Allison Deal, MS
UNC Lineberger Comprehensive Cancer Center
Receiving chemotherapy for advanced cancer can take a toll on a person’s quality of life. Side effects are common, and unless a patient is proactive in reporting these symptoms to their provider, they may worsen in severity and take longer to be addressed. Based on a prior single center study, the subsequent multicenter PRO-TECT trial was conducted across 52 US-based community oncology practices to determine whether weekly symptom reporting improves survival, quality of life (as measured by the EORTC-QLQ-C30; subscale scores range from 0-100 with higher scores indicating better QOL), and other outcomes, compared with usual care in patients undergoing treatment for metastatic cancer.
The PRO-TECT trial enrolled about 1,100 patients and showed meaningful differences between arms in physical function, symptom control, and health-related quality of life for the group as a whole. After 3 months of study, patients in the usual care arm reported similar symptom control as they had at baseline, while those in the intervention arm saw improvements (increase of 2.37 points). We wanted to see if the weekly symptom reporting might benefit some subgroups of patients more than others, so we ran stratified analyses using general linear mixed models. It turns out that there were bigger improvements in symptom control in the PRO arm for 1) Black patients, compared to White patients (4.84 v 1.81), 2) females, compared to males (3.36 v 0.83), 3) those with high-school education or lower, compared to those with more than a high-school education 4.02 v 1.43), and 4) younger (<65) patients, compared to older (≥65) patients (2.95 v 1.68). These differential effects did not appear to be due to baseline differences in quality of life between arms, nor in participation rates in responding to the weekly surveys. Some patients in the subgroups that saw larger improvements reported that the intervention “improved discussions with their providers.”
We hypothesize that this type of intervention may have worked better in traditionally underserved subgroups by removing the bias that is known to permeate face-to-face interactions of some patients with their providers. Additionally, this intervention also eliminated communication barriers for patients who may be more hesitant to discuss bothersome symptoms with their provider or to reach out with concerns between visits. Although this was an exploratory subgroup analysis, it provides important considerations for future research.
As a biostatistician, I am proud to be part of an amazing study team working to improve the quality of life of patients with cancer by developing tools and studies to evaluate new interventions. I am particularly excited about this project that was the award winner for the 2024 Outstanding Poster at the ISOQOL Annual Conference. We are in the process of writing a manuscript that includes additional details from this subgroup analysis. Additionally, the PCORI-funded OncoPRO initiative, based on results of the PRO-TECT trial, is supporting implementation of electronic symptom surveys to cancer patients at practices in the US. Given the known disparities that exist in the US in cancer health outcomes, it is vital to develop interventions that can help narrow these inequities and ensure all people receive the best care possible.
This newsletter editorial represents the views of the author and does not necessarily reflect the views of ISOQOL.
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