Feasibility of patient-reported outcomes collection in clinical routine at a radiotherapy department
DOI:
https://doi.org/10.2340/ao.v65.45546Abstract
Background and purpose: Routine collection of patient-reported outcome measures (PROMs) may provide valuable real-world data on quality of life (QoL) and treatment tolerability, complementing clinical outcomes. This study evaluated the feasibility of launching a semi-automated, department-wide PROM collection program at a large tertiary radiotherapy centre.
Patients and methods: Patients ≥ 18 years referred for radiotherapy were invited to participate. Exclusion criteria were inability to provide informed consent, severe cognitive conditions, or language barriers. PROMs were collected using a web-based application (“Blå Appen”) at baseline, end-of-treatment, and follow-up intervals, using the EORTC QLQ-C30 questionnaire (Version 3).
Results: During the study period (January 2022 to April 2025), 12,472 patients underwent treatment in the department. A total of 4,764 provided informed consent for study participation, where 3,699 (77.6%) remained after exclusion due to data loss or data inconsistency. Among these, 3,056 patients (82.6%) provided at least one usable PROM questionnaire at baseline. Participants were younger (median age 69 years vs. 71 years). Overall, global health status was relatively high at baseline and remained stable or slightly improved at one-year follow-up. To further investigate clinically significant changes in QoL over time, we evaluated the proportion of patients in each diagnostic category who experienced a change of > 10 points in selected QLQ-C30 scales between baseline and follow-up. Breast cancer patients had the highest rates of meaningful improvement and the lowest rates of major deterioration. In contrast, prostate cancer patients were more prone to significant declines in QoL scales over time.
Interpretation: This prospective study demonstrates that department-wide collection of PROM is feasible. Using a digital platform, we achieved a high initial response rate and successfully engaged patients across a broad range of cancers. The routine PROM collection provided valuable insights into patients’ quality of life and symptom burden during and after treatment.
Downloads
References
Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol. 2016;34(6):557–65.
https://doi.org/10.1200/JCO.2015.63.0830 DOI: https://doi.org/10.1200/JCO.2015.63.0830
Amnicare. Stretch Care. Stockholm. 2024.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76.
https://doi.org/10.1093/jnci/85.5.365 DOI: https://doi.org/10.1093/jnci/85.5.365
Coon CD, Schlichting M, Zhang X. Interpreting within-patient changes on the EORTC QLQ-C30 and EORTC QLQ-LC13. Patient. 2022;15(6):691–702.
https://doi.org/10.1007/s40271-022-00584-w DOI: https://doi.org/10.1007/s40271-022-00584-w
Cherny NI, Parrinello CM, Kwiatkowsky L, Hunnicutt J, Beck T, Schaefer E, et al. Feasibility of large-scale implementation of an electronic patient-reported outcome remote monitoring system for patients on active treatment at a community cancer center. JCO Oncol Pract. 2022;18(12):e1918–26.
https://doi.org/10.1200/OP.22.00180 DOI: https://doi.org/10.1200/OP.22.00180
Franzoi MA, Ferreira AR, Lemaire A, Rodriguez J, Grosjean J, Ribeiro JM, et al. Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium. Lancet Reg Health Eur. 2024;44:101005.
https://doi.org/10.1016/j.lanepe.2024.101005 DOI: https://doi.org/10.1016/j.lanepe.2024.101005
Kurosawa S, Koike K, Arai T, Yoshida S, Ito M, Kuriyama Y, et al. Feasibility and usefulness of symptom monitoring with electronic patient-reported outcomes: an experience at single-center outpatient oncology clinic. Support Care Cancer. 2024;33(1):3.
https://doi.org/10.1007/s00520-024-09062-5 DOI: https://doi.org/10.1007/s00520-024-09062-5
Patt D, Wilfong L, Hudson KE, Patel A, Books H, Pearson B, et al. Implementation of electronic patient-reported outcomes for symptom monitoring in a large multisite community oncology practice: dancing the texas two-step through a pandemic. JCO Clin Cancer Inform. 2021;5:615–21.
https://doi.org/10.1200/CCI.21.00063 DOI: https://doi.org/10.1200/CCI.21.00063
Kwiatkowski F, Mouret-Reynier MA, Duclos M, Bridon F, Hanh T, Van Praagh-Doreau I, et al. Long-term improvement of breast cancer survivors’ quality of life by a 2-week group physical and educational intervention: 5-year update of the ‘PACThe’ trial. Br J Cancer. 2017;116(11):1389–93.
https://doi.org/10.1038/bjc.2017.112 DOI: https://doi.org/10.1038/bjc.2017.112
Penttinen H, Rautalin M, Roine R, Jahkola T, Kellokumpu-Lehtinen PL, Huovinen R, et al. Quality of life of recently treated patients with breast cancer. Anticancer Res. 2014;34(3):1201–6.
Saevarsdottir SR, Gudmundsdottir SL. Mobile Apps and quality of life in patients with breast cancer and survivors: systematic literature review. J Med Internet Res. 2023;25:e42852.
https://doi.org/10.2196/42852 DOI: https://doi.org/10.2196/42852
Tran TXM, Jung SY, Lee EG, Cho H, Cho J, Lee E, et al. Long-term trajectory of postoperative health-related quality of life in young breast cancer patients: a 15-year follow-up study. J Cancer Surviv. 2023;17(5):1416–26.
https://doi.org/10.1007/s11764-022-01165-4 DOI: https://doi.org/10.1007/s11764-022-01165-4
Nguyen PL, Alibhai SM, Basaria S, D’Amico AV, Kantoff PW, Keating NL, et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol. 2015;67(5):825–36.
https://doi.org/10.1016/j.eururo.2014.07.010 DOI: https://doi.org/10.1016/j.eururo.2014.07.010
Ternov KK, Sønksen J, Fode M, Lindberg H, Kistorp C, Bisbjerg R, et al. Fatigue, health-related quality-of-life and metabolic changes in men treated with enzalutamide or abiraterone acetate plus prednisone for metastatic castration-resistant prostate cancer: a randomised clinical trial (HEAT). Eur J Cancer. 2022;171:75–84.
https://doi.org/10.1016/j.ejca.2022.04.034 DOI: https://doi.org/10.1016/j.ejca.2022.04.034
Bade BC, Zhao J, Li F, Tanoue L, Lazowski H, Alfano CM, et al. Trends and predictors of Quality of Life in lung cancer survivors. Lung Cancer. 2024;191:107793.
https://doi.org/10.1016/j.lungcan.2024.107793 DOI: https://doi.org/10.1016/j.lungcan.2024.107793
Trejo MJ, Bell ML, Dhillon HM, Vardy JL. Baseline quality of life is associated with survival among people with advanced lung cancer. J Psychosoc Oncol. 2020;38(5):635–41.
https://doi.org/10.1080/07347332.2020.1765065 DOI: https://doi.org/10.1080/07347332.2020.1765065
Caissie A, Lane J, Barber B, Chisholm S, Kildea J. Patient engagement in the implementation of electronic patient-reported outcome tools: the experience of two early-adopter institutions in the pan-Canadian radiotherapy patient-reported outcome initiative. Clin Oncol (R Coll Radiol). 2025;39:103745.
https://doi.org/10.1016/j.clon.2024.103745 DOI: https://doi.org/10.1016/j.clon.2024.103745
Lyhne JD, Gade L, Hansen L, Johansen A, Smith A, Jensen LH, et al. Survivor-driven development of a PROM for use in routine colorectal cancer care. Acta Oncol. 2025;64:475–83.
https://doi.org/10.2340/1651-226X.2025.42032 DOI: https://doi.org/10.2340/1651-226X.2025.42032
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2026 Ingrid Fagerström Kristensen, Anton Linnér, Martin P Nilsson, Viktor Rogowski, Per Munck af Rosenschöld, Mats Jerkeman
This work is licensed under a Creative Commons Attribution 4.0 International License.
