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Research Article
17 January 2025

Real-world ePRO use and clinical outcomes using electronic patient-reported symptom monitoring for patients with advanced non-small-cell lung cancer receiving first-line pembrolizumab

Authors: L. Johnetta Blakely https://orcid.org/0000-0001-6075-4937 [email protected], Sabine Oskar https://orcid.org/0000-0002-8942-7734, Ian Kudel https://orcid.org/0000-0003-1032-452X, Ashley Roush, Zoya Shamsi, Toni Perry, Annette Christianson, Brittni Smith, and Thomas Burke https://orcid.org/0000-0001-6335-0559Author Info & Affiliations
Volume 14, Number 2
https://doi.org/10.57264/cer-2024-0122
PDFFormats

Abstract

Aim: This ambispective observational study assessed the impact of Noona, an electronic patient-reported outcomes (ePRO) platform, for patients with non-small cell lung cancer (NSCLC) treated in a community oncology setting. Methods: Adults with advanced NSCLC, ECOG performance status of 0–2, who received first-line (1L) pembrolizumab (monotherapy or with chemotherapy) were eligible. Those initiating pembrolizumab from 1 July 2017 to 30 June 2019, identified retrospectively (historical cohort), were compared with those initiating pembrolizumab from 1 October 2019 to 30 September 2021 who were prospectively offered Noona (standard of care [SoC] cohort). The Kaplan–Meier method and Cox proportional hazards models were used to compare pembrolizumab real-world time on treatment (rwToT; primary outcome measure) and rw time to next treatment or death (rwTTNTD) between historical and SoC cohorts. Healthcare resource use (HCRU) was compared using generalized linear models with Poisson distribution. Analyses were repeated to compare outcomes in the SoC cohort between Noona users (created a profile and used any function ≥one-time during 1L therapy) and nonusers with >42 days on 1L pembrolizumab. Data cutoff was 30 June 2020 and 30 September 2022 for historical and SoC cohorts, respectively. Results: Median pembrolizumab rwToT was 4.4 months (95% CI: 3.9–5.1) in the historical cohort (n = 448) versus 4.1 months (95% CI: 3.3–4.8) in the SoC cohort (n = 462; adjusted hazard ratio [aHR], 0.9; 95% CI: 0.8–1.0; p = 0.14 vs historical cohort). In the SoC cohort, 147 of 341 eligible patients (43%) established a Noona profile; 122/341 (36%) were Noona users. Median rwToT was 6.4 months (95% CI: 5.1–7.4) and 6.9 months (95% CI: 5.6–7.6) among Noona users and Noona nonusers (n = 219), respectively (aHR, 1.1; 95% CI: 0.8–1.4; p = 0.95 vs Noona users). The rwTTNTD and HCRU were comparable in historical versus SoC cohorts and for Noona users versus nonusers. During the first year after establishing a Noona profile, 92 of 147 patients (63%) used the platform; monthly use was 32–42%, and checking laboratory results was the most used function overall (by 52% of the 147). Conclusion: Notwithstanding the null findings of this study, positive results of ePRO use in clinical trials and observational studies support the treatment-related symptom monitoring and survival benefits of ePRO utilization.

Plain language summary

What is this article about?

Patients with cancer often experience unpleasant symptoms related to their cancer treatment as well as to their cancer itself. Remote symptom monitoring using electronic patient-reported outcome (ePRO) tools could help patients to communicate easily with healthcare providers about their symptoms, which in turn could help them to stay on their cancer therapy by managing any unpleasant or unexpected symptoms more quickly and effectively. We studied the use of an ePRO tool for patients treated at a large network of cancer clinics who had advanced non-small cell lung cancer (NSCLC) and received an immunotherapy called pembrolizumab for their first cancer therapy. We evaluated the length of time they remained on pembrolizumab and compared it between patients treated before versus after the ePRO tool became available in September 2019 and between patients who did versus did not use the ePRO tool after it became available.

What were the results?

We found no differences in either comparison: the length of time on pembrolizumab was not statistically different between patients treated before or after ePRO tool availability or between patients who used or did not use the ePRO tool. There were also no differences in the time until patients received their next cancer treatment nor in use of healthcare resources. During the first year after signing up for the ePRO tool, about two-thirds of patients (63%) used it at least once and checking lab test results was the most common function used.

What do the results of the study mean?

Despite the fact that this study found no benefits of ePRO use for patients with advanced NSCLC, other studies have reported treatment-related symptom monitoring and survival benefits of ePRO tools for patients with cancer. The low levels of ePRO use in this study suggest a need for future research and improved strategies to increase ePRO uptake and use.

Shareable abstract

Notwithstanding null findings of a new study, positive results of ePRO use in clinical trials and other observational studies support the symptom monitoring and survival benefits of ePRO use.

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