JMIR Publications

ABSTRACT

Background:

Personalized nutritional management during cancer remains challenging in clinical practice. The development of an electronic patient-reported outcome platform (ePROM) provides novel opportunities.

Objective:

This study aimed to evaluate the effectiveness and adherence of nutritional management using ePROMs in patients with cancer.

Methods:

This multi-center prospective longitudinal cohort study included 6,124 patients diagnosed with cancer. Exposure duration was based on adherence to the ePROM journal, with the primary outcomes being adequate energy intake (EI) and protein intake (PI). Logistic regression analysis was conducted to identify the factors associated with EI and PI, reporting odds ratios (ORs) and 95% confidence intervals (CIs). A restricted cubic spline plot was used to illustrate the association between the adjusted ORs and adherence duration. The semMediation approach was applied to assess the impact of multiple mediators on the outcomes.

Results:

The study cohort comprised 61.1% men and 38.9% women, with a median age of 60.85 years. Overall, 1,024 (16.7%) and 2,591 (42.3%) patients achieved adequate EI and PI scores, respectively. Approximately 50% of the patients in the adequate EI/PI group continued the ePROM journal for one month, compared to only 30% in the inadequate EI/PI group (P<0.001). This trend remained significant in the second, third, and sixth months. Logistic regression analysis demonstrated that longer adherence to ePROM journaling was independently associated with adequate EI (OR=1.08, 95% CI: 1.05–1.12; P<0.001) and PI (OR=1.30, 95% CI: 1.24–1.36; P<0.001), as well as a reduced risk of malnutrition (OR=0.95, 95% CI: 0.92–0.98; P<0.001), after adjusting for confounders. Mediation analysis revealed that most symptoms did not significantly mediate these effects, except constipation, reflux, and delirium, which showed statistical significance but minimal indirect effects.

Conclusions:

Nutritional management via ePROM is a feasible approach, with improved effectiveness as adherence duration increases. The observed benefits resulted primarily from direct effects rather than from symptom improvement. Clinical Trial: ChiCTR2100047535