Adoption of patient-reported outcomes (PROs) in clinical practice for older patients receiving active anticancer treatment: Impact on health-related quality of life (QoL).
Authors: Zichi Clizia , Sperti Elisa , Marino Donatella , Lacidogna Gaetano , Vignani Francesca , Baratelli Chiara , Turco Carmela Giovanna Cleopatra , Ballaminut Daniela , Bellezza Annalisa , Chiotto Paola , Ciriolo Giovanna , Comite Rossella , Codegone Fulvia , Florio Santina , Fusco Luisa , Polimeno Laura , Pozzi Donatella , Zilio Eliana , Terzolo Sabrina , Di Maio Massimo 
Published: June 2021

e24014

Background: PROs are the gold standard to describe subjective symptoms. In order to improve clinical management of outpatients receiving active anti-cancer treatment at Medical Oncology, Mauriziano Hospital, Turin, Italy, in January 2018 we introduced in routine clinical practice an assessment of patient-reported symptoms and toxicities. We demonstrated that use of PROs in clinical practice was associated with a significant QoL improvement, compared to the traditional visit (Baratelli, Support Care Cancer 2019). In this secondary analysis, we show the results obtained in older pts ( > 70yrs). Methods: Eligible pts were receiving an active anti-cancer treatment, as outpatients. Pts treated in 2017 underwent “usual” visits (group A), while pts treated in 2018 before each visit received a paper questionnaire by a dedicated nurse, in order to provide information about symptoms and toxicities to be discussed during visit (group B). Primary objective was the comparison of QoL changes, measured by EORTC QLQ-C30. Results: Out of 211 pts, 88 were older than 70 yrs (47 group A, 41 group B). Median age was 76 (70-84 yrs). Most common tumors were colorectal (25.0%), lung (22.7%) and pancreatic (17.0%). 68.2% were receiving first-line treatment. Tumors and setting were similar between group A and B. Younger and older pts had comparable baseline QoL scores: mean global QoL score was 59.96 in younger pts vs. 57.39 in older pts. After 1 month, global QoL of older pts was significantly improved in group B compared to group A: mean change from baseline was -0.89 group A vs. +4.47 group B (p = 0.006, effect size 0.23). There were statistically significant differences in mean changes from baseline, in favor of group B, for role functioning (-5.67 group A and -0.81 group B, p = 0.034, effect size 0.20) and emotional functioning (-2.30 group A and +3.25 group B, p = 0.014, effect size 0.36). Mean changes from baseline for pain were significantly better for group B (-3.25) than group A (+6.03, p = 0.01, effect size 0.43). There were no significant differences between the 2 groups in terms of other functional scales or symptoms. There was no significant heterogeneity in the proportion of QoL responders between younger and older pts (p = 0.60). The proportion of older pts obtaining a clinically significant improvement in global QoL was numerically higher in group B (36.6%) compared to group A (19.1%, p = 0.09). Odds Ratio of obtaining an improvement in global QoL for group B vs group A was 1.73 (95%CI 0.75 – 3.99) in younger pts and 2.44 (95%CI 0.93 – 6.40) in older pts. Conclusions: This secondary analysis shows that the use of PROs in clinical practice, thanks to an active role of nurses and discussion of symptoms with physicians during the visit, is associated, also in older patients receiving active anticancer treatment, with a significant improvement in global QoL.