Research

ESMO guidelines tackle role of PROMs in the cancer clinic


New guidelines from the European Society for Medical Oncology recommend the use of standardised patient-reported outcome measures to improve clinical symptom management.

Advocating for the use of questionnaires or systematic assessments, a panel of international experts said the patient-reported outcomes data provided an evidence-based approach for the detection and management of treatment toxicities, disease progression or recurrence and enable optimal care.

The guidelines said there were clear benefits for both patients and clinicians in using the symptom measures, but warned appropriate systems must be in place to ensure their effective use.

“The opportunity to use PROMs completed by patients and received by nurses and/or doctors enables timely and systematic assessment of clinical trends of symptoms and side-effects,” the guideline said.

“The use of electronic systems for administering PROMs to patients with cancer and communicating this information back to their clinicians has been shown to improve symptom control, physical function, QoL, adherence to treatment, reduction in emergency room and hospital admissions and survival.”

One of the guideline authors, Clinical Associate Professor at the Sydney Medical School and a Senior Staff Specialist of Radiation Oncology at Westmead Hospital, Dr Purnima Sundaresan said the guidelines were ultimately aimed at providing patient-centred, holistic care.

She said the use of PROMs in clinical care in Australia was uncommon.

“While we’re all familiar with the use of PROMs in the setting of clinical trials comparing the outcome of one treatment against each other, and one of the areas has been patient-reported outcomes,” she said.

“But in routine clinical care, I would say it is not something that has been adopted widely.”

She said implementing PROMs in clinical care required take up, infrastructure and resourcing at the health service level.

The guidelines gave a range of uses for the PROMs for patients undergoing active cancer treatment, in clinical practice, and for end-of-life care.

It suggested using standardised, digital-based models to ensure comprehensive assessments of patient symptoms.

As an implementation guide, the guidelines recommended: pre-implementation planning through stakeholder engagement and identifying a technology solution, devising workflows for the care teams, training care teams in PROM use, testing, go-live and evaluations, and ongoing monitoring.

“Success rates of PROM implementation have been variable, and are dependent on the level of organisational commitment and available resources – planning, technology usability, engagement of clinic stakeholders, training, monitoring and oversight,” the guidelines said.

“Like other clinical informatics and care enhancement programs, PROM implementation has a high risk of failure if key principles are missing. Implementing and sustaining PROMs requires the engagement of clinical and administrative staff and leadership, as well as patients.”

The guidelines cited research that found healthcare providers often under-detect symptoms or their severity during oncology treatment. This was especially for non-life-threatening symptoms that impacted patient quality of life.

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