ideasIdea
Weekly symptom check-ins with automatic alerts as standard of care on treatment
Patients on chemotherapy or immunotherapy answer a short weekly symptom questionnaire on their phone; severe answers alert the nurse the same day. Trials show this prolongs life.
Electronic patient-reported outcome monitoring with nurse alerts improved quality of life, reduced emergency visits and improved overall survival in a randomised trial at Memorial Sloan Kettering (Basch et al.) and in the PRO-TECT cluster-randomised trial in community practices. Uptake remains low because nobody is paid for the nursing time. The proposal is a reimbursed care standard: every patient on active systemic therapy is offered weekly ePRO monitoring with defined alert thresholds and response times, and payers cover the monitoring as they cover a drug.
Hypothesis
System-wide ePRO monitoring reduces unplanned admissions during systemic therapy by at least 15% and improves symptom control, and the savings exceed the cost of nursing time.
Rationale
Clinicians under-detect symptoms between visits; early management of dehydration, pain and nausea prevents cascades to admission. The evidence base is unusual in supportive care for including a survival signal.
What would test it
Payer-led pragmatic rollout with a randomised stepped start across practices; measure admissions, emergency visits, dose intensity delivered 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
3
Bottlenecks it attacks
- Patients lack understanding, navigation and agency · Most patients cannot understand their options, find trials, or push back, so decisions are made for them.
- 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.