EPRO-Based Monitoring Improves Early Symptom Management in Patients With Cancer

In this interview with Pharmacy Times at the 2026 American Society of Clinical Oncology Annual Meeting, Debra Patt, MD, PhD, MBA, EVP policy and strategy, Texas Oncology, and president of Community Oncology Alliance, discusses the growing role of electronic patient-reported outcome (ePRO) monitoring in improving cancer care delivery. Patt explains that remote symptom monitoring platforms such as Canopy allow oncology teams to identify and address symptoms ranging from fatigue to gastrointestinal toxicities earlier, potentially reducing emergency department visits and hospitalizations while helping patients remain on therapy longer. She highlights the importance of operational infrastructure, including dedicated remote triage nursing teams, rapid response workflows, and sustainable reimbursement strategies, for successful implementation of remote therapy monitoring programs.

Pharmacy Times: Your study showed fewer hospitalizations with ePRO-based remote monitoring. What types of symptoms or alerts most often triggered interventions, and how can oncology pharmacists help manage these issues early?

Debra Patt, MD, PhD, MBA: We track many different types of symptoms on the ePRO tool, ranging from subtle symptoms such as fatigue to fever, shortness of breath, cough, and gastrointestinal symptoms. When those symptoms are flagged, an alert is sent to our nursing triage team, which prompts a callback to the patient to learn more about the symptoms and manage them appropriately.

I would say the most commonly reported symptom among that patient population is probably fatigue, but there is a wide array of symptoms with varying degrees of clinical acuity. In addition to the range of symptoms we are seeing, patients also have the ability to grade those symptoms on a Likert scale, which assesses symptom severity. That is helpful in giving nurses insight into the acuity of the symptom and how it may need to be managed.

Pharmacy Times: As more practices adopt RTM platforms like Canopy, what operational factors are most important for success, particularly around triage, medication management, and follow-up care?

Patt: When practices implement electronic patient-reported outcome instruments such as Canopy, there are many factors that contribute to success. The factor I have found to be most important is establishing an operational framework for nursing staffing. At Texas Oncology, my practice, we created a group of remote triage nurses who work virtually as a dedicated team. That is not because we do not have other nurses in the practice—we do have desk nurses who work closely with clinicians, physicians, and advanced practice providers—but because we wanted a team solely dedicated to symptom management to reduce response times to patient-reported symptoms.

Response time is a key performance indicator that we track every day. Last month, our average response time was 37 minutes, which is excellent. Across the country, I see many practices with response times of 24 or even 48 hours, including some academic centers. Establishing an operational framework that allows timely responses to ePRO alerts indicating symptoms requiring management is really key to success and to getting patients what they need in a timely fashion.

Another important aspect is reimbursement. At Texas Oncology, we have largely not billed for this service, even though it falls under remote therapeutic monitoring and can be billed appropriately. Setting up a compliance and revenue cycle team to ensure the billing process has the appropriate rigor is extremely important when practices operationalize these programs. Although we have offered this care delivery enhancement essentially free to patients, that is not a sustainable solution. Practices and organizations need mechanisms to support and pay for these care delivery enhancements, which makes the billing component, while secondary, critically important for long-term sustainability.

Pharmacy Times: The RTM group had increased steroid use and longer time on treatment. Do you think earlier recognition of immune-related adverse events helped patients stay on therapy longer, and what role can oncology pharmacists play in that process?

Patt: Absolutely, I do think that ePROs allow us to address symptoms early, before they become more severe. By identifying and managing adverse events earlier, before they require emergency department visits or hospitalization, we are more likely to avoid those outcomes, better manage adverse events, and keep patients on effective therapy.

I think we have now seen this demonstrated in several studies. In the first ePRO study that Ethan Basch presented in 2017, we saw that patients stayed on therapy longer and lived longer when they used electronic patient-reported outcomes compared with standard care. We see that mirrored in this study as well, where patients receiving therapy were able to remain on treatment longer when they were using ePROs. I think it is evident across multiple studies now that this approach can improve patient outcomes.

To your second question, pharmacists are a very important part of that journey because cancer care is a team sport. It is not just physicians or nurses—it is physicians, nurses, pharmacists, and advanced practice providers all working together to support patients throughout their treatment journey. Frequently, many members of the care team help troubleshoot adverse effects, make dosing adjustments, and introduce new ways to manage symptoms as we interact with patients.

Pharmacy Times: Patients using RTM reported immune-related symptoms much more frequently than controls. How could ePRO-based monitoring change how oncology teams identify and manage ICI toxicities in routine practice?

Patt: I think electronic patient-reported outcomes are going to be a much more sensitive tool. We saw that patients reported more events when they were using ePRO monitoring tools. What that likely means is not necessarily that the distribution of events was different, but rather that patients were less likely to report symptoms when they were not using an ePRO tool.

By implementing ePROs and enabling more sensitive symptom reporting, cancer practices and institutions have an opportunity to intervene earlier, when symptoms are still mild. That makes it more likely that patients can avoid serious adverse events and continue on their treatment journey. This is meaningful for patients because they want to remain on active therapy, and they would much rather stay at home than require treatment in the emergency department or hospital.

It also allows clinicians to shift from intermittent interactions with patients to a more continuous level of support from pharmacists, nurses, and other clinicians within the practice.

I would also add that we are really in a time of paradigm shift in cancer care. The implementation of electronic patient-reported outcomes is becoming a new standard of care, and organizations are going to need to understand how to optimally implement these tools in clinical practice to best serve patients. Patients increasingly need continuous support, particularly with some of our newer therapies that can carry more serious adverse events, such as step-up bispecific therapies and cell therapies. These patients require continuous monitoring and engagement with the clinical team, and they are better able to receive that support when they have remote symptom monitoring at home.