PROs should be integral to evidence-based cancer care. Here I summarize the latest expert opinions on the subject in the form of a conversation between two oncologists. This information should be helpful to healthcare practitioners and patients alike. As always, please consult your own medical doctors for case-by-case advice.

1. Get Started
Patient feedback on
treatment effectiveness
and affordability ie, patient-
reported outcomes (PROs)
will assume more
importance in the future,
especially for cancer care.
Two oncologists discuss
ways to integrate PROs
into performance
measurements.

2. Fragmented care, lack of interoperability
between data systems, gaps in care
transitions, and failure to communicate
among healthcare stakeholders
negatively impact the patient.
Disjointed care can add
to the burden of
healthcare costs.
Dangi-Garimella S. http://www.ajmc.com/journals/evidence-based-oncology/2016/october-2016/a-holistic-approach-to-cancer-care-focus-on-collaboration/P-1
.

3. I agree, but holistic solutions offer hope.
One PCMH claims a 68% reduction in ED
visits, 51% reductions in hospital
admissions for patients on chemotherapy,
and a 21% reduction in hospital lengths of
stay.
Health navigators, patient
and caregiver
engagement, patient-
centered medical homes
(PCMHs), and health-
insurance-driven
collaborative care
programs may lower costs
and improve care.
ED, emergency department
Dangi-Garimella S. http://www.ajmc.com/journals/evidence-based-oncology/2016/october-2016/a-holistic-approach-to-cancer-care-focus-on-collaboration/P-1
More
information on
holistic cancer
care.

4. Good! Now if only we can figure out
which PROs to measure and find ways to
integrate PROs into treatment outcomes.
Realizing the full public health impact of
recent advances in research, requires a
systematic approach in the clinic. Don’t
you agree?
Of key interest to the NCI’s
Outcomes Research
Branch are PROs such as
mental and physical
symptoms, including data
collected from mobile
devices. Another priority is
the evaluation and delivery
of quality cancer care.
Geiger AM. 2016. http://www.ajmc.com/journals/evidence-based-oncology/2016/october-2016/enhancing-healthcare-delivery-research-at-the-national-cancer-institute

5. Yes. The proof lies in real life,
though. Has anyone devised
best practices for assessing
PROs in cancer care?
PROs are routinely used
in clinical trials and is of
increased interest in
comparative effectiveness
research, routine clinical
practice, and electronic
medical record systems
Basch E, Spertus J, Dudley RA, Wu A, et al. 2015;18(4):493-504.

6. Actually, Basch et al. reported 9 best
practices in their 2015 paper. Some of the
findings include a rationale for measuring
outcomes and for using a PRO-PM and
describing the context of use.
A Technical Expert Panel
was
assembled by the
American Medical
Association–
convened Physician
Consortium for
Performance Improvement
to assess quality of care
via PRO-PMs.*
*PRO-PMS, Patient-reported Outcome-based performance measures of symptoms, functional status, and quality of life.
Basch E, Spertus J, Dudley RA, Wu A, et al. 2015;18(4):493-504.

7. Wow. That sounds like the same paper that a
nurse recommended to me. Were those best
practices approved by the Physician
Consortium for Performance Improvement
Measures Implementation and Informatics
Committee? Tell me more.
Methods were developed
on the basis of published PRO
standards and refined through
public comment. Programs
using PROs and PRO
guidance documents were the
main
sources.
Basch E, Spertus J, Dudley RA, Wu A, et al. 2015;18(4):493-504.

8. You got it. In addition to providing
evidence of a measure’s sensitivity to
differences a care, a framework for
implementation, interpretation,
dissemination, and continuous
refinement has to be put in place.
An underlying premise
of PROs is seeking
context-specific
information best known
by the patient eg,
symptoms in order to
enhance individual and
societal care.
Basch E, Spertus J, Dudley RA, Wu A, et al. 2015;18(4):493-504.

9. How would those laudable goals
work when we are drowning in
data from well-meaning sources
focusing on a cure eg, the cancer
moonshot?
Of the 5 Patient-
Centered Value
frameworks to assess
the value of cancer
drugs (ASCO, ESMO,
NCCN, MSKCC, and
ICER), only ICER and
ESMO note PROs* as
part of their
approaches.
*symptoms and quality of life
ASCO, American Society of Clinical Oncology (Value Framework); ESMO (Magnitude of Clinical Benefit Scale); ICER, Institute for Clinical and Economic Review (Value Assessment Framework);
MSKCC, Memorial Sloan Kettering Cancer Center (Drug Abacus); NCCN, National Comprehensive Cancer Network; Basch E. JAMA. 2016;315(19):2073-4; Basch E, Spertus J, Dudley RA, Wu A, et al. 2015;18(4):493-504.

10. We’ll see. At least PROs are inherent to
ICER and weighted in the ESMO
approach. That is better than nothing,
but I agree that how drugs make patients
feel and function are important
considerations.
An over-reliance on
severe (Grade 3/4)
toxicities negates the
downside of low-grade
therapeutic toxicities eg,
high rates of non-
adherence to AIs in adj.
BC treatment have been
attributed to chronic low-
level arthralgias and
myalgias.
adj., adjuvant; AR, aromatase inhibitors; BC, breast cancer;
Basch E. JAMA. 2016;315(19):2073-4; Basch E, Spertus J, Dudley RA, Wu A, et al. 2015;18(4):493-504.

11. Thanks. This has been a
productive chat. I will keep this
information in mind when I talk
to each one of my patients.
Additional PRO tools
for helping patients
cope with cancer-
related financial
toxicities can be found
here.
Basch E, Spertus J, Dudley RA, Wu A, et al. 2015;18(4):493-504.