Symptoms Detection Among Patients with Lymphoid Malignancies (LM) Using Electronic Patient-Reported Outcomes (ePROs) in Community Hematology-Oncology Clinics
Authors: Essell James H , Derman Benjamin A , Kolodziej Michael A. , Kwiatkowsky Lavi , Calkins Geoffrey , Parrinello Christina M , Ascha Mustafa S 
Published: December 2024

Introduction: Most lymphoid malignancies (LM) are treated in outpatient community practices. Patients with complications are required to call into their physician's practice to receive guidance on symptom management, but there are multiple barriers to symptoms reporting by phone. Given the ubiquitous nature of smart phones, one easier approach to symptoms communication includes electronic patient-reported outcomes (ePROs) software applications, which have been demonstrated to improve symptom communication, time on treatment, and patient outcomes among patients diagnosed with solid tumors but merit further study in hematologic malignancies. This is a study of ePROs symptoms and symptoms care among patients diagnosed with LM.
Methods: Patients with a record of treatment and diagnosis from June 2020 through June 2024 of follicular lymphoma, large cell lymphoma, Waldenström's macroglobulinemia, mantle cell lymphoma, or chronic lymphocytic leukemia from six community practices were included (n = 1,915). We studied 505 patients who submitted ePRO reports using the Canopy Care platform, which is a proprietary cloud-based system that integrates with electronic medical record systems of patients and clinical staff to enable communication using patient smart devices or through an interactive telephone-based system. Patients who submitted ePRO reports were compared to 1,410 patients from the same practices who did not submit ePRO reports. Descriptive statistics about symptoms were taken, Kaplan-Meier estimates about time to symptom reporting after first treatment, time from symptom report to clinical acknowledgement or care, and differences in 90-day restricted mean time on any treatment were also assessed.
Results: Demographic characteristics of ePRO-using patients were generally similar to those of patients who did not use ePROs. Patients communicated symptoms more quickly using ePROs compared to standard phone calls within the 90 days following first observed treatment: patients using ePROs reported a symptom an average of 38 days before patients not using ePROs called in about symptoms (95% CI: 35, 43, p &lt; 0.001). Patients also communicated symptoms more frequently using ePROs compared to phone: 61.8% of patients reported fatigue by ePRO compared to 10.4% by phone, 14.5% reported fever by ePRO compared to 7.9% by phone, 5.5% reported heart palpitations by ePRO compared to 0.2% by phone, and 22.0% reported dizziness/lightheadedness by ePRO compared to 2.8% by phone.
For symptom reports necessitating clinical action, a median 47 minutes passed between ePRO submission and nurse triage assessment (IQR: 13.6, 270.2 minutes) whereas 97.7 minutes passed between phone calls about symptom reports and clinical management (IQR: 47.7, 224.9 minutes). At 90 days following the first treatment for LM, 76% (95% CI:71, 83%) of patients who enrolled in ePROs prior to first treatment and submitted an ePRO report remained on treatment, whereas 65% (95% CI: 63, 68%) of patients not enrolled in the ePROs system remained on treatment.
Conclusions: Patients diagnosed with LM who use ePRO systems report symptoms more quickly and more frequently than those who don't use ePROs. The use of ePROs and resultant increased communication between patients and providers leads to more patient symptoms being addressed and increased time on treatment at 3 months, and may require less time to follow up compared to symptoms reported by phone. With these encouraging results we will study ePRO use in Chimeric Antigen Receptor T cell therapy patients in community practices.