Increasingly, practices will use and evaluate ePROs and DSMSTs in cancer care settings.
The Enhancing Oncology Model (EOM), designed by the Centers for Medicare & Medicaid Services (CMS), was launched recently by the US Department of Health and Human Services and CMS to identify ways of improving health care providers’ ability to deliver the best possible outcomes in patient-centered care. EOM was described as a 5-year voluntary payment model implemented to improve quality of cancer care for Medicare patients and reduce costs of care.
EOM builds upon the earlier Oncology Care Model, further focusing on increasing health equity; incentivizing practices and health care providers to interact with patients between appointments; addressing patients’ cancer care experience and health outcomes; and engaging patients in discussions regarding prognosis, treatment options, symptom management, and quality-of-life screenings on social determinants of health (SDOH). For practices participating in EOM, use of electronic patient-reported outcomes (ePROs) and implementation of activities promoting health equity will be required. EOM will also require participants to identify health equity gaps within their beneficiary population and detail their evidence-based strategies for mitigating health disparities.
Oncology pharmacists will be involved in implementing EOM in their practice settings, which will likely increase their communication with patients and opportunities to participate in—and lead—initiatives for monitoring and addressing symptoms, quality of life, and ePROs. To date, implementing ePROs in practices has been shown to enhance patient quality of life, reduce acute care visits, and improve overall survival. However, questions and challenges persist regarding implementation of ePROs into routine patient symptom and clinical care assessments.
Electronic systems have been found to help facilitate patient reporting and self-monitoring during and after cancer treatments, based on data from studies investigating multiple disease states globally. Web-based programs allow these electronic systems to be accessible on mobile devices. This can support real-time assessments and reporting that facilitate rapid patient evaluation and feedback, which can be invaluable when patients experience severe symptoms.
Additionally, ePROs allow patients to use these electronic systems in remote settings so they can quickly notify their care team of worsening symptoms or treatment complications between clinic visits. Clinical trials comparing ePRO surveys with usual care when monitoring symptoms have demonstrated significant improvements in symptom control and quality of life for patients using ePROs.
Furthermore, digital self-management support tools (DSMSTs) have been found to facilitate communication between health care providers and patients, while assisting patients with monitoring and improving their own health status. This can empower patients with cancer to feel more involved and in control of their health, potentially providing physical and mental benefits.
Digital platforms may also facilitate symptom assessment in different cultural and linguistic patient populations. Research has investigated the use of emoji-based visual analog scales by comparing these to standard pain assessment using a numeric rating scale. The results showed high levels of patient engagement in the emoji-based rating system.
As more medical emojis become available, they could be useful in annotating patient instructions and helping patients convey their symptoms to providers. However, a digital divide may exclude patients with little or no access to technology, which may affect older patients lacking the access and knowledge necessary for this type of reporting. As with other challenges related to SDOH, patients who have the greatest need for symptom monitoring and treatment support may be those with the greatest difficulty in accessing these virtual platforms to help them engage with their health care teams.
Success of ePROs depends on effective communication between patients and health care providers. The ePROs have limitations; patients who are extremely ill or too young or who have cognitive impairment may be unable to report outcome measures. Cultural or linguistic relevance of ePROs may be less important in various populations, and there are potential differences in utility between English-proficient patients and those with limited proficiency. However, oncology pharmacists have the knowledge and skills to effectively assess patients’ ability to utilize different resources, access and comprehend information, and communicate with the health care team. They can help implement new virtual systems as necessary to benefit each patient’s reporting preferences and needs.
As we address SDOH and the evolving nature of the digital transformation in health care after COVID-19, ePROs and DSMSTs will frequently be used and evaluated in research and standard care settings. Oncology pharmacists should be involved in their design, implementation, and assessment, and should utilize them for monitoring patient symptoms, addressing gaps in health equity, and demonstrating their roles and value in interventions to improve health outcomes and quality of life in cancer care.
About the Author
Lisa E. Davis, PharmD, FCCP, BCPS, BCOP, is the new editor in chief of Pharmacy Times Oncology Edition™. Davis holds positions as a clinical pharmacist in early phase clinical trial and breast cancer programs at the University of Arizona (Arizona) Cancer Center and a clinical professor of pharmacy practice and science at the Arizona College of Pharmacy. Davis also sits on the Hematology/Oncology Pharmacy Association Board of Directors and is a member of the Cancer Prevention and Control Program and scientific review committee at the Arizona Cancer Center.