Congress Abstracts 2006

133

THE FUTURE IS NOW: ELECTRONIC COLLECTION OF PATIENT REPORTED OUTCOMES. Ann Culkin, RN, OCN^®, and Ethan Basch, MD, MSc, Memorial Sloan-Kettering Cancer Center, New York, NY.

Symptom monitoring is a fundamental component of cancer care and clinical research. Oncology nurses routinely elicit and record patients' symptoms during chemotherapy. This information is used to assess disease, treatment experience and treatment outcome. A collaborative development of a web-based platform was developed to collect patient symptoms. A core set of symptoms was selected based on their perceptibility for cancer patients receiving cytotoxic chemotherapy regardless of cancer type utilizing the CTCAE (NCI Common Terminology Criteria for Adverse Events (3).

There is growing momentum for patients to self-report symptoms without intermediate clinician filtration. (Basch, 2005). Various methods have been used to collect patient reported outcomes. A web-based design utilizing Symptom Tracking and Reporting (STAR) was initiated for patients receiving cytotoxic chemotherapy. This system allowed patients to enter and track their own symptoms based on the CTCAE.

A questionnaire was developed with a grading scale using items from the NCI CTCAE, version 3. These included anorexia, constipation, diarrhea, fatigue, nausea, pain and vomiting. In addition, disease-specific items pertinent to lung cancer (cough, dyspnea) were chosen for use in the unique patient population. Outpatients were approached by a research study assistant to complete the questionnaire in waiting areas. A report was then generated for review by the clinician at their visit.

In patients with lung cancer, there were discrepancies in clinician reporting and patient reporting most significantly in fatigue, dyspnea, and pain, while there was most agreement on cough, anorexia, and constipation (Basch, 2005). Across all symptoms, it was more common for patients' to grade higher symptom severity than clinicians.

Integration of patient self-reporting into toxicity monitoring systems may improve patient safety and data quality (Basch, 2005). Patient reported outcomes may facilitate earlier toxicity reporting. In patients with lung cancer, when compared to other disease-specific malignancies, it was noted that this population of patients was less web-avid, and more acutely ill. In an ideal clinical setting, oncology nurses would be provided access to their patient's reports in order to improve symptom management and foster discussion related to patient outcomes.