Defining critical symptom parameters for an ePRO-based management pathway during systemic treatment for advanced upper gastrointestinal cancer: a longitudinal study.

Abstract

Purpose: Establishing a care pathway based on electronic patient-reported outcomes (ePROs) is necessary to effectively assess and manage outpatients undergoing active treatment. This study investigated symptom burden in patients with advanced upper gastrointestinal (UGI) cancer and the characteristics needed for implementing an ePRO system to monitor these patients.

Methods: Patients undergoing systemic therapy for metastatic UGI cancer rated symptom severity and functional impairment by completing the MD Anderson Symptom Inventory for Gastrointestinal Cancer (MDASI-GI) repeatedly for 12 months. Group-based trajectory analysis classified patients into a high-severity symptom group if their symptoms were consistently rated higher than other patients' symptoms over time. A composite score of the most-severe symptoms was calculated and evaluated.

Results: Of 111 enrollees, 92 patients (esophageal, 35%; gastroesophageal junction, 25%; gastric, 40%) provided PRO data at baseline plus at least the first 2 weeks of treatment. More than 55% of patients were in the high-severity group for fatigue, lack of appetite, numbness/tingling, and drowsiness, and more than 33% were in the high-severity symptom for inability to eat, nausea, pain, and disturbed sleep. A composite score of these 8 symptoms (45% in the high-severity symptom group; mean 4.5, median 4.4) was associated with poorer quality of life.

Conclusion: In this real-world longitudinal study, 45% of patients with advanced UGI reported 8 disease- or treatment-specific symptoms that were persistently more severe over time. This provides a rationale for implementing ePRO-based routine assessment and management of this patient cohort during systemic therapy, especially during the first 12 weeks of treatment.