Effectiveness of real-world ePRO implementation among patients with metastatic cancer.

392 Background: Electronic patient-reported outcome (ePRO) questionnaires for patients with metastatic cancer may facilitate early symptom detection, clinician intervention, and improved outcomes. The objective of this study is to determine the impact of ePRO implementation on hospitalizations and emergency room visits and/or referrals to supportive oncology services in a real-world setting. Methods: In this retrospective observational cohort study, we performed logistic regression analyses to evaluate the association between ePRO completion and non-completion and health care utilization among patients with metastatic cancer at an academic ambulatory oncology center. Participants were patients with metastatic cancer who were assigned to complete an ePRO questionnaire and received medical oncology care between January 1, 2019 and March 1, 2020. The primary outcome was a composite outcome of emergency room (ER) visits and/or hospitalizations. Secondary outcome was a composite outcome of referrals to palliative care, social work, and/or psychosocial oncology. Both primary and secondary outcomes were assessed at 90 days and 180 days from the date of the patient’s first ePRO assignment. Results: Among 1,449 patients included (768 [65.8%] ≥ 65 years old; 698 [48.2%] women), 282 (19.5%) patients completed ≥ 1 questionnaire. The median number ePRO questionnaire(s) completed per patient was 1 (IQR 1-2). Hispanic patients (5 [1.8%] vs. 51 [4.4%]; p = 0.04) and patients with limited English proficiency (10 [3.5%] vs. 98 [8.5%]; p = 0.005) completed ePROs less often. In our multivariable model, ePRO respondents were as likely as non-respondents to be hospitalized and/or visit the ER at 90 days (OR 1.18 [95% CI 0.68, 2.05; p = 0.55]) and at 180 days (OR 1.31 [95% CI 0.83, 2.05; p = 0.25]) and were as likely as non-respondents to be referred to supportive oncology services at 90 days (OR 1.11 [95% CI 0.61, 2.04; p = 0.73]) and at 180 days (OR 1.26 [95% CI 0.76, 2.09; p = 0.51]). Conclusions: ePRO completion was infrequent and did not appear to reduce hospitalizations and/or ER visits or increase referrals to supportive oncology services. Non-responders were more often Hispanic or had limited English proficiency. Additional research is needed to understand how to optimize ePRO completion among patients with metastatic cancer to facilitate improved outcomes.