Electronic patient-reported symptoms after ambulatory cancer surgery Journal Article
| Authors: | Cracchiolo, J. R.; Tin, A. L.; Assel, M.; McCready, T. M.; Stabile, C.; Simon, B.; Carlsson, S. V.; Vickers, A. J.; Laudone, V. |
| Article Title: | Electronic patient-reported symptoms after ambulatory cancer surgery |
| Abstract: | Importance: Complex cancer procedures are now performed in the ambulatory surgery setting. Remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePROs) can identify patients at risk for acute hospital encounters. Defining normal recovery is needed to set patient expectations and optimize clinical team responses to manage evolving problems in real time. Objective: To describe the patterns of postoperative recovery among patients undergoing ambulatory cancer surgery with RSM using an ePRO platform - the Recovery Tracker. Design, Setting, and Participants: In this retrospective cohort study, patients who underwent 1 of 5 of the most common procedures (prostatectomy, nephrectomy, mastectomy, hysterectomy, or thyroidectomy) at the Josie Robertson Surgery Center at Memorial Sloan Kettering Cancer Center from September 2016 to June 2022. Patients completed the Recovery Tracker, a brief ePRO platform assessing symptoms for 10 days after surgery. Data were analyzed from September 2022 to May 2023. Main Outcomes and Measures: Symptom severity and interference were estimated by postoperative day and procedure. Results: A total of 12433 patients were assigned 110936 surveys. Of these patients, 7874 (63%) were female, and the median (IQR) age at surgery was 57 (47-65) years. The survey response rate was 87% (10814 patients responding to at least 1 of 10 daily surveys). Among patients who submitted at least 1 survey, the median (IQR) number of surveys submitted was 7 (4-8), and each assessment took a median (IQR) of 1.7 (1.2-2.5) minutes to complete. Symptom burden was modest in this population, with the highest severity on postoperative days 1 to 3. Pain was moderate initially and steadily improved. Fatigue was reported by 6120 patients (57%) but was rarely severe. Maximum pain and fatigue responses (very severe) were reported by 324 of 10814 patients (3%) and 106 of 10814 patients (1%), respectively. The maximum pain severity (severe or very severe) was highest after nephrectomy (92 of 332 [28%]), followed by mastectomy with reconstruction (817 of 3322 [25%]) and prostatectomy (744 of 3543 [21%]). Nausea (occasionally, frequently, or almost constantly) was common and experienced on multiple days by 1485 of 9300 patients (16%), but vomiting was less common (139 of 10812 [1%]). Temperature higher than 38 °C was reported by 740 of 10812 (7%). Severe or very severe shortness of breath was reported by 125 of 10813 (1%). Conclusions and Relevance: Defining detailed postoperative symptom burden through this analysis provides valuable data to inform further implementation and maintenance of RSM programs in surgical oncology patients. These data can enhance patient education, set expectations, and support research to allow iterative improvement of clinical care based on the patient-reported experience after discharge. © 2024 American Medical Association. All rights reserved. |
| Keywords: | adult; aged; middle aged; cancer surgery; retrospective studies; major clinical study; constipation; fatigue; postoperative period; cancer patient; hysterectomy; neoplasm; neoplasms; mastectomy; cohort analysis; health survey; breast reconstruction; retrospective study; nephrectomy; age; dyspnea; postoperative complication; postoperative complications; cancer center; symptom; disease severity; prostatectomy; data analysis; thyroidectomy; hospital discharge; patient reported outcome measures; convalescence; postoperative pain; skin redness; sex; surgical patient; intestine function disorder; ambulatory surgery; ambulatory surgical procedures; patient-reported outcome; surgical oncology; contusion; postoperative nausea; symptom burden; illness trajectory; postoperative vomiting; humans; human; male; female; article; symptom assessment; pain severity; postoperative swelling; body temperature disorder; electronic patient reported outcome; remote symptom monitoring; telemonitoring |
| Journal Title: | JAMA Surgery |
| Volume: | 159 |
| Issue: | 5 |
| ISSN: | 2168-6254 |
| Publisher: | American Medical Association |
| Date Published: | 2024-05-01 |
| Start Page: | 554 |
| End Page: | 561 |
| Language: | English |
| DOI: | 10.1001/jamasurg.2024.0133 |
| PUBMED: | 38477892 |
| PROVIDER: | scopus |
| PMCID: | PMC10938249 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Jennifer R. Cracchiolo -- Source: Scopus |
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