Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

The impact of real-time Patient Reported Outcome Measures (PROMs) on Emergency Department presentations in people with breast cancer (#32)

Kate Webber 1 2 , Alastair Kwok 1 2 , Sok Mian Ng 1 , Olivia Cook 3 4 , Eva Segelov 2
  1. Department of Oncology, Monash Health, Clayton, VIC, Australia
  2. School of Clinical Sciences, Monash University, Clayton, Vic, Australia
  3. Nursing and Midwifery, Monash University, Clayton, Vic, Australia
  4. McGrath Foundation, Sydney, NSW, Australia

Aims: 

To assess the impact of real-time PROMs prior to outpatient breast oncology consultations on Emergency Department (ED) presentations and overall survival (OS), and identify symptoms most associated with unplanned presentations. 

Methods: 

Patients with breast cancer were invited to complete the EQ-5D-5L, Edmonton Symptom Assessment System-Revised and Supportive Care Needs Survey-Short-Form (SCNS-SF34) prior to scheduled appointments, on waiting room iPads (December 2019–March 2020) or remotely online (October 2020–April 2021). Clinical characteristics and ED presentations were extracted from medical records for participants and non-participants. Chi-squared and t-tests were used for between-group comparisons. OS was assessed using the Kaplan-Meier method with Cox regression.

Results: 

Data were extracted from 559 clinic consultations (170 in-person; 389 telehealth) with 241 patients [mean age 60 (SD 12); 11% undergoing treatment with palliative intent]. PROMs participation was lower among telehealth attendees (47% vs 60% in-person, p=0.03), and among people speaking a language other than English (33% vs 56%, p=0.02). No significant differences were observed between participants and non-participants in age, stage, treatment intent (curative vs palliative) or treatment received. Fewer ED presentations within 30 days were recorded among participants than non-participants (9 vs 25 presentations, p=0.02). Among PROMs participants, ED presentations were associated with higher mean scores for pain (5.8 vs 3.3), tiredness (6.9 vs 4.7), depression (4.0 vs 2.8) and constipation (3.4 vs 1.4) at the preceding consultation, all p<0.05. ED presentations were also associated with lower EQ-5D-VAS and higher SCNS physical and psychological domain scores. OS at 2 years was 95.3% for participants vs 93.6% for non-participants. Age and treatment intent, but not participation in the intervention, were associated with OS (0.041, p<0.001, and 0.42 respectively).

Conclusions: 

Completing PROMs prior to breast oncology consultations was associated with fewer ED presentations. Targeted interventions focussing on key symptoms and to support participation for people who speak a language other than English and for telehealth attendances are required.