Feasibility of weekly patient-reported symptom monitoring using patients' own smartphones in outpatient cancer chemotherapy: the SMART-PRO study

Electronic patient-reported outcome (ePRO) systems using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) can improve symptom monitoring, but the feasibility of implementing such systems with a bring-your-own-device (BYOD) approach in routine oncology practice, particularly among older adults, is not well established. We conducted a single-arm prospective observational study in Japan to evaluate weekly BYOD-based ePRO monitoring of adverse events in outpatients receiving chemotherapy. Twenty-eight patients used smartphones to complete weekly PRO-CTCAE/CTCAE-based questionnaires for 12 weeks. Alerts were automatically generated when severity or frequency thresholds were met. Feasibility outcomes were weekly ePRO response rates and the distribution of alert-generating symptoms; HRQoL (EORTC QLQ-C30) was assessed at baseline, week 6, and week 12. The mean age was 66.7 years and most patients had stage IV disease. The weekly ePRO response rate ranged from 75% to 93% in the overall cohort and remained at or above 75% in patients aged ≥70 years. Pain-related items most frequently triggered alerts, followed by numbness and tingling, rash, fatigue, and skin-related disorders. The EORTC QLQ-C30 global health status score increased numerically from 54.8 at baseline to 63.5 at week 6 and 63.4 at week 12, with no marked deterioration observed over 12 weeks. These findings indicate that weekly PRO-CTCAE/CTCAE-based ePRO monitoring using a BYOD approach is feasible in routine outpatient oncology care, including among older adults who use smartphones. This study provides preliminary evidence for BYOD-based ePRO implementation in this underexplored population.