{"entity":{"id":"rejuv-measure-epro-as-treatment","kind":"technology","name":"Asking people how they are, every week, as a treatment in its own right","aka":[],"tldr":"Several randomised trials tested asking patients to report symptoms every week, with a nurse alerted when something is bad or getting worse. It reliably improves how people feel and function and cuts emergency visits. Whether it lengthens life did not hold up: two trials found a survival benefit and the largest trial, designed to test exactly that, found none.","summary":"This is the one place on this front where a measurement turned out to be an intervention, and it has the best randomised evidence of anything here. It also has an honest negative result in the middle of it, which is given the same prominence as the positive ones.\n\nThe first trial. Basch and colleagues randomised 766 people receiving routine outpatient chemotherapy for advanced solid tumours at Memorial Sloan Kettering to report 12 common symptoms on tablet computers, with weekly email prompts at home and email alerts to nurses for severe or worsening symptoms, against usual care. The primary outcome was change in the EQ-5D index at six months. \"HRQL improved among more participants in the intervention group than usual care (34% v 18%) and worsened among fewer (38% v 53%)\". Emergency visits, hospital admissions and duration of chemotherapy tolerated also favoured the intervention. The 2017 survival analysis of the same trial, published as a research letter in JAMA, reported a longer median overall survival in the symptom monitoring arm; the letter itself is behind a paywall and carries no abstract, so the exact medians are not reproduced here and the reader should take them from the letter rather than from this page.\n\nThe lung cancer trial. Denis and colleagues randomised 133 patients with advanced lung cancer who had no evidence of progression after initial treatment to a web-mediated follow-up based on weekly self-scored symptoms, with an automatic alert email to the oncologist when symptoms matched predefined criteria, against routine follow-up with CT scans every three to six months. \"The median OS was 19.0 months (95% confidence interval [CI] = 12.5 to noncalculable) in the experimental and 12.0 months (95% CI = 8.6 to 16.4) in the control arm\", hazard ratio 0.32 (95% CI 0.15 to 0.67). The mechanism was legible: performance status at the first detected relapse was 0 to 1 for 75.9 per cent in the web arm against 32.5 per cent in the control arm, so more people were well enough to have further treatment. A two-year survival update was published in JAMA in 2019. The trial was small, single-country and unblinded, and the control arm's 12-month median is low, which is the main objection to it.\n\nThe largest trial, and the result that did not replicate. PRO-TECT (Alliance AFT-39) cluster-randomised 52 United States community oncology practices and enrolled 1,191 adults being treated for metastatic cancer between October 2017 and March 2020. Patients in the intervention arm completed a weekly survey by internet or automated telephone for up to a year; severe or worsening symptoms triggered alert emails to nurses. The prespecified primary outcome was overall survival at 24 months from the National Death Index, and the final report states that the analysis \"found no significant differences for overall survival between arms (hazard ratio, 0.99; P = .86)\".\n\nThe secondary outcomes of the same trial were positive and were published in JAMA in 2022. At three months, against usual care, mean QLQ-C30 changes favoured the intervention for physical function (mean difference 2.47, 95% CI 0.41 to 4.53), symptom control (2.56, 95% CI 0.95 to 4.17) and health-related quality of life (2.43, 95% CI 0.90 to 3.96), with odds ratios for a clinically meaningful benefit of 1.35, 1.50 and 1.41 respectively. Emergency department visits also favoured the intervention, a mean of 1.02 against 1.30.\n\nThe curative-intent trial. eRAPID randomised 508 patients with colorectal, breast or gynaecological cancers starting chemotherapy, mostly with curative intent, to usual care or weekly online symptom reporting with automated severity-dependent advice for 18 weeks. Physical well-being improved at 6 and 12 weeks but not at 18, which was the primary endpoint, so on its own terms this trial was negative. Fewer patients in the intervention arm had a clinically meaningful deterioration in physical well-being at 12 weeks, 47 against 56 per cent; there were no differences in admissions or chemotherapy delivery; and at 18 weeks the intervention arm reported better self-efficacy and better health on the EQ-5D visual analogue scale. The benefit was in the non-metastatic subgroup, not the metastatic one.\n\nWhat the evidence supports, stated carefully. Routine weekly symptom reporting with a response attached improves physical function, symptom control and quality of life, and reduces emergency visits, consistently across trials and across subgroups. It should not be sold as a way to live longer: the single trial designed and powered to test survival as its primary outcome found a hazard ratio of 0.99.\n\nThe part that is easy to forget. None of these trials tested a questionnaire. They tested a questionnaire plus a nurse who read the alert and did something. The PRO-TECT investigators named the absence of protected nursing time as a limitation of their own trial and recommended that future implementations protect it. A system that collects symptoms and routes the alerts nowhere has not been tested and has no reason to work.","status":"established","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Patient-reported_outcome","links":[{"label":"Basch et al., Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial (JCO 2016)","url":"https://doi.org/10.1200/JCO.2015.63.0830"},{"label":"Basch et al., Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment (JAMA 2017)","url":"https://doi.org/10.1001/jama.2017.7156"},{"label":"Denis et al., Randomized trial comparing a web-mediated follow-up with routine surveillance in lung cancer patients (JNCI 2017)","url":"https://doi.org/10.1093/jnci/djx029"},{"label":"Denis et al., Two-year survival comparing web-based symptom monitoring vs routine surveillance following treatment for lung cancer (JAMA 2019)","url":"https://doi.org/10.1001/jama.2018.18085"},{"label":"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)","url":"https://doi.org/10.1001/jama.2022.9265"},{"label":"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)","url":"https://europepmc.org/article/MED/41915775"},{"label":"Deal et al., Benefits of electronic symptom monitoring during cancer treatment by age, sex, race, and education (Alliance AFT-39) (JCO Oncology Practice 2026)","url":"https://doi.org/10.1200/OP-26-00015"},{"label":"Absolom et al., Phase III randomized controlled trial of eRAPID: eHealth intervention during chemotherapy (JCO 2021)","url":"https://doi.org/10.1200/JCO.20.02015"}],"tags":["rejuvenation","survivorship","evidence:strong","instruments"],"related":["rejuv-measure-missing-data-and-who-is-not-asked","rejuv-measure-wearables-and-step-counts"],"cancers":["nsclc","colorectal","breast-hr-positive","ovarian","pancreatic"],"sections":["rejuvenation","supportive-care","ai-computation"],"technologies":["epro-symptom-monitoring","rejuv-measure-pro-ctcae","rejuv-measure-eortc-qlq-c30","rejuv-measure-eq-5d","rejuv-measure-epro-implementation","telehealth-oncology","oncology-nursing","palliative-care"],"targets":[],"drugs":[],"companies":[],"institutions":["mskcc"],"pathways":[],"terms":["quality-of-life","cancer-related-fatigue"],"trials":[],"people":[],"bottlenecks":["b-patient-voice","b-care-fragmentation","b-toxicity-qol","b-workforce"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Frequent structured self-report detects symptomatic deterioration between scheduled visits, where it would otherwise go unreported until the next appointment or an emergency presentation. A threshold-triggered alert converts that detection into a clinical action, which is where the benefit comes from; the earlier action preserves performance status and avoids unplanned admission.","strengths":["Several adequately sized randomised trials, in academic and community settings and in two health systems","Consistent benefit on physical function, symptom control, quality of life and emergency visits","Benefits at least as large in Black, less educated, female and younger participants, so it does not widen a gap","Cheap relative to anything else on this front, and built on existing portals"],"limitations":["The trial designed to test survival found none, hazard ratio 0.99","The effect sizes on quality of life are around 2.5 points on a 0 to 100 scale","Requires nursing capacity to answer the alerts, which the largest trial named as its own weak point","eRAPID missed its primary endpoint at 18 weeks in a curative-intent population","Weekly reporting compliance is about two thirds over several months"],"since":2016},"route":"/technologies/rejuv-measure-epro-as-treatment/","neighbours":{"technology":[{"id":"palliative-care","kind":"technology","name":"Early integrated palliative care","route":"/technologies/palliative-care/"},{"id":"epro-symptom-monitoring","kind":"technology","name":"Electronic patient-reported outcome (ePRO) symptom monitoring","route":"/technologies/epro-symptom-monitoring/"},{"id":"rejuv-measure-eortc-qlq-c30","kind":"technology","name":"EORTC QLQ-C30: the questionnaire most cancer trials use","route":"/technologies/rejuv-measure-eortc-qlq-c30/"},{"id":"rejuv-measure-eq-5d","kind":"technology","name":"EQ-5D: health reduced to one number, and what that number is for","route":"/technologies/rejuv-measure-eq-5d/"},{"id":"rejuv-measure-patient-reported-outcomes","kind":"technology","name":"How recovery is measured: the questionnaires behind the numbers","route":"/technologies/rejuv-measure-patient-reported-outcomes/"},{"id":"oncology-nursing","kind":"technology","name":"Oncology nursing and nurse-led care","route":"/technologies/oncology-nursing/"},{"id":"rejuv-measure-pro-ctcae","kind":"technology","name":"PRO-CTCAE: side effects graded by the person having them","route":"/technologies/rejuv-measure-pro-ctcae/"},{"id":"telehealth-oncology","kind":"technology","name":"Telehealth and hospital-at-home in oncology","route":"/technologies/telehealth-oncology/"},{"id":"rejuv-measure-missing-data-and-who-is-not-asked","kind":"technology","name":"The questionnaires that were never returned, and the people never asked","route":"/technologies/rejuv-measure-missing-data-and-who-is-not-asked/"},{"id":"rejuv-measure-wearables-and-step-counts","kind":"technology","name":"Wearables and step counts: measuring what someone actually does","route":"/technologies/rejuv-measure-wearables-and-step-counts/"},{"id":"rejuv-measure-minimally-important-difference","kind":"technology","name":"What a difference has to be before a person would notice it","route":"/technologies/rejuv-measure-minimally-important-difference/"},{"id":"rejuv-measure-epro-implementation","kind":"technology","name":"What has actually been implemented since those trials, and what has not","route":"/technologies/rejuv-measure-epro-implementation/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"ovarian","kind":"cancer","name":"Ovarian cancer","route":"/cancers/ovarian/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"section":[{"id":"ai-computation","kind":"section","name":"AI & Computation","route":"/fronts/ai-computation/"},{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"institution":[{"id":"mskcc","kind":"institution","name":"Memorial Sloan Kettering Cancer Center","route":"/institutions/mskcc/"}],"term":[{"id":"cancer-related-fatigue","kind":"term","name":"Cancer-related fatigue (tiredness)","route":"/terms/cancer-related-fatigue/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","route":"/bottlenecks/b-workforce/"},{"id":"b-patient-voice","kind":"bottleneck","name":"Patients lack understanding, navigation and agency","route":"/bottlenecks/b-patient-voice/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}