Association of routine electronic symptom monitoring with reduced opioid use in patients with head and neck cancers.

Abstract

1579 Background: Patient reported outcomes (PROs) have become increasingly important in modern healthcare. Head/neck cancer (HNC) is associated with numerous side effects that significantly impact patients quality of life short and long term. We developed FACT-HN-RAD, a brief cancer and treatment specific PRO aiming to efficiently capture side effect burden for patients with HNC undergoing radiotherapy (RT). Here we report the clinical implementation of this measure through the electronic medical record (EMR) at two institutions. Methods: The PRO was prospectively integrated into routine clinical care for patients with HNC through deployment in the EMR weekly during RT (up to 7 weeks) and at 1-, 3-, 6-, 9-, and 12-month post RT. We compared a historic cohort of patients (treated July 2021-July 2023) to those treated after PRO deployment (Aug 2023-Aug 2025), assessing PRO adherence, opioid use, emergency room (ER) encounters and inpatient admissions. Baseline demographic characteristics were summarized using descriptive statistics. Clinical outcomes were compared using parametric and nonparametric statistical tests. Results: OF the 2,288 patients, 1,304 were in the PRO cohort and 984 were in the historic cohort. Patients had a median age of 65 (IQR 56-73) and were mostly White (81.9%), non-Hispanic (91.3%), and current/former smokers (57.5%) with a median of 20 smoking pack years (IQR 3.8-46.5). In the PRO cohort, 51.9% (n=677) submitted at least one response to the assigned PRO. Within each individual patient for the total assigned series, within patient adherence was 50.9% (ie each patient filled out approximately half of the assigned PROs over a one year timeframe). Patients in the PRO cohort required less opioids with 49.1% (n= 640) receiving any opioid prescription in the PRO cohort as compared to 60.9% (n=577) historically (p<0.001). The average daily strength of opioids decreased 28% in the PRO cohort (mean MME 150.1mg, SD 458.7) versus historically (mean MME 207.9mg, SD 574.8) (p<0.001), and the total opioids prescribed to patients decreased 44% in the PRO cohort (mean MME 3,565mg, SD 12,105) versus historically (mean MME 6,363mg, SD 18,387) (p<0.001). Patients in the PRO cohort overall had fewer ER visits during and within the first year after finishing RT, with 13.3% (n=173) visiting the ER as compared to 29.4% (n=289) historically (p<0.001). Patients in the PRO cohort had fewer inpatient admissions within the first year after finishing RT, 28.8% (n=375) as compared to 48.8% (n=480) historically (p<0.001). Conclusions: We demonstrate that the integration of routine electronic PROs into the care of patients undergoing HNC RT is associated with clinical benefits when compared to a historic cohort including reduced opioid use, reduced ER visits, and reduced inpatient admissions. This promising approach in the definitive RT setting warrants further study in a randomized clinical trial.