Introduction:

Mobile health technology and integration of patient-reported outcomes (PROs) into clinical care has the potential to transform how patients communicate with their care teams. Though PRO symptom assessment and management has been shown to improve patient care and outcomes in ambulatory care settings, few studies have examined the feasibility, usability, or utility of PROs from remote symptom assessment after major cancer surgery.  We developed a mobile app-based symptom assessment tool and sought to evaluate patient and provider acceptability and usability of the tool in patients recovering from radical cystectomy.

Methods:

A multi-phased feasibility and usability pilot study was designed to adapt the NCI PRO-CTCAE to include symptom items relevant to surgery. This resulted in 7 supplemental questions that were reviewed by clinician and NCI stakeholders and added to 8 existing PRO-CTCAE items. A mobile app-based symptom assessment tool (SAT) was developed and patient usability evaluated by a focus group of 5 bladder cancer patients and their caregivers.  Fifteen patients were accrued prior to cystectomy and followed postoperatively for 30 days after hospital discharge during which time they were asked to complete daily symptom questionnaires on an electronic tablet provided to them and wear a Garmin biometric monitoring device. Retention, withdrawal, and question completion were used to assess feasibility. Usability was assessed with a usability questionnaire administered at an end-of-study interview. Clinical utility was explored by correlating daily symptom reports to adverse recovery events such as complications and readmission.

Results:

Fifteen patients with a median age of 72 years completed the study during recovery from cystectomy. Six (40%) patients experienced a complication, 11 (73.3%) had an unexpected healthcare encounter, and 2 (13%) required readmission. Participants completed an average of 76.5% of daily surveys over the 30-day study period and 99.3% of symptom questions were answered once a survey was initiated. The average time required to complete the questionnaire was 152 seconds. All patients responded that they agreed or strongly agreed that the daily survey was easy to use, and 9 (60%) stated that they thought it was a better way to communicate with the care team about symptoms. Type and severity of symptom appeared to cluster by adverse recovery according to visual-analogue mapping (Figure 1).

Conclusion:

Remote symptom assessment is feasible after cystectomy and was rated as highly usable by patients. Patient-reported symptom scores may signal developing complications and help clinicians identify patients who may benefit from intervention.

Funding: Moffitt Cancer Center & Research Institute HOB Innovation Fund