Quality-of-Life, Symptom Burden, and Tolerability in Frail Patients without Caregivers in Real-world Oncology Practice
Author(s)
Emelly Rusli, MPH1, Aaron Galaznik, MD, MBA1, Debra Wujcik, RN, PhD2;
1Carevive by HealthCatalyst, Boston, MA, USA, 2Independent Oncology Consultant, Columbia, TN, USA
1Carevive by HealthCatalyst, Boston, MA, USA, 2Independent Oncology Consultant, Columbia, TN, USA
Presentation Documents
OBJECTIVES: Patient-reported outcomes (PROs) and Social Determinants of Health (SDOH) are used to explore patient needs individually, yet rarely in tandem. PRO platforms, especially in oncology, make it possible to bring them together real-world care to identify patients potentially needing care escalation over time, with particular focus on the role of frailty and caregiver absence.
METHODS: This retrospective study used pan-tumor data from 9/2020 to 11/2024, from patients enrolled in the Carevive PROmpt PRO platform across multiple institutions. All patients reported baseline SDoH, race and frailty, and completed weekly surveys assessing function, QoL and treatment bother. Alerts triggered by PRO-CTCAE-assessed moderate/severe symptoms were also analyzed. Patient-reported tolerability (PRT) was calculated per Brose et al. (2024) using the FACT-GP5, defining high treatment bother (HTB) as “Quite a bit” or “Very much”.
RESULTS: 206 patients were included. Median age was 69, 55% female, 84% white, with 12-week median follow-up. Nearly half (49%) were on Medicare, 62% retired, 59% without college degree, 45% living >20 miles from the center, 60% married, 80% living with one other adult (LAA). About 80% reported moderate/severe symptoms, with median 2 alerts/patient/week. Top symptoms were fatigue, pain, neuropathy, constipation, and anxiety. Overall PRT showed those LAA had more persistent HTB than those living alone, (7.7% vs 4.9%, respectively). For patients LAA, persistent HTB decreased from 9.2% in weeks 1-4 to 6.1% in weeks 5+. In contrast, patients living alone (LA) reported increased persistent HTB over time (4.9% vs. 7.1%, respectively). QoL and physical function were comparable between LA and LAA, with directional function decline was seen at 11 weeks in those LA.
CONCLUSIONS: Findings suggested frail patients with no caregiver may experience HTB and severe symptoms (including anxiety) over time, potentially warranting intervention. This demonstrates how PROs, coupled with SDoH data, in oncology practices can actionably bolster patient-centered care beyond clinic visits.
METHODS: This retrospective study used pan-tumor data from 9/2020 to 11/2024, from patients enrolled in the Carevive PROmpt PRO platform across multiple institutions. All patients reported baseline SDoH, race and frailty, and completed weekly surveys assessing function, QoL and treatment bother. Alerts triggered by PRO-CTCAE-assessed moderate/severe symptoms were also analyzed. Patient-reported tolerability (PRT) was calculated per Brose et al. (2024) using the FACT-GP5, defining high treatment bother (HTB) as “Quite a bit” or “Very much”.
RESULTS: 206 patients were included. Median age was 69, 55% female, 84% white, with 12-week median follow-up. Nearly half (49%) were on Medicare, 62% retired, 59% without college degree, 45% living >20 miles from the center, 60% married, 80% living with one other adult (LAA). About 80% reported moderate/severe symptoms, with median 2 alerts/patient/week. Top symptoms were fatigue, pain, neuropathy, constipation, and anxiety. Overall PRT showed those LAA had more persistent HTB than those living alone, (7.7% vs 4.9%, respectively). For patients LAA, persistent HTB decreased from 9.2% in weeks 1-4 to 6.1% in weeks 5+. In contrast, patients living alone (LA) reported increased persistent HTB over time (4.9% vs. 7.1%, respectively). QoL and physical function were comparable between LA and LAA, with directional function decline was seen at 11 weeks in those LA.
CONCLUSIONS: Findings suggested frail patients with no caregiver may experience HTB and severe symptoms (including anxiety) over time, potentially warranting intervention. This demonstrates how PROs, coupled with SDoH data, in oncology practices can actionably bolster patient-centered care beyond clinic visits.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
PCR219
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
SDC: Oncology