A prospective study of electronic quality of life assessment using tablet devices during and after treatment of head and neck cancers
Introduction
Patient-reported outcomes are increasingly important endpoints not only in clinical trials but also in routine clinical practice. There is growing interest in transitioning to electronic qualify of life (eQOL) data collection to improve efficiency, accuracy, and accessibility of information. This is especially crucial within the realm of head and neck oncology, where practice is constantly advancing to improve not only cancer survival but also quality of life, and outcomes need to be measured efficiently.
However, there are concerns around implementation of eQOL data collection, including patient acceptance and usability given a wide range of familiarity and comfort with technology. Studies have suggested that electronic-based surveys are feasible to implement in the oncology and non-oncology settings, though there are variable ways in which this outcome has been measured including cost, compliance, requirements for assistance, patient-reported burden, and time to complete survey [1], [2], [3], [4].
Additionally, given the rapid advancement in technology, another important factor in electronic patient-reported outcomes (ePRO) studies is the mode of electronics used. In the current era, many people access information using mobile smart phones or tablets. The use of tablets in particular is an appealing method of delivery given its easier mobility compared with a computer or laptop and its larger screen size compared to a handheld device, and has been the primary platform for site-based ePRO data collection [5], [6]. However, because there is likely an even greater variation of dexterity and experience with these types of technologies, it is important to assess their relative usability and feasibility when used as ePRO platforms specifically in head and neck cancer patients who may have social challenges.
The primary objective of this study was to evaluate the feasibility of eQOL data collection using a touch-screen tablet device in a multidisciplinary setting in patients undergoing treatment for head and neck cancer. We were particularly interested in compliance and time to complete survey to inform integration of this form of eQOL data collection into clinic workflow and the design and implementation of future head and neck quality of life (QOL) trials.
Section snippets
Patients and design
After obtaining institutional review board approval, we prospectively enrolled patients at our institution who were 18 years or older with a pathological diagnosis of head and neck cancer (all subtypes) and who could understand and read English. Each patient completed two questionnaires [EORTC-QLQ-C30 and EORTC-QLQ-H&N35] at initial consult, midway through treatment, at the completion of treatment and at each subsequent follow-up visit for one year after treatment (follow-up appointments were
Patient characteristics
A total of 50 patients were included in this study. The majority (80%) of patients were male. Median age of all patients was 58.1 years (range 36.7–92.7). All patients underwent radiation treatment for their head and neck cancers, with the majority of patients (66%) also receiving concurrent chemotherapy. About half of the patients (48%) were treated in the definitive setting while the other half (46%) were treated in the post-operative setting. Two patients did not undergo their radiation
Discussion
New user-friendly data capture technologies have enabled more efficient approaches for assessment of QOL without requiring significantly more time and by minimizing data entry errors. Electronic data collection has been utilized for QOL assessments in clinical trials, and will likely continue to extend its role within the field of oncology. Though there have been several studies published examining the feasibility of ePRO [9], [10], [11], [12], our study is the first to our knowledge to
Conflict of interest
The authors have no conflicts of interest to disclose.
References (16)
- et al.
Can electronic web-based technology improve quality of life data collection? Analysis of radiation therapy oncology group 0828
Pract Radiat Oncol
(2014) - et al.
Qualitative and quantitative evaluation of EHR-integrated mobile patient questionnaires regarding usability and cost-efficiency
Int J Med Inform
(2012) - et al.
PRO data collection in clinical trials using mixed modes: report of the ISPOR PRO mixed modes good research practices task force
Value Health
(2014) - et al.
A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC quality of life group
Eur J Cancer
(2000) - et al.
Patient-reported outcome assessment after total joint replacement: comparison of questionnaire completion times on paper and tablet computer
Arch Orthop Trauma Surg
(2015) - et al.
Automated collection of quality-of-life data: a comparison of paper and computer touch-screen questionnaires
J Clin Oncol
(1999) - et al.
Capturing patient-reported outcome (PRO) data electronically: the past, present, and promise of ePRO measurement in clinical trials
Patient
(2014) - 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
J Natl Cancer Inst
(1993)
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These authors contributed equally to this work.