# Basch: asking patients to report symptoms online during chemotherapy improved survival

Source: https://onco.cc/key-papers/paper-basch-epro-survival-jama-2017/  
OnCo record `paper-basch-epro-survival-jama-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Patients on chemotherapy for advanced cancer who reported 12 symptoms weekly through a web tool, with nurse alerts for severe symptoms, lived a median 5 months longer than those receiving usual care.

## Summary

This single-centre trial at Memorial Sloan Kettering randomised 766 patients starting chemotherapy for metastatic solid tumours to weekly electronic self-reporting of 12 common symptoms (with email alerts to nurses when symptoms worsened or were severe) or to usual care, in which symptoms were discussed at visits.

The 2016 JCO report showed better health-related quality of life at 6 months (improved in 34% vs 18%), fewer emergency department visits (34% vs 41%), fewer hospitalisations and longer time on chemotherapy (8.2 vs 6.3 months). This 2017 research letter reported the overall survival analysis: median 31.2 months with self-reporting versus 26.0 months with usual care.

The survival result, replicated in a French lung cancer trial (Denis, JAMA 2019), turned symptom monitoring into a standard of care and drove the design of the multi-site PRO-TECT trial.

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: JAMA
- Year: 2017
- DOI: 10.1001/jama.2017.7156
- Authors: Basch E, Deal AM, Dueck AC, et al.
- Findings: Median overall survival 31.2 vs 26.0 months (HR 0.83, 95% CI 0.70-0.99; p = 0.03); Health-related quality of life improved in 34% vs 18% at 6 months (JCO 2016); Emergency department visits 34% vs 41%; hospitalisations 45% vs 49%; Patients stayed on chemotherapy longer: median 8.2 vs 6.3 months
- What it means: Routinely asking patients how they feel between visits, and acting on the answers, is a treatment in itself. It catches problems early, keeps people on effective therapy longer and appears to extend life. Cancer centres now build symptom monitoring into electronic records, though implementation is uneven.
- Caveats: Single centre; survival was a secondary endpoint and the effect size is modest; The larger multi-site PRO-TECT trial (2022) improved physical function and symptom control but did not show a survival benefit; Requires nursing capacity to respond to alerts; the mechanism may be earlier intervention rather than the reporting itself; Patients unfamiliar with computers were given a bespoke system, a subgroup that showed the largest benefit

## Sources

- DOI: https://doi.org/10.1001/jama.2017.7156
- Primary report (JCO 2016): https://doi.org/10.1200/JCO.2015.63.0830
- ClinicalTrials.gov NCT00578006: https://clinicaltrials.gov/study/NCT00578006

## Connected records

- ideas: [Patient-reported side-effects (PRO-CTCAE) collected and published in every registrational trial](https://onco.cc/ideas/idea-moon-pro-ctcae-in-every-pivotal-trial/), [Patient-reported symptoms captured as standard structured data in every clinic](https://onco.cc/ideas/idea-data-pro-as-structured-standard/), [Weekly electronic symptom reporting as a standard of care during systemic therapy](https://onco.cc/ideas/idea-acc-electronic-pro-monitoring-standard/), [Weekly symptom check-ins with automatic alerts as standard of care on treatment](https://onco.cc/ideas/idea-moon-pro-monitoring-standard/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Electronic patient-reported outcome (ePRO) symptom monitoring](https://onco.cc/technologies/epro-symptom-monitoring/), [Electronic patient-reported outcomes and remote monitoring](https://onco.cc/technologies/remote-patient-monitoring/)
- institutions: [Memorial Sloan Kettering Cancer Center](https://onco.cc/institutions/mskcc/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [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/)
- journals: [JAMA](https://onco.cc/journals/jama/)
- people: [Ethan Basch](https://onco.cc/people/ethan-basch/)

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