective patient experiences can be measured and quantified in a meaningful way. In fact, patient experience data collected using high-quality #PRO instruments are increasingly used as outcome measures in clinical trials.
— @onc_ce (@onc_ce) February 15, 2023
10a) So WHY #PROs? And how good are they??
— @onc_ce (@onc_ce) February 15, 2023
👉Evidence clearly shows that clinicians under-estimate incidence & severity of their patients’ symptoms in routine care settings. pic.twitter.com/uyINxub5UK
11) This recognition ➡️ various efforts to integrate #PROs into routine care processes in oncology, to effectively amplify 📢the patient voice.
— @onc_ce (@onc_ce) February 15, 2023
13a) Modern #PRO tools increasingly allow clinicians & researchers to select individual items or create scales best suited to their local context & a particular purpose. One prominent example are the @NIH-developed “#PROMIS” measures.
— @onc_ce (@onc_ce) February 15, 2023
14a) So we have progressed to the point of moving beyond research and now applying #PROs to clinical practice. They aren’t just research tools w/ rather unclear or limited applications to real-world clinical practice.
— @onc_ce (@onc_ce) February 15, 2023
15a) Example: in #RCT of 766 pts w/advanced solid tumors on outpt palliative chemotx at @MSKCancerCenter, weekly e-queries for symptom data ➡️improvements in #QoL, ⬇️healthcare utilization (ED use & hospitalization), ⬆️time on chemotx), & overall survival, vs routine cancer care.
— @onc_ce (@onc_ce) February 15, 2023
16) The symptom data reported by these pts were reviewed by nurses and acted upon accordingly. This trial clearly demonstrates the added value of collecting additional data on patients’ experiences, directly from patients themselves, beyond what is done in routine care processes.
— @onc_ce (@onc_ce) February 15, 2023
17b) The tool is called the #ESAS (Edmonton Symptom Assessment Scale/System). In a retrospective study of data from over 250,000 pts w/ cancer, a robust propensity-matching analysis showed that those who completed the ESAS at least once . . .
— @onc_ce (@onc_ce) February 15, 2023
18a) Other studies point to value in collecting patient experience data using other approaches too, such as telephone-based interactive voice response (#IVR) systems. These have the potential benefit of reducing disparities . . . pic.twitter.com/U9dksnOuwo
— @onc_ce (@onc_ce) February 15, 2023
19a) So can #PRO assessments improve the patient experience of advanced cancer such as #mNSCLC?
— @onc_ce (@onc_ce) February 15, 2023
As a matter of fact, as we’ve learned more about how to measure the patient experience of cancer, the value of PROs has become clear.
19c) In 🫁 cancer especially, one proven intervention is integrated specialist #palliative care. The efficacy of this approach was demonstrated largely on the basis of improvements in #PROs.
— @onc_ce (@onc_ce) February 15, 2023
20) Overall survival was also improved among pts randomized to the palliative care intervention. Survival benefit among ambulatory patients with advanced solid cancers has been confirmed in multiple clinical trials & meta-analyses
— @onc_ce (@onc_ce) February 15, 2023
See 🔓 https://t.co/5s4iTwMsCV . pic.twitter.com/AoX84vlVMj
22a) The next big challenge in the story of #PROs is one of #implementation_science. How can we deploy PROs efficiently and effectively in busy oncology practices of varying types? Many questions remain:
— @onc_ce (@onc_ce) February 15, 2023
❓What PRO tool(s) are best? pic.twitter.com/ClBuIpfO33
22c)
— @onc_ce (@onc_ce) February 15, 2023
❓What obligations arise upon collecting #PRO data, regarding acting upon the results?
❓Do only certain cancer populations benefit from PRO monitoring (e.g. advanced cancers), or should all patients be offered PRO monitoring?
23a) There are also related questions about other types of patient-generated health data that are now easily obtainable via fitness trackers or other connectivity-enabled devices, such as step counts, body composition, heart rate, weight, sleep duration/quality, etc. pic.twitter.com/aZPdgy2Ubc
— @onc_ce (@onc_ce) February 15, 2023
24a) One interesting example of such an effort is the Moovcare mobile application, which uses weekly symptom surveys to help detect 🫁 cancer progression.
— @onc_ce (@onc_ce) February 15, 2023
25a) So as we 🎁up, let’s return to those #mNSCLC data. Recently, 2 systematic reviews of Ph 3 #oncology trials found that many solid tumor trials did not include #QoL as an endpoint:
— @onc_ce (@onc_ce) February 15, 2023
🔓 https://t.co/i6Y3MiMMqi
🔓 https://t.co/aCW6cALplP
25c) . . . looking back at you, @myESMO, incorporate #PRO data into instruments developed to define the value of a treatment, such as the ESMO-Magnitude of Clinical Benefit Scale (https://t.co/7QWlQuCC1B).
— @onc_ce (@onc_ce) February 15, 2023
26a) As a patient experience researcher and advocate, I am delighted to see the current emphasis on increasingly measuring and attending to these issues as part of holistic, person-centered cancer care. We have much more work left to do together though . . .
— @onc_ce (@onc_ce) February 15, 2023
27) So what have you learned? #PROs may include all of the following EXCEPT:
— @onc_ce (@onc_ce) February 15, 2023
a. measures of tolerance
b. measures of healthcare resource utilization
c. efficacy endpoints
d. symptom scales
28b) The #ESMO_MCBS #PRO instrument includes measures of all of the following EXCEPT:
— @onc_ce (@onc_ce) February 15, 2023
a. overall survival
b. progression-free survival
c. healthcare resource utilization
d. response rate
30) And you just earned 0.5hr 🆓CE/CME! Go to https://t.co/0YSCzsIHsZ and claim your certificate. I am @tomleblancMD and I 🙏for joining us. FOLLOW @onc_ce for more expert-authored education, delivered entirely on Twitter!#FOAMed #OncTwitter #MedEd @MedTweetorials
— @onc_ce (@onc_ce) February 15, 2023