The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: Patient-reported outcomes (PROs) are information collected directly from patients regarding their health status. Emerging evidence has suggested that integrating PRO assessments into oncology clinical practice can have various benefits for patient care and health. This systematic review and meta-analysis investigated the effects of routine PRO monitoring on the overall survival of people with any type of cancer. We included six studies that compared these interventions to the care that is usually provided to cancer patients. The results seemed to indicate that monitoring PROs in cancer care could positively influence overall survival and that benefits could be largest for individuals with advanced lung cancer. Possible explanations for these findings are that PRO surveillance may allow clinicians to respond to problems more rapidly or that better symptom management could improve tolerance to therapy, thus extending its benefits. However, since available studies are few and of suboptimal quality, additional rigorous research is needed to consolidate our results. ABSTRACT: This study examined the effects of the routine assessment of patient-reported outcomes (PROs) on the overall survival of adult patients with cancer. We included clinical trials and observational studies with a control group that compared PRO monitoring interventions in cancer clinical practice to usual care. The Cochrane risk-of-bias tools were used. In total, six studies were included in the systematic review: two randomized trials, one population-based retrospectively matched cohort study, two pre–post with historical control studies and one non-randomized controlled trial. Half were multicenter, two were conducted in Europe, three were conducted in the USA and was conducted in Canada. Two studies considered any type of cancer, two were restricted to lung cancer and two were restricted to advanced forms of cancer. PRO screening was electronic in four of the six studies. The meta-analysis included all six studies (intervention = 130.094; control = 129.903). The pooled mortality outcome at 1 year was RR = 0.77 (95%CI 0.76–0.78) as determined by the common effect model and RR = 0.82 (95%CI 0.60–1.12; p = 0.16) as determined by the random-effects model. Heterogeneity was statistically significant (I(2) = 73%; p < 0.01). The overall risk of bias was rated as moderate in five studies and serious in one study. This meta-analysis seemed to indicate the survival benefits of PRO screening. As routine PRO monitoring is often challenging, more robust evidence regarding the effects of PROs on mortality would support systematic applications.