Supplementary data: Real-world impact of patient-reported outcome measurement on overall survival, healthcare use and treatment discontinuation in cancer patients

These are peer-reviewed supplementary materials for the article 'Real-world impact of patient-reported outcome measurement on overall survival, healthcare use and treatment discontinuation in cancer patients' published in the Journal of Comparative Effectiveness Research.Supplemental Table 1: Absolute standardized differences of baseline characteristics between exposed (n = 5,950) and unexposed (n = 13,559) patients prior to matching (n = 19,509).Supplementary Table 2: Absolute standardized differences of baseline characteristics between exposed (n = 48,00) and unexposed (n = 4,800) patients after matching.Supplemental Table 3: Examining the association between PRO collection and outcomes of interest, stratified by cancer site and within metastatic disease patients.Aim: The purpose of this retrospective, population-based, observational cohort analysis was to assess whether routine patient-reported outcomes (PRO) monitoring alone has an impact on real-world overall survival (OS) and hospitalizations among individuals diagnosed with lung, breast or colorectal cancer. The importance of follow-up care in post-PRO data collection was also discussed. Patients & methods: Administrative databases covering 17 cancer centers from Alberta, Canada were queried and individuals ≥18 years old and diagnosed with lung, breast or colorectal cancer from 1 January 2016 to 31 December 2019 were included and followed until 31 December 2020. Patients were stratified by whether they received routine PRO monitoring initiated within 120 days of diagnosis and matched 1:1 with use of propensity scores based on baseline characteristics. OS was assessed from the index date to death, and the respective Kaplan–Meier curves were estimated along with hazard ratios from Cox Proportional Hazard Models. Linear and logistic regression models were used to estimate mean differences and odds ratios (OR) respectively for healthcare resource utilization events including cancer physician visits, emergency department visits and outpatient ambulatory care encounters. Results: 4800 patients were included in each matched cohort. There was no statistically significant difference between PRO monitoring and non-monitoring cohorts in OS (HR = 1.01; 95% CI: 0.93–1.09; p = 0.836) and treatment discontinuation (OR = 0.98; 95% CI: 0.85–1.12; p = 0.75). Median OS was 51.5 months for unmonitored cohort (95% CI: 47.5–NA) versus 50.6 months for monitored cohort (95% CI: 47.6–55.7). Compared with PRO-monitored patients, unmonitored patients were associated with lower hospitalization risks (OR = 1.12; 95% CI: 1.03–1.22; p = 0.01). However, PRO-monitored patients experienced significantly fewer physician visits in comparison to unmonitored patients (MD = -1.036; 95% CI: -1.288 to -0.784, p < 0.001). Conclusion: Our results show that capturing patient-reported symptoms alone reduced the number of physician visits but neither reduced hospitalizations nor improved OS in this real-world cancer population. To drive more meaningful clinical impact, PRO monitoring programs must be met with rigorous follow-up response to the identified symptoms.

本数据集为《比较疗效研究杂志》上发表的论文《患者报告结局测量对癌症患者整体生存、医疗使用及治疗中断的实际情况影响》的同行评审补充材料。补充表1：在匹配前，暴露组（n = 5,950）与未暴露组（n = 13,559）患者基线特征的绝对标准化差异（n = 19,509）。补充表2：匹配后，暴露组（n = 48,00）与未暴露组（n = 4,800）患者基线特征的绝对标准化差异。补充表3：探讨患者报告结局（PRO）收集与感兴趣结局之间的关联，按癌症部位分层，并在转移性疾病患者中进行考察。研究目的：本项基于人群的回顾性、观察性队列分析旨在评估在肺癌、乳腺癌或结直肠癌患者中，仅对常规患者报告结局（PRO）进行监测是否对实际的整体生存（OS）和住院率产生影响。此外，还讨论了在PRO数据收集之后的随访护理的重要性。患者与方法：检索了加拿大阿尔伯塔省17个癌症中心的行政数据库，纳入了2016年1月1日至2019年12月31日期间诊断的≥18岁肺癌、乳腺癌或结直肠癌患者，并追踪至2020年12月31日。患者根据是否在诊断后120天内接受常规PRO监测进行了分层，并基于基线特征使用倾向得分进行1:1匹配。OS从指数日期至死亡进行评估，并估计相应的Kaplan-Meier曲线以及Cox比例风险模型中的风险比。使用线性回归和逻辑回归模型分别估计医疗资源利用事件（包括癌症医师就诊、急诊室就诊和门诊就诊）的平均差异和比值比（OR）。结果：每个匹配队列中均纳入了4800名患者。在PRO监测与非监测队列中，OS（HR = 1.01；95% CI：0.93–1.09；p = 0.836）和治疗中断（OR = 0.98；95% CI：0.85–1.12；p = 0.75）之间没有统计学上的显著差异。未监测队列的中位OS为51.5个月（95% CI：47.5–NA），而监测队列的中位OS为50.6个月（95% CI：47.6–55.7）。与PRO监测患者相比，未监测患者与较低的住院风险相关（OR = 1.12；95% CI：1.03–1.22；p = 0.01）。然而，与未监测患者相比，PRO监测患者经历的医师就诊次数显著减少（MD = -1.036；95% CI：-1.288至-0.784，p < 0.001）。结论：我们的研究结果表明，仅捕捉患者报告的症状可减少医师就诊次数，但并未降低住院率或改善实际癌症人群的OS。为了实现更具临床意义的临床影响，PRO监测项目必须与对识别出的症状的严格后续响应相结合。