Patient-reported outcome measurement (PROM) program in patients with lymphoma receiving intravenous therapy: Preliminary results of a prospective study using PRO-CTCAE to individualize healthcate and to reduce unscheduled appointments.
Authors: Cordoba Raul , Ramos Sergio , Castillo Eva , Barreras Ruiz Natalia , Riesco Miriam , Herrero Antonio , Cruz Susana , Pardo Alberto , Pascual Adriana , Lopez-Garcia Alberto , Perez Maria-Angeles , Morillo Daniel , Askari Elham , Prieto Elena , Llamas Pilar , Becares Javier , Barriocanal Carla , del Olmo Marta , Short Jorge , Arcos Javier 
Published: June 2022

e18670

Background: PROMs have been included in cancer clinical trials but it is yet to come in daily clinical practice. Their implications in healthcare management have not been well stablished yet. We hypothesize that patients subscribed to these programs may benefit from a better self-perception of health status and might require fewer hospital admissions and emergency room visits, which could allow a reduction in the costs of treatment. Methods: “E-Res Salud” is a value-based healthcare program implemented in patients with hematological malignancies in our institution. Patients (pts) with diagnosis of any type of lymphoma in the need of treatment between 1st Jan 2019 and 31st Dec 2020 were included in our research. Inclusion in PROMs program was offered to every patient starting intravenous treatment in 2020. Pts who started treatment in 2019 and those who rejected inclusion in 2020 were considered the control arm of our study. The principal endpoint was to compare physician and patient-reported adverse events through a standardized questionnaire such as PRO-CTCAE. Secondary endpoints included association between inclusion in PROMs program and reduction of hospital admissions and emergency room visits. Results: A total of 142 pts were included in our study; 76 of them (53.5%) were included in a PROMs program. There were no differences in pts characteristics with regards of age or sex. Most frequent diagnoses were diffuse large B-cell, follicular and Hodgkin lymphoma. Adverse events (AEs) most frequently reported by physicians were hematological complications (76.1%), general (73.9%), gastrointestinal symptoms (59.9%) and infections (43.7%). When patients were asked to report AEs of higher intensity, the most frequently reported were general (31.6%), genitourinary (26.3%), gastrointestinal (23.7%), neurological (15.8%) and cutaneous (13.2%) symptoms. Patients included in PROMs program experienced reported fewer general (64.5% vs. 84.8%; p < 0.05) and infectious (30.3% vs. 59.1%; p < 0.05) AEs than those in the control arm. Moreover, inclusion in the PROMs program was associated with fewer number of visits to Emergencies, with 34.2% of pts vs 60% of pts not enrolled in the PROM program (p = 0.003). None of the different types of AEs were associated to an increase in the number of admissions or outpatient consultations. With such a short follow-up we have not found association between any type of AE and survival. Conclusions: This program can help to increase awareness among hematologists about patients’ perception of symptoms and what really matters to them. Our study establishes the association of PROMs with health care utilization among patients with different types of lymphoma. A longer follow-up and changes in PROMs during the treatment will be further analyzed.