# Weekly electronic symptom reporting as a standard of care during systemic therapy

Source: https://onco.cc/ideas/idea-acc-electronic-pro-monitoring-standard/  
OnCo record `idea-acc-electronic-pro-monitoring-standard` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Patients on cancer treatment who report their symptoms every week through an app or phone line, with nurses acting on alerts, feel better and go to the emergency department less. Two early trials also found longer survival, but the largest trial, designed to test survival, found no difference. The quality-of-life benefit is reason enough to make it routine and paid for.

## Summary

Randomised trials show that routine electronic patient-reported outcome monitoring with a nurse responding to alerts improves quality of life and reduces emergency visits. Basch and colleagues randomised 766 patients at one cancer centre (JCO 2016) and later reported longer overall survival (JAMA 2017), and a French trial in 133 patients with lung cancer under follow-up also reported longer survival (Denis, JNCI 2017). PRO-TECT, which cluster-randomised 52 United States community practices and 1,191 patients with overall survival as its primary outcome, found no survival difference (hazard ratio 0.99) but confirmed better physical function, quality of life and symptom control and fewer emergency visits. The investigators name the barriers to adoption as no protected nursing time to answer alerts, software that does not connect to the health record, and no payment outside specific models. The proposal is to make PRO monitoring a reimbursed standard of care during systemic therapy, with minimum response standards and open symptom item sets.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Tags: protocol-upgrade; upgrade:proven-unevenly-used; evidence:strong
- Hypothesis: Systems that adopt reimbursed PRO monitoring will reduce emergency attendance during chemotherapy by at least 10% and improve symptom control scores, replicating trial effects at population scale.
- Rationale: The effect is one of the largest supportive-care benefits with Level 1 evidence; the barrier is implementation, which payment and standards can address.
- Proposed test: A payer-led rollout across multiple practices with matched-control comparison of emergency visits, hospitalisations, and patient-reported symptom burden.
- Maturity: being-tested-at-scale
- Actor: payer

## Notes

- Protocol upgrade, graded proven but unevenly used on the quality-of-life, function and emergency-visit outcomes; the survival question is not settled. How many people treated for cancer are offered weekly symptom reporting outside a trial or a payment model has not been measured in any country OnCo could find; `rejuv-measure-epro-implementation` sets out what has and has not changed, including the United States Enhancing Oncology Model that requires participating practices to collect electronic patient-reported outcomes.

## Sources

- Basch et al., Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: a randomized controlled trial (J Clin Oncol 2016): https://doi.org/10.1200/JCO.2015.63.0830
- Basch et al., Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer: PRO-TECT (JAMA 2022): https://doi.org/10.1001/jama.2022.9265
- Basch et al., Comparing the Effectiveness of Electronic Symptom Monitoring versus Usual Care in Improving Survival among Patients with Metastatic Cancer: the PRO-TECT trial, final report (Europe PMC): https://europepmc.org/article/MED/41915775
- Denis et al., Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients (J Natl Cancer Inst 2017): https://doi.org/10.1093/jnci/djx029
- Basch et al., JAMA 2017: overall survival with PRO monitoring: https://jamanetwork.com/journals/jama/fullarticle/2630810
- NCI PRO-CTCAE: https://healthcaredelivery.cancer.gov/pro-ctcae/

## Connected records

- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Asking people how they are, every week, as a treatment in its own right](https://onco.cc/technologies/rejuv-measure-epro-as-treatment/), [Electronic patient-reported outcome (ePRO) symptom monitoring](https://onco.cc/technologies/epro-symptom-monitoring/), [What has actually been implemented since those trials, and what has not](https://onco.cc/technologies/rejuv-measure-epro-implementation/)
- institutions: [Memorial Sloan Kettering Cancer Center](https://onco.cc/institutions/mskcc/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Basch: asking patients to report symptoms online during chemotherapy improved survival](https://onco.cc/key-papers/paper-basch-epro-survival-jama-2017/), [Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer: A Randomized Clinical Trial](https://onco.cc/key-papers/paper-basch-jama/)

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