Study shows integration with health care systems remains critical to success

By Linetta Koppert, member of the H2O Initiative and Oncological surgeon, clinical epidemiologist, MD PhD at Erasmus MC responds to new data from ASCO

We at H2O welcome the presentation of secondary endpoints from the PRO-TECT study related to patient reported outcomes (PROs) and intervention feasibility. These finding, presented as part of the #ASCOPlenarySeries, demonstrate simple electronic systems can be effective in tracking PROs, resulting in significant improvements in symptom management and better clinical outcomes. The authors state that at 3 months, patients who tracked PROs reported benefits in physical function, symptom control and quality-of-life above that of the control group.

The PRO-TECT study is a randomized trial conducted at 52 U.S. community oncology practices across 25 states. The study abstract and a comprehensive summary of the presentation given by Ethan Basch, MD, MSc, of the UNC Lineberger Comprehensive Cancer Center and principal investigator of the PRO-TECT study, during the November ASCO Plenary Series is available here.

It is so important to see published data on the improvements in outcomes; this is the driving force behind everything we do on the H2O Initiative. It is also further evidence of the challenges we face in gathering PROs in a way which doesn’t increase the burden on health systems.

We believe it really is possible to reduce the burden on the healthcare system while improving outcomes. In my own clinical practice for breast cancer, my colleagues and I are already encouraging patients to feel confident in reporting quality of life outcomes. We help them understand this important data for us to know. The small amount of time it takes to proactively share is far outweighed by the benefit of being able to review treatment options, and where necessary, make adjustments. It does require a little effort on both sides, but we see that it leads to patients getting the best possible support.

In my own clinical practice for breast cancer, my colleagues and I are already encouraging patients to feel confident in reporting quality of life outcomes. We help them understand this important data for us to know.

What really stands out for us in the PRO-TECT study, aside from the excellent results for the patients, is the authors’ consideration of user experience, for both patients and clinicians. The study appears to have been designed to be as easy as possible for patients to use, even those with little experience with technology. They report an average patient compliance rate of 91%, which is truly impressive. However, the authors sound a note of caution: ‘Although 90% of patients said they would recommend the intervention to other patients based on their experience, only 64% of nurses would recommend the PRO system to other clinics. The burden of managing alert notifications on top of usual duties was a key reason cited by the nurses who would not recommend the PRO system.’

This very much aligns with our understanding of some of the challenges with gathering PROs, and demonstrates that we must continue to find solutions which integrate with existing healthcare systems. We recognise this is very difficult to do on large scale. We must think differently. And this is the H2O unique proposition; to discover the most practical ways to introduce continuous outcome measurement in clinical practice. We are finding new ways to leverage technologies and unleashing innovation to create efficiencies, reducing the burden for the healthcare system.

This is the H2O unique proposition; to discover the most practical ways to introduce continuous outcome measurement in clinical practice.

The PRO-TECT study authors make some recommendations around reducing this burden, including allocating specific time to front desk staff and nurses. It’s this sort of practical approach which is needed, alongside appropriate technologies. Our ambition with H2O is to create a standardized language for multiple diseases across multiple countries. We believe a one-size fits all approach would not work, so alongside finding excellent technology solutions, a significant focus of our partnerships with technology providers will concentrate on how we can integrate with existing healthcare systems in a way which is as seamless as possible.

We do believe the future is bright since ‘patient journey app-initiatives’ are being broadly introduced in healthcare, supporting implementation of PROs. We encourage this real transformation of healthcare not only by creating a standardized outcomes language but moreover by  implementing technology.

Studies like PRO-TECT continue to give us evidence that using PROs can be transformational, and provide encouragement that we are right to focus on bringing healthcare providers, as well as patients, along on the journey with us.