Using eHealth to Measure Patient-Reported Oral Chemotherapy Side Effects Improves Overall Outcomes. Now We Need to Standardize It.

In an article published in the June 2023 issue of the Clinical Journal of Oncology Nursing, ONS member Cynthia Huff, DNP, RN, OCN®, CRNI, CNL, reported on the results of a literature review to understand whether collecting patient-reported outcomes electronically improves outcomes and the feasibility of standardizing the magnitude of electronic oral chemotherapy questionnaires available today.

What the Evidence Says

Huff identified 10 articles disseminating findings on patient-reported outcome measures that met the inclusion criteria for the literature review and found that they shared the following themes.

Use of patient-reported outcomes measures in oncology: The literature review showed that eHealth reporting improved patient-provider communication, facilitated clinical decision-making, provided reliable clinical and symptom experience data, and could be used as a standardized data collection tool, Huff reported.

Benefits and challenges with portal messaging: The studies demonstrated that eHealth messaging improved adherence, symptom management, early detection of cancer changes, and survival outcomes, Huff said, although one study found that the survival benefit and lower risk for emergency department visits didn’t extend to older patients.

One of the studies surveyed patients about their experience with eHealth messaging and found that they described both benefits (e.g., timely provider feedback and access to providers, better care coordination between healthcare providers) and challenges (using the technology, concerns about respecting the provider’s time, confusion about flagging messages as urgent).

Acceptance and usability of eHealth tools: Although they agreed that eHealth tools help fill the need for better oversight of ambulatory care, patients and providers across the studies identified both positive and negative aspects when using them in practice, Huff said.

	Positive Aspects	Negative Aspects
Patients	Medication reminders, ability to track symptoms over time, access to internet-based information, visual prompts for alerting providers about concerns, timely feedback relieves anxiety	Lack of family engagement with personal apps, motivation, acceptability as a communication method with their healthcare team
Providers	Offers a longitudinal tracking system for symptom management and benchmarking purposes. Nurses like its real-time perspective on patient conditions.   Younger adults demonstrated more technology experience and adapted quicker to eHealth platforms.	Workflows and time restrictions limit acceptance and usability.   Older adults were hesitant to use eHealth apps, expressed higher anxiety levels with eHealth, and required assistance to navigate the technology.

Gaps in eHealth technology: Huff’s literature review identified gaps in analyzing and applying the information collected in eHealth tools to practice rather than in the tools themselves. The studies cited a need for information on interpreting patient-reported outcomes, using them to drive clinically meaningful practice change, and defining medication adherence quality measures specifically for oral chemotherapy.

What Do We Need to Standardize Oral Chemotherapy Patient Reporting?

In the literature review discussion, Huff cited that “the development of patient-reported outcomes measures using standardized screening questionnaires such as the CTCAE, ESAS, and PROMIS measurement tools ensure clinically meaningful data streams that aid providers when considering treatment options for patients” but that no standardized tools currently exist for oral chemotherapy self-management. She called for oncology nurse scientists to conduct additional research to build the foundation for a tool that evaluates patient safety, adherence, side effects, and follow-up in the home setting.

Huff also identified an opportunity for oncology nurses to advocate for measuring patient-reported outcomes in oral chemotherapy, actively develop and test innovative apps and technologies, and disseminate results of clinical projects that effectively implemented them in the community setting.

“Establishing an oral chemotherapy adherence questionnaire—using standardized oncology-specific patient-reported outcomes measuring tools in a clinical pathway that interfaces with the patient’s electronic health record—may ensure better patient self-reporting, symptom tracking, and adherence,” Huff concluded. “In addition, a bidirectional communication channel allows patients to better self-manage their disease.”

Learn more about using eHealth tools and platforms to measure oral chemotherapy patient-reported outcomes—and earn 1 NCPD contact hour and ILNA point—by reading Huff’s full article in the Clinical Journal of Oncology Nursing.