Aims:
To assess the impact of real-time PROMs prior to outpatient gynaecological cancer consultations on Emergency Department (ED) presentations and overall survival (OS), and identify PROMs data predictive of subsequent unplanned presentations.
Methods:
Patients with gynaecological cancer were invited to complete the EQ-5D-5L, Edmonton Symptom Assessment System-Revised and the Supportive Care Needs Survey Short-Form-34 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 334 clinic consultations (99 in-person; 235 telehealth) with 104 patients [mean age 61 (SD 13); 49% undergoing treatment with palliative intent]. PROMs participation was 50%, with no significant difference by consultation mode. People speaking a language other than English had lower participation (28% vs 57%, p=0.01). No significant differences were observed between participants and non-participants in age, stage, primary tumour, treatment intent (curative vs palliative) or treatment received. An ED presentation occurred within 30 days of 7.6% of participating consultations compared to 13.5% non-participating (p=0.10). Among PROMs participants, ED presentations were associated with higher mean symptom scores at the preceding visit for nausea (3.4 vs 1.0), poor appetite (3.6 vs 1.8) and shortness of breath (4.5 vs 1.8), and lower EQ-5D VAS scores (58.3 vs 83.8), all p<0.05. OS at 2 years was 79.8% for participants and 60.8% for non-participants. Treatment intent was associated with OS, with a trend for participation in the intervention (p<0.001, and 0.057 respectively).
Conclusions:
Completion of PROMs prior to gynaecological cancer consultations was associated with trends to fewer ED presentations and improved OS. Targeted interventions focussing on symptoms associated with ED presentations and to support participation among people who speak a language other than English are required.