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Northrop A, Christofferson A, Umashankar S, Melisko M, Castillo P, Brown T, Heditsian D, Brain S, Simmons C, Hieken T, Ruddy KJ, Mainor C, Afghahi A, Tevis S, Blaes A, Kang I, Asare A, Esserman L, Hershman DL, Basu A. Implementation and impact of an electronic patient reported outcomes system in a phase II multi-site adaptive platform clinical trial for early-stage breast cancer. J Am Med Inform Assoc 2024:ocae190. [PMID: 39158353 DOI: 10.1093/jamia/ocae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVES We describe the development and implementation of a system for monitoring patient-reported adverse events and quality of life using electronic Patient Reported Outcome (ePRO) instruments in the I-SPY2 Trial, a phase II clinical trial for locally advanced breast cancer. We describe the administration of technological, workflow, and behavior change interventions and their associated impact on questionnaire completion. MATERIALS AND METHODS Using the OpenClinica electronic data capture system, we developed rules-based logic to build automated ePRO surveys, customized to the I-SPY2 treatment schedule. We piloted ePROs at the University of California, San Francisco (UCSF) to optimize workflow in the context of trial treatment scenarios and staggered rollout of the ePRO system to 26 sites to ensure effective implementation of the technology. RESULTS Increasing ePRO completion requires workflow solutions and research staff engagement. Over two years, we increased baseline survey completion from 25% to 80%. The majority of patients completed between 30% and 75% of the questionnaires they received, with no statistically significant variation in survey completion by age, race or ethnicity. Patients who completed the screening timepoint questionnaire were significantly more likely to complete more of the surveys they received at later timepoints (mean completion of 74.1% vs 35.5%, P < .0001). Baseline PROMIS social functioning and grade 2 or more PRO-CTCAE interference of Abdominal Pain, Decreased Appetite, Dizziness and Shortness of Breath was associated with lower survey completion rates. DISCUSSION AND CONCLUSION By implementing ePROs, we have the potential to increase efficiency and accuracy of patient-reported clinical trial data collection, while improving quality of care, patient safety, and health outcomes. Our method is accessible across demographics and facilitates an ease of data collection and sharing across nationwide sites. We identify predictors of decreased completion that can optimize resource allocation by better targeting efforts such as in-person outreach, staff engagement, a robust technical workflow, and increased monitoring to improve overall completion rates. TRIAL REGISTRATION https://clinicaltrials.gov/study/NCT01042379.
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Affiliation(s)
- Anna Northrop
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Anika Christofferson
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Saumya Umashankar
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Michelle Melisko
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94158, United States
| | - Paolo Castillo
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Thelma Brown
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Diane Heditsian
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Susie Brain
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Carol Simmons
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Tina Hieken
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN 55905, United States
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, United States
| | - Candace Mainor
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, United States
| | - Anosheh Afghahi
- Department of Medicine, University of Colorado, Aurora, CO 80045, United States
| | - Sarah Tevis
- Department of Surgery, University of Colorado, Aurora, CO 80045, United States
| | - Anne Blaes
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN 55455, United States
| | - Irene Kang
- Department of Medical Oncology & Therapeutics Research, City of Hope Orange County, Irvine, CA 92618, United States
- Department of Medicine, University of Southern California, Los Angeles, CA 90089, United States
| | - Adam Asare
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
- Quantum Leap Healthcare Collaborative, San Francisco, CA 94158, United States
| | - Laura Esserman
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Dawn L Hershman
- Division of Hematology/Oncology, Department of Medicine, Columbia University, New York, NY 10032, United States
| | - Amrita Basu
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
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Rollison DE, Gonzalez BD, Turner K, Jim HSL, Zhao Y, Amorrortu RP, Howard R, Ghia KM, Ngo B, Reisman P, Moore C, Perkins R, Keenan RJ, Sallman DA, Naso CM, Robinson EJ, Vadaparampil ST, Simmons VN, Schabath MB, Gilbert SM. Examining disparities in large-scale patient-reported data capture using digital tools among cancer patients at clinical intake. Cancer Med 2023; 12:19033-19046. [PMID: 37596773 PMCID: PMC10557830 DOI: 10.1002/cam4.6459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/19/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Patient-reported data can improve quality of healthcare delivery and patient outcomes. Moffitt Cancer Center ("Moffitt") administers the Electronic Patient Questionnaire (EPQ) to collect data on demographics, including sexual orientation and gender identity (SOGI), medical history, cancer risk factors, and quality of life. Here we investigated differences in EPQ completion by demographic and cancer characteristics. METHODS An analysis including 146,142 new adult patients at Moffitt in 2009-2020 was conducted using scheduling, EPQ and cancer registry data. EPQ completion was described by calendar year and demographics. Logistic regression was used to estimate associations between demographic/cancer characteristics and EPQ completion. More recently collected information on SOGI were described. RESULTS Patient portal usage (81%) and EPQ completion rates (79%) were consistently high since 2014. Among patients in the cancer registry, females were more likely to complete the EPQ than males (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.14-1.20). Patients ages 18-64 years were more likely to complete the EPQ than patients aged ≥65. Lower EPQ completion rates were observed among Black or African American patients (OR = 0.59, 95% CI = 0.56-0.63) as compared to Whites and among patients whose preferred language was Spanish (OR = 0.40, 95% CI = 0.36-0.44) or another language as compared to English. Furthermore, patients with localized (OR = 1.16, 95% CI = 1.12-1.19) or regional (OR = 1.16, 95% CI = 1.12-1.20) cancer were more likely to complete the EPQ compared to those with metastatic disease. Less than 3% of patients self-identified as being lesbian, gay, or bisexual and <0.1% self-identified as transgender, genderqueer, or other. CONCLUSIONS EPQ completion rates differed across demographics highlighting opportunities for targeted process improvement. Healthcare organizations should evaluate data acquisition methods to identify potential disparities in data completeness that can impact quality of clinical care and generalizability of self-reported data.
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Affiliation(s)
- Dana E. Rollison
- Department of Cancer EpidemiologyMoffitt Cancer CenterTampaFloridaUSA
| | - Brian D. Gonzalez
- Department of Health Outcomes and BehaviorMoffitt Cancer CenterTampaFloridaUSA
| | - Kea Turner
- Department of Health Outcomes and BehaviorMoffitt Cancer CenterTampaFloridaUSA
| | - Heather S. L. Jim
- Department of Health Outcomes and BehaviorMoffitt Cancer CenterTampaFloridaUSA
| | - Yayi Zhao
- Department of Cancer EpidemiologyMoffitt Cancer CenterTampaFloridaUSA
| | | | - Rachel Howard
- Department of Health InformaticsMoffitt Cancer CenterTampaFloridaUSA
| | - Kavita M. Ghia
- Collaborative Data Services Core, Moffitt Cancer CenterTampaFloridaUSA
| | - Bryan Ngo
- Department of Business Intelligence and AnalyticsMoffitt Cancer CenterTampaFloridaUSA
| | - Phillip Reisman
- Department of Health InformaticsMoffitt Cancer CenterTampaFloridaUSA
| | - Colin Moore
- Department of Clinical InformaticsMoffitt Cancer CenterTampaFloridaUSA
| | - Randa Perkins
- Department of Clinical InformaticsMoffitt Cancer CenterTampaFloridaUSA
| | - Robert J. Keenan
- Department of Thoracic OncologyMoffitt Cancer CenterTampaFloridaUSA
| | - David A. Sallman
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Cristina M. Naso
- Department of Virtual HealthMoffitt Cancer CenterTampaFloridaUSA
| | - Edmondo J. Robinson
- Center for Digital HealthMoffitt Cancer CenterTampaFloridaUSA
- Department of Internal and Hospital MedicineMoffitt Cancer CenterTampaFloridaUSA
| | | | - Vani N. Simmons
- Department of Health Outcomes and BehaviorMoffitt Cancer CenterTampaFloridaUSA
| | | | - Scott M. Gilbert
- Department of Health Outcomes and BehaviorMoffitt Cancer CenterTampaFloridaUSA
- Department of Genitourinary OncologyMoffitt Cancer CenterTampaFloridaUSA
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Dreher N, Matthys M, Hadeler E, Shieh Y, Acerbi I, McAuley FM, Melisko M, Eklund M, Tice JA, Esserman LJ, Veer LJV. A case-case analysis of women with breast cancer: predictors of interval vs screen-detected cancer. Breast Cancer Res Treat 2022; 191:623-629. [PMID: 34843026 PMCID: PMC9189918 DOI: 10.1007/s10549-021-06451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The Breast Cancer Surveillance Consortium (BCSC) model is a widely used risk model that predicts 5- and 10-year risk of developing invasive breast cancer for healthy women aged 35-74 years. Women with high BCSC risk may also be at elevated risk to develop interval cancers, which present symptomatically in the year following a normal screening mammogram. We examined the association between high BCSC risk (defined as the top 2.5% by age) and breast cancers presenting as interval cancers. METHODS We conducted a case-case analysis among women with breast cancer in which we compared the mode of detection and tumor characteristics of patients in the top 2.5% BCSC risk by age with age-matched (1:2) patients in the lower 97.5% risk. We constructed logistic regression models to estimate the odds ratio (OR) of presenting with interval cancers, and poor prognosis tumor features, between women from the top 2.5% and bottom 97.5% of BCSC risk. RESULTS Our analysis included 113 breast cancer patients in the top 2.5% of risk for their age and 226 breast cancer patients in the lower 97.5% of risk. High-risk patients were more likely to have presented with an interval cancer within one year of a normal screening, OR 6.62 (95% CI 3.28-13.4, p < 0.001). These interval cancers were also more likely to be larger, node positive, and higher stage than the screen-detected cancers. CONCLUSION Breast cancer patients in the top 2.5% of BCSC risk for their age were more likely to present with interval cancers. The BCSC model could be used to identify healthy women who may benefit from intensified screening.
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Affiliation(s)
- Nickolas Dreher
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA.
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Madeline Matthys
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA
| | - Edward Hadeler
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yiwey Shieh
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA
| | - Irene Acerbi
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA
| | - Fiona M McAuley
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA
| | - Michelle Melisko
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA
| | | | - Jeffrey A Tice
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA
| | - Laura J Esserman
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA
| | - Laura J Van't Veer
- University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA
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Wong EC, Kaplan CP, Barulich M, Melisko M. Assessing preferences for receiving supportive care resources among patients seen at a Breast Care Center. Breast Cancer Res Treat 2020; 183:381-389. [PMID: 32647938 DOI: 10.1007/s10549-020-05786-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/02/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with breast cancer or at high risk for breast cancer have supportive care needs. Although cancer centers offer social, psychological, and other support to these patients, these services are not always utilized, and patients continue to report unmet supportive care needs. Reasons for non-utilization of these services have not been well documented. In this analysis, we examine patient reasons for service non-utilization and evaluate patients' interest in receiving information about and paying for other supportive care services. METHODS Study participants were contacted by email 7-14 months following appointments at the University of California, San Francisco (UCSF) Breast Care Center (BCC) and were invited to complete a 26-question survey about supportive care utilization at UCSF. RESULTS In total, 195 patients (45%) completed surveys. Of these, 68% had breast cancer. Among patients with breast cancer, fewer than half completed appointments with psychological services. Lack of self-perceived need was the primary reason patients did not pursue psychological services. Overall, 61% of participants were interested in learning more about psychological services, 27% in nutrition counseling, and 20% in exercise counseling. Participants were more interested in individual counseling than in group counseling but were less interested in paying for services. CONCLUSION Patients often feel that they do not need supportive services. Breast cancer patients are interested in learning more about psychological services, exercise counseling, and nutrition counseling. Although many cancer centers offer group coaching and counseling sessions on these topics, patients may be more willing to engage in individual counseling.
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Affiliation(s)
- Emily C Wong
- University of California San Francisco, San Francisco, California, USA.
| | - Celia P Kaplan
- University of California San Francisco, San Francisco, California, USA.,Multi-Ethnic Health Equity Research Center (MERC), University of California San Francisco, San Francisco, California, USA
| | - Mikela Barulich
- University of California San Francisco, San Francisco, California, USA
| | - Michelle Melisko
- University of California San Francisco, San Francisco, California, USA
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