2895 - Implementing ePROMs in a Safety-Net Radiation Oncology Clinic: Pre- and Post-COVID-19

R. N. W. Tsai^1,2, Y. Lin^1,2, M. M. Qureshi³, M. T. Truong^1,2, and K. S. Mak^1,2; ¹Boston University Chobanian & Avedisian School of Medicine, Boston, MA, ²Department of Radiation Oncology, Boston Medical Center, Boston, MA, ³Boston Medical Center, Boston, MA

Purpose/Objective(s): Patient reported outcomes (PROs) are important cancer-related outcomes, yet efficient administration of electronic patient reported outcome measures (ePROMs) in safety-net hospitals remains challenging. We provide an update on the routine use of ePROMs in a safety-net radiation oncology clinic, and analyze the potential impact of the COVID-19 pandemic on patient participation. Materials/

Methods: Patients seen in consultation for lung or head and neck cancer were screened by language preference (English, Spanish, French, Portuguese) and absence of metastases from 3/2019-3/2020 and subsequently 8/2021-10/2022 after clinic COVID-19 precautions were relaxed. Patients were administered a set of baseline ePROMs (EQ-5D-3L, FACT, PRO-CTCAE) using a widely used patient-centered outcomes platform. Associations between patient demographics and ePROM completion were evaluated.

Results: A total of 187 head and neck (n=93; 49.7%) and lung cancer (n=94; 50.3%) patients were identified. Ninety-three patients were seen after the onset of the pandemic (49.7%). Median age was 65 years (IQR 58-72). Most patients were male (62.6%) and English-speaking (81.8%). Whites, Blacks, and Asians/Others comprised 40.6%, 37.4%, and 13.9% of patients, respectively. Twenty-eight patients were Hispanic (15.0%). Sixteen patients (8.6%) no-showed or cancelled, while 171 (91.4%) patients were seen in consultation, of whom 88 (51.5%) completed initial questionnaires. The most common reason for ePROM incompletion was clinical decision and/or clinic understaffing (n=48; 28.1%). Fifteen patients experienced difficulty with tablet technology due to physical impairment (8.8%). Twenty (11.7%) patients refused to complete ePROMs, with reasons cited including survey length and/or low energy. Younger age was associated with ePROM completion (p=0.02). Language, race, ethnicity, insurance, marital status, gender, disease site, and survey date (pre- vs. post-pandemic) were not associated with ePROM completion.

Conclusion: Routine implementation of ePROMs in a safety-net oncology setting is feasible, but challenging and labor-intensive with just over half of patients completing questionnaires. Improving ease and accessibility of PRO collection for these vulnerable patients, particularly the elderly, should be prioritized by addressing technological and physical barriers, and questionnaire fatigue. There was no significant difference between rates of pre- and post-pandemic survey completion.