Unsupervised dynamic ePRO reporting of immunotherapy related symptoms in cancer patients

Introduction: The use of electronic patient reported outcome (ePRO) in patients has been demonstrated to improve patient care and symptom management in curative and palliative settings. We examined the electronic and dynamic reporting of wellbeing, symptoms, and cognition in unsupervised patients with solid cancers of bladder, breast and lung in neoadjuvant, adjuvant and metastatic therapy settings. Participants undergoing immune checkpoint inhibitor (ICI) treatment were provided a mobile smartphone app for standardized and structured reporting on wellbeing and symptoms according to the CTCAE Criteria, as well as cognitive test and vital parameters. Case Presentation: Data of 14 patients was available for descriptive analysis. Besides checkpoint inhibition, patients received concomitant chemotherapy with carboplatin and taxanes. Three patients were excluded for lack of app usage. The eleven patients presented here entered a total of 9624 symptom ratings and rated their wellbeing 2983 times. Patients recorded a median number of symptom entries of 453 (IQR 109-1401). 49 different symptoms were reported in total with a median of 8 per patient (IQR 4-15). Of the 24 symptoms that were frequently shared among multiple patients, all are considered clinically relevant and associated with immunotherapeutic interventions. The most commonly patient reported symptoms were fatigue (82%), diarrhea (45%), limb and muscle pain (45%), sleep problems (45%) and dyspnea (36%). Overall, symptoms severity was reported at grades between 0.1 (very mild) to 9.0 (very severe), at a mean grade of 2.6. The most severely rated unique entry was for limb and muscle pain, edema of limbs showed the highest mean rating (5.9). The median duration of app use was 195 days (IQR 108-472). The descriptive analysis showed a general trend of patients with higher grade symptoms reporting a lower grade of wellbeing but no clear association with cognitive performance. Conclusion: Unsupervised patients showed high app usage adherence and frequency of data entries, which was comparable to previous reports on supervised patients undergoing immunotherapeutic interventions.