ideasIdea
Weekly electronic symptom reporting as a standard of care during systemic therapy
Patients on chemotherapy who report their symptoms weekly through an app, with nurses acting on alerts, live longer and visit emergency rooms less. This should be routine and paid for.
Randomised trials (Basch and colleagues, 2016-2022) showed that routine electronic patient-reported outcome monitoring with nurse response improves quality of life, reduces emergency visits, and in one trial improved overall survival. Adoption remains patchy because of workflow and payment barriers. The proposal is to make PRO monitoring a reimbursed standard of care during systemic therapy, with minimum response standards and open symptom item sets.
Hypothesis
Systems that adopt reimbursed PRO monitoring will reduce emergency attendance during chemotherapy by at least 10% and improve symptom control scores, replicating trial effects at population scale.
Rationale
The effect is one of the largest supportive-care benefits with Level 1 evidence; the barrier is implementation, which payment and standards can address.
What would test it
A payer-led rollout across multiple practices with matched-control comparison of emergency visits, hospitalisations, and patient-reported symptom burden.
Maturity
being tested at scale
Who has to act
payer
Cost to try
Medium ($1M to $50M)
Years to first evidence
2
Bottlenecks it attacks
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.