Remote Symptom Monitoring Linked to Reduced Hospitalization Risk for Patients With Cancer

Remote symptom monitoring (RSM) for patients with cancer was associated with a reduced risk of hospitalizations, suggesting national implementation could reduce health care utilization and complement value-based care initiatives, according to a study published in JAMA Network Open.1

In the Enhancing Oncology Model (EOM), an alternative payment model launched by the CMS Center for Medicare and Medicaid Innovation as a successor to the Oncology Care Model (OCM), the collection of electronic patient-reported outcomes (ePROs) is a notable addition that facilitates improved RSM.1 CMS accepted a second round of EOM applications, with policy updates for the new cohort taking effect on July 1, 2025.2

“The choice to add ePROs for RSM is a natural fit for value-based health care because of both the potential to leverage underlying infrastructure built within OCM (eg, navigation, distress screening processes) and robust literature from randomized clinical trials that found ePRO-based RSM adds value,” the authors wrote.1 With prior research showing significant benefits linked with RSM among patients with cancer, including reduced hospitalizations and longer survival, the oncology community has advocated for ePROs as the standard of care.

At 3 months, hospitalizations among patients enrolled in RSM were 19% lower vs historical controls. | Image Credit: Nuttapong punna - stock.adobe.com

While clinical trials have shown success with the implementation of ePROs, these studies mostly included small numbers of patients, and data on the use of ePROs for RSM in the clinical setting are lacking, the authors explained. They also noted the need for more data on marginalized patient groups—such as Black patients and those living in rural or disadvantaged areas—who face barriers such as a lack of digital health literacy and challenges with the use of technology in the health care setting.

“As practices consider the second invitation to join EOM and payers consider which practice transformations should be included within payment reform demonstrations, additional data on ePRO-based RSM are needed across diverse populations,” the authors wrote. “Thus, this study evaluated the association of ePRO-based RSM delivered as part of standard care with health care utilization in a diverse health care delivery system caring for large proportions of patients who are Black, live in rural areas, or reside in communities with limited resources.”

Of a total of 5949 patients assessed, 1392 were enrolled in RSM, which was a web-based ePRO reporting platform accessible on any smart device or computer. The median (IQR) age was 61 (51-69) years, 67% of patients were female, and the cohort included 378 (27%) Black patients, 922 (66%) White patients, 262 (19%) patients residing in rural areas, and 1281 (28%) patients living in areas considered to have high neighborhood disadvantage.

At 3 months, hospitalizations among patients enrolled in RSM were 19% lower vs historical controls (relative risk [RR], 0.81; 95% CI, 0.73-0.91). At 6 months, the risk of hospitalization was 13% lower among those receiving RSM (RR, 0.87; 95% CI, 0.80-0.96). However, there were no significant differences in intensive care unit (ICU) or emergency department (ED) visits between the groups. The 3-month RR for ICU admissions was 0.82 (95% CI, 0.59-1.13), and the 6-month RR was 0.83 (95% CI, 0.65-1.06). Regarding ED visits, the 3-month RR was 1.02 (95% CI, 0.89-1.16), and the 6-month RR was 1.03 (95% CI, 0.92-1.15).

Across subset analyses, there were similar patterns in RR at 3 and 6 months for hospitalizations, ED visits, and ICU admissions. Patients with a high comorbidity burden (defined as 4 or more comorbid conditions) had a lower risk of hospitalizations at 3 months and 6 months vs historical controls (3-month RR, 0.76 [95% CI, 0.64-0.90]; 6-month RR, 0.86 [95% CI, 0.75-0.99]), as did those with 0 to 1 comorbidity. However, there were no statistically significant differences in hospitalization among Black patients, those living in rural areas, or those living in areas with high neighborhood disadvantage.

One study limitation was that only a portion of patients participated in RSM due to incomplete program rollout and patients declining to enroll in the program, the authors noted. There were also few Hispanic patients represented in the study (less than 5% of the population) and other subpopulations who may have distinct language or cultural needs. Additionally, the study was conducted at a large comprehensive cancer center and a smaller academic cancer center, limiting its generalizability to the community setting. The authors emphasized that the study is hypothesis-generating and requires further investigation.

“In a large scale, clinical practice population, RSM using ePROs was associated with reduced health care utilization in the form of hospital admission in a diverse oncology population,” the authors concluded. “Findings were observed in a diverse patient population, supporting broad applicability and highlighting the potential for this EOM-required practice transformation activity to impact value in cancer care delivery.”

References

1. Rocque GB, Franks JA, Deng L, et al. Remote symptom monitoring with electronic patient-reported outcomes in clinical cancer populations. JAMA Netw Open. Published online May 13, 2025. doi:10.1001/jamanetworkopen.2025.9852
2. Enhancing Oncology Model. CMS. Updated May 30, 2024. Accessed May 13, 2025. https://www.cms.gov/priorities/innovation/innovation-models/enhancing-oncology-model