JMIR Publications

ABSTRACT

Background:

Patient-reported outcomes (PROs) are considered the gold standard for assessing subjective health status in oncology patients. Electronic assessment of PROs has become increasingly popular in recent years in both clinical trials and practice. However, there is limited evidence on how well elderly cancer patients can complete ePRO assessments.

Objective:

We aimed to investigate how well adult cancer patients of different age ranges could complete ePRO assessments at home and in a treatment facility, and to identify factors associated with the ability to complete questionnaires electronically.

Methods:

This retrospective longitudinal single-center study involved cancer survivors who participated in inpatient cancer rehabilitation. Patients completed ePRO assessments before rehabilitation at home (T1) and after rehabilitation at the facility (T2). We analyzed the rate of patients who could complete the ePRO assessment at T1 and T2, the proportion of patients who needed assistance in completing the ePRO assessment, and the time it took patients to complete standardized questionnaires. Multivariate logistic regression analyses were conducted to identify predictors of ePRO completion rate and the need for assistance.

Results:

Between 2017 and 2022, n=5,571 patients were included in the study. Patients had a mean age of 60.3 years (range 18 to 93 years), and 1,135 (20.3%) of them were classified as geriatric patients (≥70 years). While more than 90% of patients could complete the ePRO assessment, there was a decrease in patients above 70 years of age, with around 80–84% completing the assessment. Approximately 20% of patients reported a need for assistance with the ePRO assessment at home, compared to 6% at the institution. Patients over the age of 70 had a significantly higher need for assistance compared to younger age groups. Moreover, a gender difference was observed, with elderly women reporting a higher need for assistance than men (70-80 years: 44.6% vs. 27.4%, P<0.001; >80 years: 72.3% vs. 50.9%, P<0.001). While ePRO completion rate differed between cancer entities, the effect sizes were small to negligible (at home: P=0.004; ϕ=.07; inhouse: P<0.001; ϕ=.10). On average, patients needed 4.9 minutes to remotely complete a 30-item questionnaire (EORTC QLQ-C30) and patients in the older age groups took significantly longer compared to younger age groups. Lower age and higher physical functioning were the clearest predictor for both ePRO completion rate and the need for assistance in the multivariate regression analysis.

Conclusions:

The study results indicate that ePRO assessment is feasible in elderly cancer populations, but elderly patients may require assistance (e.g., from relatives) to complete home-based assessments. It may be more feasible to conduct assessments in-house in this population, particularly for individuals over 80 years of age. Additionally, it is crucial to carefully consider which resources are necessary and available to support patients in using the devices.