Oral Oncolytics and the importance of routine collection of PROs

While more convenient and less invasive than intravenous therapy, patients taking oral oncolytic medications do not receive the same level of oversight regularly provided by physicians and nurses at the clinic. It is challenging because many patients experience a high symptom burden due these medications, leading many to be at risk of becoming nonadherent to their treatment. Some patients will entirely stop taking their medications within the first month of therapy.?

Adherence to oral oncolytics, as well as management of symptoms, is vital to achieve the optimal clinical response that is now reliant on self-management.

Patient-reported outcomes (PROs) are used to gather information from patients during treatment. Patient symptom monitoring during cancer therapy has shown to have a positive impact on outcomes and quality of life. As healthcare has moved to a value-based model, PROs are not only used by care teams to make better decisions on care but payers use them to assess performance of care given, which influences reimbursement.?

Many studies have been done to support the use of PROs. But most PROs are not submitted daily to clinicians. How effective can treatment be if PROs are not routine, if care teams do not know how patients are doing every day in between office visits?

In the study, Patient- versus physician-reporting of symptoms and health status in chronic myeloid leukemia researchers concluded that, “routine collection of patient reported symptom data in daily clinical practice may facilitate greater awareness in physicians of their patients’ symptom burden, which in turn may enhance in the management of patients with CML.”

This study, "compared the reporting of health status and symptom severity, for a set of core symptoms related to first-line imatinib therapy, between patients and their treating physicians." In the past, studies in malignant tumors showed discrepancies on severity between patients and physicians as well as on patient reported symptoms vs provider reported symptoms. No study before this had investigated possible discrepancies between patient- and physician-reporting in the CML setting.

Both physicians and patients were asked to complete a questionnaire including questions on symptom severity and health status. The symptoms assessed were: abdominal discomfort, diarrhea, edema, fatigue, headache, muscle cramps, musculoskeletal pain, nausea and skin problems.

Findings showed that physicians generally underestimated the severity of symptoms and overestimated the overall health status of their patients. While underestimation was found to be at the low end of the symptom scale, even mild symptoms can impact the quality of life with CML patients. The underestimation may lead physicians to wrongly believe these patients may not be at risk for stopping medication.?

At Dosentrx, we believe patients should have the proper tools and support to easily report on their symptoms and side effects.?

References

Efficance, F, Rosti, G, Aaronson, N, Cottone, F, Angelucci, E, Monica, S. Vignetti, M, Baccarani, M. Patient- versus physician-reporting of symptoms and health status in chronic myeloid leukemia. Haematologica. Vol. 99 No. 4 (April 2014).

Mackler E, Petersen L, Severson J, Blayney DW, Benitez LL, Early CR, Hough S, Griggs JJ. Implementing a Method for Evaluating Patient-Reported Outcomes Associated With Oral Oncolytic Therapy. Journal of Oncology Practice?13, no.?4 (April 01, 2017) e395-e400.

McNamara E, Redoutey L, Mackler E, et al: Improving Oral Oncolytic Patient Self-Management. Journal of Oncology Practice Journal of Oncology Practice?12, no.?9. (September 01, 2016) e864-e869.

Nachar V, PharmD, Farris, K. PhD, Beekman K, MD, Griggs, MD, Hough S, PharmD, Mackler, E. Pharm D. Clinician Report of Oral Oncolytic Symptoms and Adherence Obtained via a Patient-Reported Outcome Measure (PROM), Journal of Oncology Practice 10, no.?3 (May 01, 2014) 162-167.

Salgado, T.M., Mackler, E., Severson, J.A. The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices. Supportive Care Cancer 25, (2017) 1797–1807.