# What has actually been implemented since those trials, and what has not

Source: https://onco.cc/technologies/rejuv-measure-epro-implementation/  
OnCo record `rejuv-measure-epro-implementation` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The trials finished years ago and most people being treated for cancer are still not asked their symptoms between appointments. The clearest thing that changed is a United States payment model that now requires practices to collect them.

## Summary

A reader can reasonably ask why, if weekly symptom reporting reliably improves how people feel, it is not simply what happens. The answer is in three parts.

What has changed. The Centers for Medicare and Medicaid Services built it into a payment model. The Enhancing Oncology Model "began on July 1, 2023 and added a second cohort on July 1, 2025. The first and second cohorts will run for seven and five years, respectively, both ending June 30, 2030." Participating practices receive "$110 per beneficiary per month (or $140 per beneficiary per month for dually eligible individuals)" and must carry out care redesign activities that include "24/7 access to a clinician with EHR access", "patient navigation", "comprehensive care plans", "screening for social needs" and "collection and monitoring of electronic patient reported outcomes (ePROs)". That is the single most consequential thing to have happened to this evidence: a financial requirement rather than a recommendation. It applies to participating practices in one country, for a defined set of cancer types, and ends in 2030.

Also changed: the regulatory framing of what to measure. The United States Food and Drug Administration's Oncology Center of Excellence argued for separating three concepts in cancer trials, symptomatic adverse events, physical function and disease-related symptoms, rather than relying on one multi-item quality of life score, and PRO-CTCAE was built as the instrument for the first of them. That has changed what appears in trial protocols.

What has not changed. Routine between-visit symptom reporting is not standard practice in most health systems, including those whose own trials produced the evidence. The barriers reported by the investigators themselves are specific and unglamorous: no protected nursing time to work the alerts, software that does not talk to the electronic record, and no reimbursement outside a model like the one above. The PRO-TECT final report lists exactly those, recommending "to protect some nursing effort in future implementations and to integrate the ePRO software with EHR systems", and notes that the trial itself ran without that integration and partly during the COVID-19 pandemic when site staff were pulled away from the coordination roles the intervention relied on.

What this corpus cannot tell you. We could not find a reliable published figure for the proportion of people treated for cancer in any country who are offered routine electronic symptom monitoring outside a trial or a payment model. That number would be the right measure of implementation and we do not have it. Equivalent statements about implementation in the United Kingdom, continental Europe and elsewhere rest on single-centre service reports rather than on a national count, and this record does not pretend otherwise.

The honest summary is that the evidence is a decade old, the mechanism is understood, the cost is low, and the obstacle is that somebody has to be paid to answer the alert.

## Fields

- Kind: Technology
- Status: emerging
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; measurement; instruments; policy
- Principle: An intervention whose benefit comes from a human response to an alert cannot be implemented by deploying the software alone. Implementation requires the alert to reach a named person with protected time, the record system to carry the data, and a payer to fund the time, which is why a payment model moved this further than a decade of trial results did.
- Strengths: A national payment model now requires collection in participating practices, with a stated per-patient monthly payment; The regulatory framing of which outcomes to measure in trials has changed; The barriers are named precisely by the trialists rather than left vague
- Limitations: Not standard care in most health systems despite the randomised evidence; The payment model covers one country, selected cancer types, and ends in 2030; No published national figure for how many patients are actually offered it; Depends on nursing capacity that is not funded outside such models

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Patient-reported_outcome
- Centers for Medicare and Medicaid Services: Enhancing Oncology Model: https://www.cms.gov/priorities/innovation/innovation-models/enhancing-oncology-model
- Basch et al., Comparing the effectiveness of electronic symptom monitoring versus usual care in improving survival among patients with metastatic cancer: the PRO-TECT trial, final research report (Europe PMC, PMID 41915775): https://europepmc.org/article/MED/41915775
- Kluetz et al., Focusing on core patient-reported outcomes in cancer clinical trials: symptomatic adverse events, physical function, and disease-related symptoms (Clin Cancer Res 2016): https://doi.org/10.1158/1078-0432.CCR-15-2035
- Basch et al., Effect of electronic symptom monitoring on patient-reported outcomes among patients with metastatic cancer: the PRO-TECT randomized clinical trial (JAMA 2022): https://doi.org/10.1001/jama.2022.9265
- National Cancer Institute: PRO-CTCAE: https://healthcaredelivery.cancer.gov/pro-ctcae/

## Connected records

- technologies: [After treatment in the United States: the survivorship care plan, and what the trial found](https://onco.cc/technologies/rejuv-access-survivorship-care-us/), [Asking people how they are, every week, as a treatment in its own right](https://onco.cc/technologies/rejuv-measure-epro-as-treatment/), [Electronic patient-reported outcome (ePRO) symptom monitoring](https://onco.cc/technologies/epro-symptom-monitoring/), [Oncology nursing and nurse-led care](https://onco.cc/technologies/oncology-nursing/), [PRO-CTCAE: side effects graded by the person having them](https://onco.cc/technologies/rejuv-measure-pro-ctcae/), [PROMIS: the item banks that let a short questionnaire be precise](https://onco.cc/technologies/rejuv-measure-promis/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [Telehealth and hospital-at-home in oncology](https://onco.cc/technologies/telehealth-oncology/), [The questionnaires that were never returned, and the people never asked](https://onco.cc/technologies/rejuv-measure-missing-data-and-who-is-not-asked/), [What recovery costs in the United States](https://onco.cc/technologies/rejuv-access-what-it-costs-us/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [AI & Computation](https://onco.cc/fronts/ai-computation/), [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- terms: [Quality of life](https://onco.cc/terms/quality-of-life/), [Real-world evidence](https://onco.cc/terms/real-world-evidence/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/), [Not enough oncologists, nurses, pathologists, physicists](https://onco.cc/bottlenecks/b-workforce/)

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