What Do Oncology Patients Think of Electronic Monitoring?

Oncological patients are generally open to new electronic monitoring systems, according to the results of an Italian survey published in ESMO Real World Data and Digital Oncology. The survey evaluated patients’ perspectives on the electronic version of Patient Reported Outcome Measures (ePROMs).

Patient Reported Outcomes (PROs) are defined as any report on a patient’s health status that comes directly from the patient himself or herself, without interpretation by a physician or anyone else. “PROMs are the tools (specially constructed questionnaires) that allow us to collect this information,” said Massimo Di Maio, director of University Medical Oncology at Le Molinette Hospital in Turin. Di Maio, who was in charge of oncology at Mauriziano Hospital in Turin for years, is also the author of the first ESMO Guidelines on the use of PROMs in the continuum of oncological care, which were published in September 2022.

Who’s Afraid of Technology?

Researchers from Turin surveyed 220 patients who were attending the oncological day hospital at Mauriziano Hospital, where PROMs have been used in a paper format for years to the satisfaction of doctors and patients. The patients had been diagnosed with various types of tumors, and 58% were over the age of 60 years. They were asked to evaluate their satisfaction (on a scale of 1-10) with current symptom monitoring systems, which generally were based on oncologist questions during visits or on paper PROMs. 

About 72% of patients rated current procedures with a score ≥ 8. About 82% expressed support for the introduction of an electronic version of questionnaires (ie, ePROMs) in the form of smartphone or tablet apps or websites. Furthermore, most patients reported having no major issues with technology use or Internet connection. “Patients older than 60 years (26% vs 19%, P = .007) or patients with a low grade of education (38% vs 15%, P < .001) were those most likely to declare poor handling of computer devices," wrote the authors, explaining that, in view of the potential introduction of ePROMs, it is necessary to consider these populations to avoid disparities in access to these important tools. Providing different versions of PROMs can help overcome this barrier, they wrote.

Obstacles to Overcome 

In this generally positive framework, a minority of patients expressed doubts, including concerns about privacy related to the use of ePROMs (2% agreeing or fully agreeing with the statement) and fear that doctors may attach little importance to data derived from these tools (1.5%). The percentage of patients expressing concern that the use of ePROMs could undermine the doctor–patient relationship was higher (16%).

“It is necessary to explain to the patient that the possible introduction of these tools is not intended to replace but to improve and complement an already existing relationship and that this helps in the correct and timely management of symptoms,” said study author Anna Amela Valsecchi, medical oncologist at the University of Turin and Le Molinette. “The added value of the electronic version of PROMs is the possibility, at least in theory, to monitor symptoms in real time remotely,” she added.

Despite the data and positive experiences already reported in Italy, the use of PROMs is not yet common in Italian oncology. “The first reason is cultural,” said Di Maio. “These tools are still seen as accessories and not as an integral part of patient care as a drug can be. Furthermore, there is an objective logistical-organizational difficulty. Dedicated personnel are needed. It is necessary to establish who will take care of the reports. In short, a real reorganization of roles and the enlistment of trained and dedicated personnel is needed. This demand is not easily met in the current Italian healthcare landscape.”

Commitment and Optimism

The scientific community is committed to promoting PROMs. The national conference of the Italian Association of Medical Oncology (AIOM), which is scheduled for June 21 and 22 in Bologna, will focus on PROMs. “The idea came from Francesco Perrone, AIOM president, and now we are working on the program. We intend to involve institutions, regulatory bodies, and patient representatives and clinicians who have had field experiences in using ePROMs,” said Di Maio.

“I am optimistic and hope that resources can be found to implement these tools. We need to start! Once started, I am sure that the positive impact of these tools will begin to be understood,” said Valsecchi, noting that patients often request the questionnaire from their doctors. “They consider it a useful tool in their care journey,” she concluded.

This story was translated from Univadis Italy, which is part of the Medscape professional network, using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.