# Trajectories of Patient-Reported Outcomes among Diverse Cancer Patients in Ambulatory Oncology Clinics

## TL;DR

This study tracks how cancer survivors' health and symptoms change over time, finding that some cancer types need more personalized care to improve quality of life.

## Contribution

The study identifies cancer-specific patterns in symptom burden and HRQOL trajectories, informing personalized survivorship care strategies.

## Key findings

- Gynecological cancer survivors reported the highest symptom burden across multiple domains.
- Head and neck cancer survivors showed improvement in HRQOL over time, while gastrointestinal cancer survivors experienced worsening HRQOL.
- Marital status and comorbidity burden were independent predictors of PRO scores across cancer types.

## Abstract

Patient-reported outcomes (PROs) offer critical insights into cancer survivors’ symptoms and health-related quality of life (HRQOL). This study evaluated longitudinal trajectories of PROs among cancer survivors across diverse cancer types and identified factors associated with symptom burden and HRQOL.

We conducted a retrospective longitudinal observational study of 3,809 cancer survivors in ambulatory oncology clinics who completed electronic health record-integrated PRO assessments measuring anxiety, depression, pain interference, fatigue, and physical function, and HRQOL. Linear mixed-effect models evaluated PRO trajectories over time across seven common cancer types.

Survivors with gynecological cancers reported the highest symptom burden across multiple domains, particularly anxiety, pain interference, physical function, and fatigue. Male genital system cancer survivors consistently showed lower symptom burden and better HRQOL. Head and neck cancer survivors improved in pain interference, fatigue, physical function, and HRQOL over time compared to other cancer types, while gastrointestinal cancer survivors exhibited worsening HRQOL than hematologic and head and neck cancer survivors. Marital status and comorbidity burden were independent predictors for all PRO scores.

PRO trajectories varied substantially by cancer types, underscoring the need for personalized, cancer-specific survivorship care strategies.

While standard follow-up may suffice for male genital system and head and neck cancer survivors, more intensive interventions may be required for gynecological and gastrointestinal cancer survivors to address persistent symptom burden. Routine, EHR-integrated PRO monitoring can identify cancer survivors at risk for persistent symptom burden, guiding timely, tailored interventions to improve long-term HRQOL.