# Dose adjustments driven by patients' own symptom reports, tested against clinician judgement

Source: https://onco.cc/ideas/idea-tr1-patient-reported-toxicity-dose-algorithms/  
OnCo record `idea-tr1-patient-reported-toxicity-dose-algorithms` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Patients report symptoms on their phone each week; a set of rules turns severe or worsening symptoms into a dose hold or reduction before the next clinic visit. This could keep people on treatment longer and feeling better.

## Summary

Protocolised dose-modification algorithms triggered by weekly PRO-CTCAE reports (with nurse review), compared in a randomised trial with standard clinician-assessed dose modification at scheduled visits. Builds on the randomised evidence that symptom monitoring with alerts improved QoL and survival in chemotherapy patients, extending it to dosing decisions for oral agents.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: PRO-driven dose algorithms will reduce grade 3+ toxicity and unplanned hospital visits while increasing time on treatment and non-inferior PFS compared with visit-based dose management.
- Rationale: Clinicians under-detect and under-grade symptoms relative to patients; toxicity that is caught early can be managed with a dose hold rather than a permanent reduction or discontinuation.
- Proposed test: A randomised trial across community oncology practices for patients starting oral targeted therapy, PRO-driven algorithm versus usual care, with time on treatment and grade 3+ toxicity as co-primaries.
- Maturity: early-clinical
- Actor: clinic

## Sources

- PRO-CTCAE (NCI): https://healthcaredelivery.cancer.gov/pro-ctcae/
- Symptom monitoring with patient-reported outcomes during routine cancer treatment (JAMA 2017): https://jamanetwork.com/journals/jama/fullarticle/2630810

## Connected records

- technologies: [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/)
- bottlenecks: [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/), [Wrong doses](https://onco.cc/bottlenecks/b-dose-optimisation/)

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