Digital symptom monitoring using patient-reported outcome (PRO) surveys can improve clinical outcomes in patients with cancer, according to new research. 

The findings were presented at the American Society of Clinical Oncology (ASCO) Virtual Plenary Series by Ethan Basch, MD, of UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina.

“Multiple prior studies showed that, as clinicians, unfortunately, we miss up to half of our patients’ symptoms, with downstream consequences, including avoidable hospital or emergency room admissions, treatment modifications, and preventable suffering,” Dr Basch said.

With this in mind, Dr Basch and colleagues conducted the PRO-TECT trial ( Identifier: NCT03249090) to test whether patient outcomes can be improved through symptom monitoring via PRO surveys between visits.

Trial Details

PRO-TECT was conducted at 52 US community oncology practices. The practices were randomized 1:1 to usual care or to digital symptom monitoring with PRO surveys.

The study cohort included 1191 patients with solid tumors or hematologic malignancies, with 593 patients treated at the PRO practices and 598 patients treated at the control practices.

Patients at the PRO practices were asked to complete a weekly survey via web or automated phone system. The survey included questions related to common symptoms (pain, nausea, vomiting, constipation, diarrhea, dyspnea, insomnia, depression, and oral intake), performance status, falls, and financial toxicity.

If patients reported severe or worsening symptoms, email alerts were sent to clinical nurses. The alerts also included evidence-based symptom management advice. In addition, the system generated reports showing the longitudinal symptom trajectory, which could be discussed at clinical team visits.

In the control practices, nurses and patients received copies of symptom management pathways, and usual care consisted of standard interactions between clinicians and patients.

Compliance and Perceptions

On average, 91.5% of patients completed their weekly PRO surveys. Of the 20,565 completed surveys, 6979 (33.9%) triggered alerts. The most commonly reported symptoms included pain, diarrhea, dyspnea, and nausea.

Nurses acted on 4122 alerts (59.1%), providing phone counseling, supportive medications, referrals, and new appointments.

Both patients and nurses reported positive impressions of the digital monitoring system. However, about a quarter of nurses said they would not like to continue using the system because the alerts added to their workload.

“Nurses felt that a small amount of protected time was needed to address the alerts, and future implementations should account for this need for protected nursing time to assure successful uptake,” Dr Basch said.

Clinical Benefit

Physical function, symptom control, and health-related quality of life (HRQOL) were measured at baseline and at months 1, 3, 6, 9, and 12.

Patients at the PRO practices experienced more clinically meaningful benefits across the various time points, when compared with patients at the control practices, Dr Basch reported.

For example, at 3 months, the PRO practices had 13.8% more patients with physical function benefits (P =.009), 16.1% more patients with symptom control benefits (P =.003), and 13.4% more patients with HRQOL benefits (P =.006).

Data for overall survival, the study’s primary endpoint, are not yet mature. However, the available results suggest that digital symptom monitoring with PRO surveys is feasible, improves clinical outcomes, and is valued by patients and clinicians during routine clinical care, Dr Basch said.

Disclosures: The PRO-TECT trial is funded by the Patient-Centered Outcomes Research Institute (PCORI) and sponsored by Alliance Foundation Trials. Dr Basch disclosed affiliations with PCORI, ASCO, AstraZeneca, Sivan, Carevive Systems, and others. Please see the original reference for a full list of disclosures.


Basch E, Schrag D, Jansen J, et al. Digital symptom monitoring with patient-reported outcomes in community oncology practices: A U.S. national cluster randomized trial. ASCO Virtual Plenary; November 16, 2021. Abstract 349527.