Feasibility test of a UK-scalable electronic system for regular collection of patient-reported outcome measures and linkage with clinical cancer registry data: The electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system

BackgroundCancer survivors can face significant physical and psychosocial challenges; there is a need to identify and predict which survivors experience what sorts of difficulties. As highlighted in the UK National Cancer Survivorship Initiative, routine post-diagnostic collection of patient reported outcome measures (PROMs) is required; to be most informative, PROMs must be linked and analysed with patients' diagnostic and treatment information. We have designed and built a potentially cost-efficient UK-scalable electronic system for collecting PROMs via the internet, at regular post-diagnostic time-points, for linking these data with patients' clinical data in cancer registries, and for electronically managing the associated patient monitoring and communications; the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system. This study aims to test the feasibility of the ePOCS system, by running it for 2 years in two Yorkshire NHS Trusts, and using the Northern and Yorkshire Cancer Registry and Information Service.Methods/DesignNon-metastatic breast, colorectal and prostate cancer patients (largest survivor groups), within 6 months post-diagnosis, will be recruited from hospitals in the Yorkshire Cancer Network. Participants will be asked to complete PROMS, assessing a range of health-related quality-of-life outcomes, at three time-points up to 15 months post-diagnosis, and subsequently to provide opinion on the ePOCS system via a feedback questionnaire. Feasibility will be examined primarily in terms of patient recruitment and retention rates, the representativeness of participating patients, the quantity and quality of collected PROMs data, patients' feedback, the success and reliability of the underpinning informatics, and the system running costs. If sufficient data are generated during system testing, these will be analysed to assess the health-related quality-of-life outcomes reported by patients, and to explore if and how they relate to disease, treatment and/or individual differences characteristics.DiscussionThere is currently no system in the UK for collecting PROMs online and linking these with patients' clinical data in cancer registries. If feasible, ePOCS has potential to provide an affordable UK-scalable technical platform to facilitate and support longitudinal cohort research, and improve understanding of cancer survivors' experiences. Comprehensive understanding of survivorship difficulties is vital to inform the development and provision of supportive services and interventions.

[1]  K. Petrie,et al.  The illness perception questionnaire: A new method for assessing the cognitive representation of illness , 1996 .

[2]  G. Otterson,et al.  The Self-regulation Model of Illness Applied to Smoking Behavior in Lung Cancer , 2009, Cancer nursing.

[3]  C. Foster,et al.  Psychosocial implications of living 5 years or more following a cancer diagnosis: a systematic review of the research evidence. , 2009, European journal of cancer care.

[4]  G. Murray,et al.  A 1-year prospective study of individual variation in distress, and illness perceptions, after treatment for breast cancer. , 2005, Journal of psychosomatic research.

[5]  S. Green,et al.  Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  A. Kasuya EuroQol--a new facility for the measurement of health-related quality of life. , 1990, Health policy.

[7]  J. Coebergh,et al.  The Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship registry: scope, rationale and design of an infrastructure for the study of physical and psychosocial outcomes in cancer survivorship cohorts. , 2011, European journal of cancer.

[8]  Increased health care utilization among long‐term cancer survivors compared to the average Dutch population: A population‐based study , 2007, International journal of cancer.

[9]  G. Andrews,et al.  Do doctors know best? Comments on a failed trial , 2001, The Medical journal of Australia.

[10]  C. Gotay,et al.  Patient‐reported Outcomes in Cancer: A Review of Recent Research and Policy Initiatives , 2007, CA: a cancer journal for clinicians.

[11]  L. Lissner,et al.  Quality of life in cancer survivors as observed in a population study of Swedish women , 2007, Scandinavian journal of primary health care.

[12]  Keith Petrie,et al.  The Revised Illness Perception Questionnaire (IPQ-R) , 2002 .

[13]  J. Nabholtz,et al.  A longitudinal prospective study of health-related quality of life in breast cancer patients following high-dose chemotherapy with autologous blood stem cell transplantation , 2005, Bone Marrow Transplantation.

[14]  M. McGurk,et al.  Head and neck cancer: to what extent can psychological factors explain differences between health-related quality of life and individual quality of life? , 2006, The British journal of oral & maxillofacial surgery.

[15]  Jacquie Hetherton,et al.  Recruitment by GPs during consultations in a primary care randomized controlled trial comparing computerized psychological therapy with clinical psychology and routine GP care: problems and possible solutions , 2004, Primary Health Care Research & Development.

[16]  F. Joly,et al.  Quality of life in long-term survivors of testicular cancer: a population-based case-control study. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[17]  G. Velikova,et al.  The Social Difficulties Inventory (SDI): development of subscales and scoring guidance for staff , 2011, Psycho-oncology.

[18]  D Brewster,et al.  Cancer prevalence in the United Kingdom: estimates for 2008 , 2009, British Journal of Cancer.

[19]  David M Dilts,et al.  Invisible barriers to clinical trials: the impact of structural, infrastructural, and procedural barriers to opening oncology clinical trials. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  C. Carver,et al.  Assessing Quality of Life in Adult Cancer Survivors (QLACS) , 2005, Quality of Life Research.

[21]  Galina Velikova,et al.  Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  M. McGurk,et al.  The relationship between the Patient Generated Index (PGI) and measures of HR-QoL following diagnosis with head and neck cancer: are illness and treatment perceptions determinants of judgment-based outcomes? , 2007, British journal of health psychology.

[23]  P. Selby,et al.  Screening for social difficulties in cancer patients: clinical utility of the Social Difficulties Inventory , 2007, British Journal of Cancer.

[24]  Mary Thomas,et al.  The effects of group exercise on fatigue and quality of life during cancer treatment. , 2006, Oncology nursing forum.

[25]  J. Bloom,et al.  Multi‐dimensional quality of life among long‐term (5+ years) adult cancer survivors , 2007, Psycho-oncology.

[26]  D. Osoba,et al.  The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. , 1993, Journal of the National Cancer Institute.

[27]  E. Ip,et al.  Evaluation of the Quality of Life in Adult Cancer Survivors (QLACS) scale for long-term cancer survivors in a sample of breast cancer survivors , 2006, Health and quality of life outcomes.

[28]  Anna M. Miller,et al.  Case-Control Comparison of Quality of Life in Long-Term Ovarian Germ Cell Tumor Survivors: A Gynecologic Oncology Group Study , 2008, Journal of psychosocial oncology.

[29]  N. Aaronson,et al.  The health-related quality of life of long-term survivors of melanoma treated with isolated limb perfusion. , 2007, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[30]  M. Zvolensky,et al.  The role of comorbidity in explaining the associations between anxiety disorders and smoking. , 2010, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[31]  R. Brooks EuroQol: the current state of play. , 1996, Health policy.

[32]  Milena M. Head,et al.  Computer use by older adults: A multi-disciplinary review , 2010, Comput. Hum. Behav..

[33]  A. Williams EuroQol : a new facility for the measurement of health-related quality of life , 1990 .

[34]  F. Anagnostopoulos,et al.  Assessing illness representations of breast cancer: a comparison of patients with healthy and benign controls. , 2005, Journal of psychosomatic research.

[35]  P. Easterbrook,et al.  Fate of Research Studies , 1992, Journal of the Royal Society of Medicine.

[36]  P. Pai,et al.  Quality of life in head and neck cancer survivors: a cross-sectional survey. , 2009, American journal of otolaryngology.

[37]  D. Forman,et al.  Integrating cancer survivors' experiences into UK cancer registries: design and development of the ePOCS system (electronic Patient-reported Outcomes from Cancer Survivors) , 2011, British Journal of Cancer.

[38]  P. Selby,et al.  Computer-based quality of life questionnaires may contribute to doctor–patient interactions in oncology , 2002, British Journal of Cancer.

[39]  A. Cull,et al.  Development and evaluation of an instrument to assess social difficulties in routine oncology practice , 2005, Quality of Life Research.

[40]  M. Kochen,et al.  Simply no time? Barriers to GPs' participation in primary health care research. , 2008, Family practice.

[41]  J. Habbema,et al.  Five‐year follow‐up of health‐related quality of life after primary treatment of localized prostate cancer , 2005, International journal of cancer.

[42]  C. Hamashima Long‐term quality of life of postoperative rectal cancer patients , 2002, Journal of gastroenterology and hepatology.

[43]  D. Forman,et al.  Primary health and supportive care needs of long-term cancer survivors: a questionnaire survey. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[44]  K. Hoffman,et al.  Psychological distress in long-term survivors of adult-onset cancer: results from a national survey. , 2009, Archives of internal medicine.

[45]  Ian Scott,et al.  Data Linkage: A powerful research tool with potential problems , 2010, BMC health services research.

[46]  Andrew Lloyd,et al.  Health Utilities Using the EQ-5D in Studies of Cancer , 2012, PharmacoEconomics.

[47]  Corey Greenlaw,et al.  A Comparison of Web-Based and Paper-Based Survey Methods , 2009, Evaluation review.

[48]  R. J. Baatenburg de Jong,et al.  Quality of life and illness perceptions in patients with recently diagnosed head and neck cancer , 2005, Head & neck.

[49]  J. Palmer,et al.  Use of a web-based questionnaire in the Black Women's Health Study. , 2010, American journal of epidemiology.

[50]  A. McTiernan,et al.  Fatigue in breast cancer survivors two to five years post diagnosis: a HEAL Study report , 2007, Quality of Life Research.

[51]  M. Groenvold,et al.  Health-related quality of life in long-term breast cancer survivors: Nationwide survey in Denmark , 2007, Breast Cancer Research and Treatment.

[52]  R. Kessler,et al.  Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey. , 1999, The American journal of psychiatry.

[53]  H. Brenner,et al.  Persistence of restrictions in quality of life from the first to the third year after diagnosis in women with breast cancer. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[54]  Geoff Hall,et al.  Development of an advanced database for clinical trials integrated with an electronic patient record system , 2011, Comput. Biol. Medicine.

[55]  D. Noh,et al.  Health-related quality of life in disease-free survivors of breast cancer with the general population. , 2006, Annals of oncology : official journal of the European Society for Medical Oncology.

[56]  R. Kessler,et al.  Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey , 2006, The Lancet.

[57]  R. Sanson-Fisher,et al.  Measuring quality of life in cancer survivors: a methodological review of existing scales , 2008, Psycho-oncology.

[58]  R. Belue,et al.  Work disability associated with cancer survivorship and other chronic conditions , 2008, Psycho-oncology.