Effectiveness of electronic patient-reported outcomes in patients with cancer undergoing immunotherapy: a real-world retrospective study

BACKGROUND: Immune checkpoint inhibitors (ICIs) are essential in advanced cancer treatments; however, they can cause severe immune-related adverse events (irAEs). Herein, we aimed to investigate the effectiveness of electronic patient-reported outcomes (ePROs) in monitoring the symptoms of patients with advanced cancer undergoing ICI therapy. METHODS: We retrospectively reviewed the medical records of patients with advanced cancer who received ICIs at the Komatsu Municipal Hospital between June 2019 and March 2024 following ePROs introduction. RESULTS: Overall, 168 patients were included, with 43 and 125 in the ePRO and conventional care groups, respectively. The incidence of grade ≥ 3 irAEs was significantly lower in the ePRO than the conventional care group (7% vs. 21%; P = 0.039). Multivariate analysis showed that ePROs use was significantly associated with fewer emergency visits (odds ratio [OR]: 0.22, P < 0.001) and hospitalizations (OR: 0.36, P = 0.027). Patients in the ePRO group demonstrated significantly longer progression-free survival (PFS) and overall survival (OS) than did those in the conventional care group (median PFS: 10.8 vs. 4.8 months, hazard ratio [HR]: 0.50, P = 0.003; median OS: not reached vs. 17.0 months, HR: 0.40, P = 0.010). These survival benefits remained statistically significant after propensity score matching (n = 37 per group; PFS: HR 0.48, P = 0.009; OS: HR 0.37, P = 0.013). CONCLUSION: Implementation of ePROs was associated with clinical benefits in patients with advanced cancer receiving ICI therapy. ePRO-based symptom monitoring may contribute to safer and more effective immunotherapy in real-world oncology practice.