Self-reported overall well-being and physical function among chemotherapy and surgery patients across six institutions.

Abstract

Electronic patient-reported outcomes (ePROs) mitigate symptom burden among cancer patients. This study hypothesized that two single-item quality of life measures, overall well-being (OWB) and physical function (PFN), could provide distinct information that augment ePROs. eSyM, an electronic symptom management program, was deployed across six institutions for patients receiving chemotherapy or surgery for a suspected or confirmed thoracic, gastrointestinal, or gynecologic malignancy. eSyM prompts patients one to three times weekly to complete a 12-item symptom questionnaire and two pictogram questions assessing OWB and PFN. The study identified characteristics associated with OWB/PFN; described correlations between OWB/PFN, severe symptoms, and total symptom burden; and characterized relationships between OWB/PFN and clinical outcomes. From September 2019 to February 2024, 10,176 patients (3669 chemotherapy and 6507 surgery) submitted 78,433 questionnaires. The plurality reported mild impairment for OWB (chemotherapy, 41%; surgery, 45%) and PFN (chemotherapy, 43%; surgery, 39%). OWB and PFN were moderately correlated with each other (chemotherapy, 0.62; surgery, 0.58); with total symptom burden (chemotherapy: OWB 0.57, PFN 0.52; surgery: OWB 0.63, PFN 0.53); and with pain, fatigue, and decreased appetite (0.39-0.61). OWB and PFN varied by employment status and institution, and were associated with emergency department visits, admissions, and survival. Self-reported OWB and PFN were moderately correlated with common symptoms, offered discriminant and face validity, and were associated with clinical outcomes. These measures supplemented information from a multi-item questionnaire and may guide management for cancer patients by contextualizing symptom reports and functioning as a brief screen to identify patients at risk for moderate-severe symptoms or other serious outcomes.