Abstract C007: Racial differences in feasibility and perceived value of electronic symptom monitoring in a cohort of Black and White bladder and prostate cancer patients
Authors: Samuel Cleo A. , Smith Angela , Chen Ronald , Elkins Wendi , Richmond Jennifer , Mahbooba Zahra , Mueller Dana E. , Basch Ethan , Bennett Antonia V. , Chung Arlene E. , Reeve Bryce B. 
Published: September 2020

Abstract
Background Racial differences in cancer-related symptom burden are well-documented, and partly linked to inequities in symptom monitoring. Electronic patient-reported outcomes (ePROs) are useful for symptom monitoring, but have rarely been evaluated in diverse patient populations. We implemented an ePRO tool among a cohort of Black and White cancer patients and evaluated (1) whether ePRO use was perceived as feasible and valuable for symptom management; and (2) if perceptions of feasibility and value differed by race. Methods We recruited 30 Black and 50 White bladder and prostate cancer patients from a single institution. Participants completed ePRO assessments prior to, during, and 3 months following completion of cancer treatment. Participants were given the option of reporting symptoms using a web- or phone-based system. A subset of participants completed end-of-study satisfaction surveys (n=9 Black; n=25 White) and qualitative interviews (n=15 Black; n=25 White) assessing ePRO feasibility and value. We analyzed end-of-study surveys and qualitative interview data, evaluating race-specific differences in user experiences with the ePRO tool. Results Both Black (77.8%) and White (96.0%) participants more commonly reported using the web-based system for symptom reporting, with the majority of participants reporting being “very satisfied” with the web-based system (71.4% Black; 66.7% White). Whites more commonly reported high levels of ease in understanding and answering symptom assessment items compared with Blacks (44.4% Black; 56.0% White). In interviews, Blacks expressed stronger preferences for phone-based and paper-based reporting due to ease in facilitating understanding of symptom items. In terms of perceived value, Blacks more often reported that the ePRO tool was “very helpful” in reminding them of symptoms experienced in the last seven days (55.6% Black; 36.0% White). In interviews, Blacks also described how the ePRO helped them better understand symptoms, while Whites noted finding value in better understanding symptoms and the ability to track their symptoms over time. Black and White respondents commonly reported that doctors communicated with them about ePRO-reported symptoms (88.9% Black; 84.0% White), but Blacks more often reported that the ePRO tool was “very helpful” in speaking to doctors about symptoms (44.4% Black; 24.0% White). In interviews, both Black and White participants indicated that ePRO use prompted more in-depth discussions about symptoms and treatment options with providers. Conclusion Electronic symptom monitoring is perceived as valuable among Black and White cancer patients. Greater perceived value of ePROs among Blacks may have implications for addressing systemic drivers of symptom disparities. As oncology practices move towards broader implementation of ePROs, it will be important to consider the health literacy needs and ePRO modality preferences of patients, in order to promote equitable adoption of electronic symptom monitoring.
Citation Format: Cleo A. Samuel, Angela Smith, Ronald Chen, Wendi Elkins, Jennifer Richmond, Zahra Mahbooba, Dana E. Mueller, Ethan Basch, Antonia V. Bennett, Arlene E. Chung, Bryce B. Reeve. Racial differences in feasibility and perceived value of electronic symptom monitoring in a cohort of Black and White bladder and prostate cancer patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C007.