The Patient Stays in the Picture
IN JUNE 2014, oncologist Fabrice Denis of the Jean Bernard Center, a cancer hospital in Le Mans, France, began approaching people diagnosed with advanced lung cancer whose disease hadn’t progressed after initial treatment. He wanted them to try an unconventional approach to health care. It didn’t involve a new drug, a combination therapy or an experimental test of an emerging technology. It was much simpler. Patients would use a web-based application to report on their condition and symptoms, and they’d have regular email access to an oncologist.
Denis wanted to study patient-reported outcomes, or PROs—experiences reported directly by people via surveys, web apps or other instruments rather than filtered through health care providers. Participants would agree to a less frequent regimen of routine follow-up CT scans, the normal way to look for cancer recurrence. (They would receive scans when their self-reported symptoms indicated the disease might be growing again.) Denis thought limiting routine scans would make the study a hard sell, but he was wrong. Within 18 months, the study was filled; 133 people with advanced lung cancer from five cancer centers in France had signed on. As it turned out, he says, “it was very easy to find patients.”
The study’s findings, published in 2017 in the Journal of the National Cancer Institute, were startling. After two years of follow-up, Denis and his group found that patients who reported their symptoms via the online tool survived, on average, seven months longer than patients receiving the usual care in the form of regular screenings. He attributes the benefit to earlier detection and treatment of relapses.