Electronic monitoring improves well-being and slows worsening symptoms in cancer patients

People with metastatic cancer who regularly report their symptoms through a home electronic monitoring system have better quality of life, clinical performance and well-being, and have fewer emergency department visits than those who do not report their symptoms. According to researchers from the Lineberger Comprehensive Cancer Center at the University of North Carolina and their colleagues, overall survival was similar in both patient categories.

The results of the national multicenter study are published in Nature Medicine.

“Doctors and nurses are often unaware of symptoms and side effects that can worsen in cancer patients between doctor visits, leading to complications and unnecessary worry. The Patient Reported Outcome Scoring System (or PROSS) was designed to allow patients to self-report their symptoms and side effects. The results of this study showed that the PROSS keeps medical teams informed so they can intervene and help patients in a timely manner.”

Ethan Basch, M.D., physician, MSc, lead author of the study, professor of medicine, chief of the Division of Medical Oncology at UNC School of Medicine and director of the Cancer Outcomes Research Program at UNC Lineberger

The PRO-TECT randomized clinical trial was conducted in 52 community cancer clinics in 26 states to evaluate the real-world impact of electronic monitoring of PROSS symptoms on clinical outcomes compared to conventional treatment.

A total of 1,191 patients were included in the study. To determine whether electronic PROSS  symptom monitoring improves outcomes, approximately half (593) of the patients were randomly assigned to the PROSS  group and the remaining (598) to the usual care/control group. Patients in the PROSS  group could report their symptoms using an Internet-based program or an automated telephone system.

The mean age of participants was 63 years, about 17% had never used the Internet, and about 26% of patients were treated in rural areas.

Although there was no difference in overall survival between those who used PROSS and those who did not (which was the primary outcome of the study), there were many quality of life benefits:

• There was a 6.1% reduction in the number of emergency care visits in patients who used PROSS compared to those who received usual care. There was also a 16% increase in the time to first emergency care utilizing PROSS compared to usual care.
• Patients in the PROSS group experienced a significant delay in the deterioration of physical function (12.6 vs. 8.5 months), a 31% slowing of symptoms (12.7 vs. 9.9 months), and a 28% improvement in health-related quality of life factors (15.6 vs. 12.2 months) compared with patients who did not use PROSS, respectively.
• Most patients felt that PROSS improved the quality of consultations with their team (77%), allowed them to better manage their treatment (84%), and these patients would recommend PROSS to other cancer patients (91%).
• 5% of patients completed the scheduled weekly symptom surveys.

“Maintaining an electronic medical record has been a barrier for some physicians and patients who have difficulty navigating patient portal systems, and addressing these inconveniences was a major consideration in creating the PROSS system in this study,” says Bash. “PROSS largely bypasses physicians and is managed by nurses and/or patient coordinators, whose jobs often include symptom management and care coordination. PROSS systems have also proven to be very easy for patients to use from a technical feasibility standpoint.”

The study was designed to be generalizable to all cancer types and treatments. The study results, based on data from dozens of cancers in the patient sample, confirmed this universality.

Although final results from the PRO-TECT study have been received, researchers plan to conduct additional analyses based on interviews with patients, nurses, and physicians; evaluate the results by taking into account various patient characteristics such as cancer type, race, and geography; and conduct various methodological evaluations of the PROSS technology.

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Published: 11.02.2025

Updated: 10.02.2025

Medical author, Medical editor:

Stepan Yuk

Medical expert:

PhD. Olexandr Voznyak