An ehealth intervention during radical radiotherapy: Patient-Reported Outcome Side effects (PROSE) study—An emerging approach from sub-Saharan Africa.
Authors: Salako Omolola , Fagbenro Gabriel , Joseph Adedayo , Enyi Adaorah Francisca , Adegboyega Bolanle Comfort , Okunade Kehinde Sharafadeen 
Published: June 2023

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Background: PROSE is an electronic patient-reported outcome tool for real-time, remote monitoring of treatment related side-effects. It enables a two way communication between the patient and clinicians. Remote monitoring of treatment related toxicities can eliminate underreporting of side effects (SE), facilitate timely symptom assessment, and improve management of SE. These will thereby reduce morbidity and hospitalization and improve treatment outcomes and quality of life of affected patients. The overarching goal of the study is to enhance the efficiency of the conventional weekly SE clinic using an emerging technology and thereby create evidence for a personalized digital health interventions for cancer patients in Africa. Methods: A prospective study among adult cancer patients receiving radical radiotherapy for head and neck, pelvic, and breast cancers at NSIA-LUTH Cancer Centre in Nigeria between March and October 2022. Eligible (≥18 years, KPS≥75%) and consenting participants were trained on to report their SE daily and receive remote clinical advice on prosecare.com . The PROSE tool was built as an adapted version of the Patient Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). The study participants were monitored throughout their radiotherapy sessions and two weeks thereafter. The cancer care team can review the Patients Reported Outcome (PRO) data through a dedicated log-in portal during the SE clinic. Participants scored their SE daily and EORTC QLQ-30 quality of life surveys were administered thrice during the study and 2 weeks thereafter. SE reports were chosen according to the site of disease; 12 items for head and neck tumors, 9 items for breast tumors, 14 items for female pelvic and 18 items for male pelvic tumors. Patient’s PROSE tool application utilization was defined as >50% daily reporting during study period. Results: A total of 137 participants were screened, of which 120 met the eligibility criteria. Of the 120 patients eligible, 23 had technical issues with the use of the PROSE tool application and 1 died during the study; thus, 96 participants data were analyzed. More than 40,000 SE reports were generated during the study. SE with highest symptom burden include urinary frequency in male pelvic cancers (n=17), radiation dermatitis in breast cancer (n=40), diarrhea in female pelvic cancer (n=19) and xerostomia in head/neck cancers (n=20). The app utilization rate was 58%. Conclusions: There was a moderate utilization (58%) of the PROSE tool application. The PROSE pilot study demonstrated the potential utility of the PROSE application as a promising tool and data resource that offers a great opportunity to improve cancer care and the development of predictive clinical algorithms by engaging patients in their own care and increased SE reporting of acute radiation toxicities.