# Weekly symptom check-ins with automatic alerts as standard of care on treatment

Source: https://onco.cc/ideas/idea-moon-pro-monitoring-standard/  
OnCo record `idea-moon-pro-monitoring-standard` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Patients on chemotherapy or immunotherapy answer a short weekly symptom questionnaire on their phone; severe answers alert the nurse the same day. Trials show this prolongs life.

## Summary

Electronic patient-reported outcome monitoring with nurse alerts improved quality of life, reduced emergency visits and improved overall survival in a randomised trial at Memorial Sloan Kettering (Basch et al.) and in the PRO-TECT cluster-randomised trial in community practices. Uptake remains low because nobody is paid for the nursing time. The proposal is a reimbursed care standard: every patient on active systemic therapy is offered weekly ePRO monitoring with defined alert thresholds and response times, and payers cover the monitoring as they cover a drug.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: System-wide ePRO monitoring reduces unplanned admissions during systemic therapy by at least 15% and improves symptom control, and the savings exceed the cost of nursing time.
- Rationale: Clinicians under-detect symptoms between visits; early management of dehydration, pain and nausea prevents cascades to admission. The evidence base is unusual in supportive care for including a survival signal.
- Proposed test: Payer-led pragmatic rollout with a randomised stepped start across practices; measure admissions, emergency visits, dose intensity delivered and patient-reported symptom burden.
- Maturity: being-tested-at-scale
- Actor: payer

## Sources

- NCI PRO-CTCAE: https://healthcaredelivery.cancer.gov/pro-ctcae/

## Connected records

- institutions: [Memorial Sloan Kettering Cancer Center](https://onco.cc/institutions/mskcc/)
- bottlenecks: [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Basch: asking patients to report symptoms online during chemotherapy improved survival](https://onco.cc/key-papers/paper-basch-epro-survival-jama-2017/)

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