The most coveted spot of the ASCO conference is the Plenary Session, in which a select few presentations, such as break-through discoveries and standard-of-care-changing studies, are hand-picked by the ASCO committee. Among the four presentations featured this year – that included reports on exciting new clinical trials in prostate, BRCA-mutated breast cancer and colon cancer – was an unusual study that didn’t involve testing of any pharmaceutical treatment!
Ethan M. Basch MD presented a study about a proactive symptom management system that was implemented at the Memorial Sloan Kettering Cancer Center. The study enrolled 766 patients across multiple cancer types who were assigned to an experimental arm involving the use of a web-based system. This system allowed patients to report symptoms remotely, either to their clinicians or to a control group that involved standard symptom management practices.
As was somewhat expected, use of the web-based symptom management system as reported by patients was associated with better quality of life. But, to the great surprise of the audience, it also resulted in longer overall survival! OS is one of the most treasured end-points in clinical trials and a gold standard for treatment approval by the FDA. And it wasn’t just any survival benefit – the median survival benefit was an increase of five months above and beyond the survival observed in the standard practice arm. To put this into perspective, there are only a few oncology drugs that can boast a similar level of survival benefit.
The ‘why’ behind these impressive results seems pretty simple. Some of the biggest problems in caring for cancer patients are: effective management of side effects to ensure that symptoms don’t cause complications; that patients continue on treatment to receive an optimal dose/duration; and that patients stay active and functional.
Based on what we at Hall & Partners Health hear from patients across many tumor types, symptom management is often reactive, delayed and inconsistent. That’s not anyone’s ‘fault’ – it’s not because of a lack of caring, or cost limitations, or not appreciating the importance of symptom management. Rather, these lapses can be attributed to human nature – on the part of both patients and clinicians: either patients forget to mention these problems during visits, or don’t want to bother their clinician when they are remote; or clinicians run out of time, or forget to specifically ask about the symptoms during the visit.
In this study, use of the system resulted in about three in four patients reporting their symptoms, and the clinical team taking action in three in four of those situations!
The implication is clear – oncologists should incorporate a proactive symptom management system into their practice. Pharma has an opportunity to embrace this idea, and to support patients and their healthcare clinicians, by adopting a symptom-reporting feedback loop into standard care protocols.
Pharma companies have increasingly been embracing a patient-centric approach to care, and many are developing support tools and systems. A proactive symptom management tool could be of great benefit to all stakeholders, especially the patients.