Assessing the Implementation of Electronic Patient-Reported Outcomes (ePRO) to Reduce Follow-up Visits for Patients...

We aimed to evaluate the acceptability, appropriateness, and feasibility of using an electronic patient-reported outcome (ePRO)-based strategy to reduce postradiation therapy (RT) visits in patients with breast cancer who reported minimal symptoms.

An ePRO instrument was administrated weekly for patients undergoing RT for breast cancer at an academic cancer center. The instrument assessed RT toxicities (breast enlargement/tenderness, skin changes, pain, and fatigue) using Patient-Reported Outcomes National Cancer Institute Common Terminology Criteria for Adverse Events and anxiety with the Generalized Anxiety Disorder 2-item screening tool. Patients rated symptom severity on a 5-point Likert scale (none to very severe). Six weeks after treatment completion, patients with no more than moderate symptoms were offered the option to cancel their routine post-RT follow-up visit. Clinical and demographic data were collected from electronic health records.

Among the 46 patients (median age: 60 years) who responded to the appointment cancellation question, 32 (70%) were White, 5 (11%) Black, 5 (11%) Asian, and 2 (4.3%) Hispanic. Regarding acceptability among respondents, we found 36 (78%) chose to keep their appointments, 7 (15%) opted to cancel, and 3 (6.5%) were not sure. In terms of appropriateness, patients who canceled or were unsure were similar in age, race, ethnicity, body mass index, and travel distance to the center, but reported fewer symptoms than those who kept their appointments, with significantly lower breast tenderness (10% vs 50%, respectively, P = .026), and a trend toward lower pain in the radiated area (30% vs 61%, P = .073) and fatigue (30% vs 56%, P = .23). As an assessment of feasibility, fewer hospitalizations within 6 months occurred among those cancelling their follow-up visit (0 vs 2 [5.6%]), whereas urgent care visits were comparable (8.6% vs 10%).

An ePRO-based strategy to inform post-RT follow-up visits appears feasible and appropriate for patients who completed breast RT with mild-to-moderate symptoms. Despite low acceptability (∼20%), the high prevalence of breast cancer suggests this strategy could still reduce the clinical burden of low-value visits.