Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial

N.E. Billingy; V.N.M.F. Tromp; N.K. Aaronson; R.J.A. Hoek; H.J. Bogaard; B.D. Onwuteaka-Philipsen; L.V. van de Poll-Franse; Jacqueline g Hugtenburg; José Belderbos; Annemarie Becker-Commissaris; Corina j g Van den hurk; Iris Walraven; N c Van walree; K De jaeger; S Samii; W y Lam-Wong; F Koppe; J a Stigt; G j m Herder; A Welling; O c j Schuurbiers-Siebers; J m Smit; A j Staal-Van den brekel; W k De jong

doi:10.1093/jnci/djad159

Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial

N.E. Billingy^*
, V.N.M.F. Tromp
, N.K. Aaronson
, R.J.A. Hoek
, H.J. Bogaard
, B.D. Onwuteaka-Philipsen
, L.V. van de Poll-Franse
, Jacqueline g Hugtenburg
, José Belderbos
, Annemarie Becker-Commissaris
, Corina j g Van den hurk
, Iris Walraven
, N c Van walree
, K De jaeger
, S Samii
, W y Lam-Wong
, F Koppe
, J a Stigt
, G j m Herder
, A Welling

O c j Schuurbiers-Siebers, J m Smit, A j Staal-Van den brekel, W k De jong

^*Corresponding author for this work

Medical and Clinical Psychology

Research output: Contribution to journal › Article › Scientific › peer-review

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Abstract

Background
Previous studies using patient-reported outcomes measures (PROMs) to monitor symptoms during and after (lung) cancer treatment used alerts that were sent to the health-care provider, although an approach in which patients receive alerts could be more clinically feasible. The primary aim of this study was to compare the effect of weekly PROM symptom monitoring via a reactive approach (patient receives alert) or active approach (health-care provider receives alert) with care as usual on health-related quality of life (HRQOL) at 15 weeks after start of treatment in lung cancer patients.

Methods
The SYMPRO–Lung trial is a multicenter randomized controlled trial using a stepped wedge design. Stage I-IV lung cancer patients in the reactive and active groups reported PROM symptoms weekly, which were linked to a common alerting algorithm. HRQOL was measured by the EORTC QLQ-C30 at baseline and after 15 weeks. Linear regression analyses and effect size estimates were used to assess mean QOL–C30 change scores between groups, accounting for confounding.

Results
A total of 515 patients were included (160 active group, 89 reactive group, 266 control group). No differences in HRQOL were observed between the reactive and active group (summary score: unstandardized beta [B] = 0.51, 95% confidence interval [CI] = -3.22 to 4.24, Cohen d effect size [ES] = 0.06; physical functioning: B = 0.25, 95% CI = -5.15 to 4.64, ES = 0.02). The combined intervention groups had statistically and clinically significantly better mean change scores on the summary score (B = 4.85, 95% CI = 1.96 to 7.73, ES = 0.57) and physical functioning (B = 7.00, 95% CI = 2.90 to 11.09, ES = 0.71) compared with the control group.

Conclusions
Weekly PRO symptom monitoring statistically and clinically significantly improves HRQOL in lung cancer patients. The logistically less intensive, reactive approach may be a better fit for implementation.

Original language	English
Pages (from-to)	1515-1525
Journal	JNCI-Journal of the National Cancer Institute
Volume	115
Issue number	12
DOIs	https://doi.org/10.1093/jnci/djad159
Publication status	Published - 2023

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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MCP_vandePoll-Franse_Quality of life after patient-initiated vs physician-initatied respons to symptom monitoring_JNCI_2023Final published version, 1.08 MBLicence: CC BY

https://academic.oup.com/jnci/article/115/12/1515/7246746

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Billingy, N. E., Tromp, V. N. M. F., Aaronson, N. K., Hoek, R. J. A., Bogaard, H. J., Onwuteaka-Philipsen, B. D., van de Poll-Franse, L. V., Hugtenburg, J. G., Belderbos, J., Becker-Commissaris, A., Van den hurk, C. J. G., Walraven, I., Van walree, N. C., De jaeger, K., Samii, S., Lam-Wong, W. Y., Koppe, F., Stigt, J. A., Herder, G. J. M., ... De jong, W. K. (2023). Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial. JNCI-Journal of the National Cancer Institute, 115(12), 1515-1525. https://doi.org/10.1093/jnci/djad159

@article{d10d5283170640bf8fadf25e3f0f4713,

title = "Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial",

abstract = "Background Previous studies using patient-reported outcomes measures (PROMs) to monitor symptoms during and after (lung) cancer treatment used alerts that were sent to the health-care provider, although an approach in which patients receive alerts could be more clinically feasible. The primary aim of this study was to compare the effect of weekly PROM symptom monitoring via a reactive approach (patient receives alert) or active approach (health-care provider receives alert) with care as usual on health-related quality of life (HRQOL) at 15 weeks after start of treatment in lung cancer patients. Methods The SYMPRO{\textendash}Lung trial is a multicenter randomized controlled trial using a stepped wedge design. Stage I-IV lung cancer patients in the reactive and active groups reported PROM symptoms weekly, which were linked to a common alerting algorithm. HRQOL was measured by the EORTC QLQ-C30 at baseline and after 15 weeks. Linear regression analyses and effect size estimates were used to assess mean QOL{\textendash}C30 change scores between groups, accounting for confounding. Results A total of 515 patients were included (160 active group, 89 reactive group, 266 control group). No differences in HRQOL were observed between the reactive and active group (summary score: unstandardized beta [B] = 0.51, 95\% confidence interval [CI] = -3.22 to 4.24, Cohen d effect size [ES] = 0.06; physical functioning: B = 0.25, 95\% CI = -5.15 to 4.64, ES = 0.02). The combined intervention groups had statistically and clinically significantly better mean change scores on the summary score (B = 4.85, 95\% CI = 1.96 to 7.73, ES = 0.57) and physical functioning (B = 7.00, 95\% CI = 2.90 to 11.09, ES = 0.71) compared with the control group. Conclusions Weekly PRO symptom monitoring statistically and clinically significantly improves HRQOL in lung cancer patients. The logistically less intensive, reactive approach may be a better fit for implementation.",

author = "N.E. Billingy and V.N.M.F. Tromp and N.K. Aaronson and R.J.A. Hoek and H.J. Bogaard and B.D. Onwuteaka-Philipsen and \{van de Poll-Franse\}, L.V. and Hugtenburg, \{Jacqueline g\} and Jos{\'e} Belderbos and Annemarie Becker-Commissaris and \{Van den hurk\}, \{Corina j g\} and Iris Walraven and \{Van walree\}, \{N c\} and \{De jaeger\}, K and S Samii and Lam-Wong, \{W y\} and F Koppe and Stigt, \{J a\} and Herder, \{G j m\} and A Welling and Schuurbiers-Siebers, \{O c j\} and Smit, \{J m\} and \{Staal-Van den brekel\}, \{A j\} and \{De jong\}, \{W k\}",

year = "2023",

doi = "10.1093/jnci/djad159",

language = "English",

volume = "115",

pages = "1515--1525",

journal = "JNCI-Journal of the National Cancer Institute",

issn = "0027-8874",

publisher = "Oxford University Press",

number = "12",

}

Billingy, NE, Tromp, VNMF, Aaronson, NK, Hoek, RJA, Bogaard, HJ, Onwuteaka-Philipsen, BD, van de Poll-Franse, LV, Hugtenburg, JG, Belderbos, J, Becker-Commissaris, A, Van den hurk, CJG, Walraven, I, Van walree, NC, De jaeger, K, Samii, S, Lam-Wong, WY, Koppe, F, Stigt, JA, Herder, GJM, Welling, A, Schuurbiers-Siebers, OCJ, Smit, JM, Staal-Van den brekel, AJ & De jong, WK 2023, 'Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial', JNCI-Journal of the National Cancer Institute, vol. 115, no. 12, pp. 1515-1525. https://doi.org/10.1093/jnci/djad159

TY - JOUR

T1 - Quality of life after patient-initiated vs physician-initiated response to symptom monitoring

T2 - the SYMPRO-Lung trial

AU - Billingy, N.E.

AU - Tromp, V.N.M.F.

AU - Aaronson, N.K.

AU - Hoek, R.J.A.

AU - Bogaard, H.J.

AU - Onwuteaka-Philipsen, B.D.

AU - van de Poll-Franse, L.V.

AU - Hugtenburg, Jacqueline g

AU - Belderbos, José

AU - Becker-Commissaris, Annemarie

AU - Van den hurk, Corina j g

AU - Walraven, Iris

AU - Van walree, N c

AU - De jaeger, K

AU - Samii, S

AU - Lam-Wong, W y

AU - Koppe, F

AU - Stigt, J a

AU - Herder, G j m

AU - Welling, A

AU - Schuurbiers-Siebers, O c j

AU - Smit, J m

AU - Staal-Van den brekel, A j

AU - De jong, W k

PY - 2023

Y1 - 2023

N2 - Background Previous studies using patient-reported outcomes measures (PROMs) to monitor symptoms during and after (lung) cancer treatment used alerts that were sent to the health-care provider, although an approach in which patients receive alerts could be more clinically feasible. The primary aim of this study was to compare the effect of weekly PROM symptom monitoring via a reactive approach (patient receives alert) or active approach (health-care provider receives alert) with care as usual on health-related quality of life (HRQOL) at 15 weeks after start of treatment in lung cancer patients. Methods The SYMPRO–Lung trial is a multicenter randomized controlled trial using a stepped wedge design. Stage I-IV lung cancer patients in the reactive and active groups reported PROM symptoms weekly, which were linked to a common alerting algorithm. HRQOL was measured by the EORTC QLQ-C30 at baseline and after 15 weeks. Linear regression analyses and effect size estimates were used to assess mean QOL–C30 change scores between groups, accounting for confounding. Results A total of 515 patients were included (160 active group, 89 reactive group, 266 control group). No differences in HRQOL were observed between the reactive and active group (summary score: unstandardized beta [B] = 0.51, 95% confidence interval [CI] = -3.22 to 4.24, Cohen d effect size [ES] = 0.06; physical functioning: B = 0.25, 95% CI = -5.15 to 4.64, ES = 0.02). The combined intervention groups had statistically and clinically significantly better mean change scores on the summary score (B = 4.85, 95% CI = 1.96 to 7.73, ES = 0.57) and physical functioning (B = 7.00, 95% CI = 2.90 to 11.09, ES = 0.71) compared with the control group. Conclusions Weekly PRO symptom monitoring statistically and clinically significantly improves HRQOL in lung cancer patients. The logistically less intensive, reactive approach may be a better fit for implementation.

AB - Background Previous studies using patient-reported outcomes measures (PROMs) to monitor symptoms during and after (lung) cancer treatment used alerts that were sent to the health-care provider, although an approach in which patients receive alerts could be more clinically feasible. The primary aim of this study was to compare the effect of weekly PROM symptom monitoring via a reactive approach (patient receives alert) or active approach (health-care provider receives alert) with care as usual on health-related quality of life (HRQOL) at 15 weeks after start of treatment in lung cancer patients. Methods The SYMPRO–Lung trial is a multicenter randomized controlled trial using a stepped wedge design. Stage I-IV lung cancer patients in the reactive and active groups reported PROM symptoms weekly, which were linked to a common alerting algorithm. HRQOL was measured by the EORTC QLQ-C30 at baseline and after 15 weeks. Linear regression analyses and effect size estimates were used to assess mean QOL–C30 change scores between groups, accounting for confounding. Results A total of 515 patients were included (160 active group, 89 reactive group, 266 control group). No differences in HRQOL were observed between the reactive and active group (summary score: unstandardized beta [B] = 0.51, 95% confidence interval [CI] = -3.22 to 4.24, Cohen d effect size [ES] = 0.06; physical functioning: B = 0.25, 95% CI = -5.15 to 4.64, ES = 0.02). The combined intervention groups had statistically and clinically significantly better mean change scores on the summary score (B = 4.85, 95% CI = 1.96 to 7.73, ES = 0.57) and physical functioning (B = 7.00, 95% CI = 2.90 to 11.09, ES = 0.71) compared with the control group. Conclusions Weekly PRO symptom monitoring statistically and clinically significantly improves HRQOL in lung cancer patients. The logistically less intensive, reactive approach may be a better fit for implementation.

U2 - 10.1093/jnci/djad159

DO - 10.1093/jnci/djad159

M3 - Article

SN - 0027-8874

VL - 115

SP - 1515

EP - 1525

JO - JNCI-Journal of the National Cancer Institute

JF - JNCI-Journal of the National Cancer Institute

IS - 12

ER -

Quality of life after patient-initiated vs physician-initiated response to symptom monitoring: the SYMPRO-Lung trial

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