Does Electronic Symptom Monitoring Improve Symptom Burden and Self-Efficacy Among Chemotherapy and Surgery Patients Across Six Cancer Centers?

PURPOSE: The multicenter Symptom Management Implementation of Patient Reported Outcomes in Oncology Consortium developed electronic Symptom Management (eSyM), an electronic health record-based symptom management program, to reduce acute care utilization. We hypothesized that implementing eSyM would also improve self-reported symptom burden and self-efficacy. METHODS: eSyM was deployed via a pragmatic stepped-wedge cluster randomized trial for adults who started chemotherapy or had surgery for confirmed or suspected GI, gynecologic, or thoracic malignancies across six cancer centers from 2019 to 2023. In parallel, we administered a survey to two distinct cohorts: patients treated before and after eSyM deployment (ie, pre-live and post-live). A REDCap-based survey collected demographic and clinical characteristics and assessed six Patient-Reported Outcomes Measurement Information System measures: self-efficacy for symptom management, pain interference, anxiety, fatigue, depression, and physical function. Differences in mean T-scores were derived for the post-live versus pre-live cohorts among chemotherapy and surgery recipients. Multivariable regression models controlled for relevant patient and clinical characteristics. RESULTS: The pre-live cohort included 1,043 respondents (490 chemotherapy and 553 surgery); the post-live cohort included 1,046 respondents (535 chemotherapy and 511 surgery). After controlling for other clinical and demographic factors, the post-live chemotherapy cohort reported statistically significantly lower fatigue and anxiety, but the reductions did not meet the clinically meaningful threshold (adjusted mean T-score difference: -1.3 and -1.8, respectively; P < .05). The post-live surgery cohort reported statistically significantly lower fatigue and anxiety; the differences met the clinically meaningful threshold (-2.0 and -2.2, respectively; P < .01). CONCLUSION: eSyM deployment was associated with reduced symptom burden, but clinically meaningful differences were only observed in fatigue and anxiety scores among surgical patients. Future studies should investigate the mechanisms by which symptom reporting affects patient outcomes, such as improving patient-clinician communication, enhancing clinician attention to symptom management, or increasing patient self-efficacy.