Effectiveness of ePRO-based symptom management for cancer patients: a systematic review and meta-analysis of randomized controlled studies

Purpose To systematically synthesize the evidence on the effectiveness of electronic patient-reported outcome (ePRO)-based symptom management on readmission rate, quality of life, symptom burden, anxiety, depression, and mortality in adult cancer patients. Method A systematic review and meta-analysis were conducted according to the PRISMA guideline in PubMed, Web of Science, EMBASE, the Cochrane Library, CINAHL, and Scopus for studies of randomized controlled trials reporting ePRO-based symptom management from January 1st, 2018, to May 31st, 2023. Two reviewers independently assessed risk-of-bias using Cochrane Risk-of-Bias version 2 and extracted the data. Subgroup analysis was conducted to identify the source of heterogeneity. Sensitivity analysis was performed by using the leave-one-out method. The study protocol was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (DOI:https://doi.org/10.37766/inplasy2023.6.0010). Results A total of 10 studies were included in our review, comprising a total of 5321 participants. The results showed ePRO-based symptom management can improve quality of life (QOL) (SMD = 4.42, 95% CI 0.14 to 8.69, P = 0.04) in cancer patients. No significant differences in the impact on the improvement of readmission rate (RR = 0.89, 95% CI 0.77 to 1.04, P = 0.15), symptom burden (SMD = 1.23, 95% CI - 1.34 to 3.79, P = 0.35), anxiety (SMD = - 0.00, 95% CI - 0.34 to 0.34, P = 0.99), depression (SMD = 0.03, 95% CI - 0.17 to 0.24, P = 0.74), and mortality (RR = 0.59, 95% CI 0.19 to 1.83, P = 0.36) between the two groups. In the subgroup analysis, readmission rates more than 30 days were significantly lower in the intervention group compared to the control group (relative rate (RR) = 0.85, 95% CI 0.72 to 0.99, P = 0.03). Also, the intervention group's QOL significantly improved compared to the control group when assessed within 1 month after the intervention (SMD = 4.35, 95% CI 3.75 to 4.94, P < 0.00001). In the sensitivity analysis, it was found that the results for readmission rates and quality of life (QOL) were unstable, indicating that further research is needed in the future. Conclusion Cancer patients often have different symptoms. Symptom management in cancer patients is an emerging topic. However, due to the limited numbers of included studies, the long-term effect of ePRO-based symptom management still needed to be validated.Registration details: inplasy (DOI:https://doi.org/10.37766/inplasy2023.6.0010).