2471 - Assessing Implementation of Electronic Patient-Reported Outcomes (ePRO) to Reduce Follow-Up Visits for Patients Undergoing Radiation Therapy for Breast Cancer

Purpose/Objective(s): This study aimed to evaluate the acceptability, appropriateness, and feasibility of using an ePRO-based strategy to reduce post-radiation therapy (RT) visits in patients with breast cancer who reported minimal symptoms.

Materials/Methods: An ePRO instrument was administrated weekly for patients undergoing RT for breast cancer at an academic cancer center. The instrument assessed RT-related toxicities (breast enlargement/tenderness, skin changes, pain, and fatigue) using PRO-CTCAE and anxiety with GAD-2. Patients rated symptom severity on a 5-point Likert scale (None to Very severe). Six weeks after treatment completion, patients with no more than moderate symptoms were offered the option to cancel their routine post-RT follow-up visit. Clinical and demographic data were collected from electronic health records. Descriptive statistics and univariate analyses were used to characterize the cohort and evaluate factors associated with follow-up visit cancellation.

Results: Among the 46 patients (median age: 60 years) who responded to the appointment cancellation question, 32 (70%) were White, 5 (11%) Black, 5 (11%) Asian, and 2 (4.3%) Hispanic. Type of RT received included whole breast irradiation (WBI) (n=22, 48%), partial breast irradiation (PBI) (n=10, 22%), post-mastectomy RT (PMRT) (n=10, 22%), and WBI with regional nodal radiation (RNI) (n=4, 8.7%). Regarding acceptability among respondents, we found 36 (78%) chose to keep their appointments, 7 (15%) opted to cancel, and 3 (6.5%) were unsure. In terms of appropriateness, patients who canceled or were unsure were similar in age, race, ethnicity, BMI, and travel distance to the center, but reported fewer symptoms than those who kept their appointments, with significantly lower breast tenderness (10% vs. 50%, respectively, p= 0.026), and a trend towards lower pain in the radiated area (30% vs. 61%, p= 0.073) and fatigue (30% vs. 56%, p= 0.23). As an assessment of feasibility, fewer hospitalizations within 6 months occurred among those cancelling their follow-up visit (0 vs. 2 [5.6%]), while urgent care visits were comparable (8.6% vs. 10%).

Conclusion: An ePRO-based strategy to inform and appropriately reduce unnecessary post-RT follow-up visits appears feasible and suitable for patients who completed breast RT with mild to moderate symptoms. Although more research is needed to improve upon low patient acceptability (15%), the high prevalence of breast cancer suggests this strategy could still reduce the clinical burden of low value visits.