Clinical Actions Generated By Remote Symptom Alerts and Electronic Patient-Reported Outcomes (ePROs) in Real-World Breast Cancer Practice

OBJECTIVES: Multiple studies have shown proactive symptom management in response to patient-reported outcomes reduces symptom burden, decreases healthcare resource utilization, and improves survival. This research aims to characterize the clinical actions implemented by the healthcare team in response to symptom alerts reported by women receiving routine breast cancer treatment.

METHODS: Women undergoing breast cancer treatment enrolled in Carevive PROmPT®, a remote symptom monitoring platform, with evidence of therapy up to 11/29/2023 were included. An algorithm-based alert was generated if symptom severity, frequency, and interference was moderate to severe. The healthcare team reviewed the alert, interacted with the patient, and recorded the response using a drop-down list of actions in the platform.

RESULTS: Over 19,425 symptoms were reported, generating 7,641 alerts. Distribution of clinical actions following the alert were clinical team notified (27.6%), continued monitoring (71.6%), supportive care (7.7%), resource utilization (2.5%), and medication change (2.3%). No action needed was noted in 5.6% of alerts and 13.6% of alerts were categorized as "Other.” A further exploration of the "Other” category (n=1,039) showed an additional distribution of clinical actions as clinical team notified (34.9%) continued monitoring (0.3%), supportive care (39.3%), resource utilization (12.3%), medication change (10.8%), and unable to reach (2.4%). Of patients whose alerts were indicated as “no action” (n=212), nearly half of them (48.1%) had indicated no need for call back and 11.3% had no further action due to reported improvements in their symptoms.

CONCLUSIONS: Continued monitoring assures the patient that the team is aware of how they are doing at home. Supportive care and medication change provides interventions to address the symptom at home, and to prevent unplanned clinic appointments or resource utilization. A small number of patients are referred to the ER or urgent care during regular care hours.