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Objectives:
Post-operative morbidity can compromise patient outcome and require acute care services.
Cancer patients who utilize the PRO-CTCAE - a standardized, validated method of capturing
patient-reported outcomes (PROs) - to report their symptoms have been shown to reduce
symptom burden, decrease the need for acute care, and preserve quality of life. Building
off this work, a fully EHR-integrated PRO system capturing side effects from surgery
could significantly improve health care delivery, particularly in rural populations
which has been further challenged by the COVID-pandemic.
Methods:
Through the NCI's Moonshot-funded IMPACT consortium, Dartmouth-Hitchcock Medical Center
(DHMC) in collaboration with 5 other health systems and Epic designed eSyM, an EHR-integrated
electronic symptom management program based on the PRO-CTCAE questionnaire. eSyM was
deployed at DHMC, a large rural academic medical cancer center, systems beginning
in spring 2020, for gynecologic oncology patients having surgery. Prompts to complete
questionnaires were disseminated via the standard DHMC Epic-based patient portal (MyChart)
on a tapered schedule averaging approximately twice/week for 90 days after surgery.
Each survey included at least 6 PRO-CTCAE symptom items including pain, nausea/vomiting,
fatigue, anxiety, wound redness and discharge as well items assessing overall wellbeing
and functional status. Composite scores were generated for each symptom: 0 for no
symptoms, 1-2 for mild/moderate symptoms, and 3 for severe symptoms. Reported severe
symptoms automatically prompted an alert message sent directly to nursing staff.
Results:
Over the past 90 days, 134 women were eligible to participate in eSyM. 101 women were
sent automated eSyM questionnaires after surgery through their patient portal. 69
(68%) activated their portal account and 48 (70%) completed at least 1 questionnaire
electronically to report symptoms. Women who used eSyM were younger than those who
did not activate their account, 54 vs. 61 years (p=0.05). Women completed a mean of
5 questionnaires over a mean of 19 days after surgery. 20% of patients reported severe
symptoms, of which pain was the most common. Women who used eSyM were less likely
to require hospitalization in the 90 days after surgery than women who did not participate
(p<0.005). Urgent care and ED visits following surgery were comparable between eSyM
users and those never activated their account
Conclusions:
Women with activated portal accounts had high rates of eSyM utilization to report
symptoms after surgery. eSyM users tended to be younger than women who did not activate
their accounts. Amidst the COVID-19 pandemic, an electronic platform to report and
monitor symptoms following surgery alleviates some of the some of the burdens placed
upon the patient and health care systems with in-person care, especially in rural
settings. Future areas of research will include more robust patient cohorts from other
institutions utilizing eSyM, and an evaluation of health care outcomes, including
symptom burden, acceptability and acute care needs associated with eSyM.
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© 2021 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
