PRO Monitoring Lacking in Real-World Settings

By Leah Lawrence - Last Updated: July 14, 2022

Assessment of patient-reported outcomes (PROs) was variable across several sites of cancer care and occurred less frequently in these real-world settings than what was reported in clinical trials evaluating monitoring of PROs.

“Routine monitoring of patient-reported outcomes (PROs) for patients with advanced solid malignancies is an evidence-based practice and critical component of high-quality cancer care that improves symptoms and quality of life, reduces unplanned acute care, and extends overall survival in clinical trial settings,” wrote Samuel U. Takvorian, MD, MSHP, of Perelman School of Medicine, University of Pennsylvania, and colleagues.

However, there is variability in the degree to which health systems have embraced routine PRO monitoring. To better describe real-world adherence to PRO reporting, Takvorian and colleagues conducted this study using deidentified electronic health record data from the National Institute Cancer Center.

The patients were aged 18 or older with documented lung cancer diagnosis receiving at least one cancer-directed systemic therapy from January to December 2019. The mean age of patients was 65.8; 19.6% were Black. The primary outcome was patient-level adherence.

In 2019, there were 18,604 encounters for 1,105 patients with lung cancer. Overall patient-level PRO adherence was 49.4%. Mean patient-level PRO adherence was 27.2% at one community site, 47.1% at the academic hospital, and 70.0% at the second community site.

According to the researchers, these rates “fall well short of PRO adherence levels observed in seminal clinical trials, which have generally exceeded 70% and, in an ongoing large pragmatic trial, exceeded 90%.”

The researchers found that age 65 or older and Black or African American race were negatively associated with PRO adherence (P<.01). Patient sex, insurance status, cancer stage, and treatment type were not associated with PRO adherence. However, site of care was highly associated with PRO adherence.

The researchers concluded that these findings demonstrate “an implementation gap that could be addressed with standardized measurement and reporting of an adherence-based quality metric.”


Takvorian SU, Anderson RT, Gabriel PE, et al. Real-world adherence to patient-reported outcome monitoring as a cancer care quality metric. JCO Oncology Practice. 2022;doi: 10.1200/OP.21.00855

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