Scaling PROMs-based remote patient monitoring in cancer care: policy ‘hot topic’ to policy lever

There is growing recognition that PROMs (patient-reported outcome measures) should be part of routine cancer care as they bring the patient’s voice directly into clinical decision-making. The National Cancer Plan highlights the importance of using PROMs to ensure patient voice and feedback is used to inform service development. PROMs sit alongside other valuable sources of insight, such as the National Cancer Patient Experience Survey, which help identify where care is working well and where inequalities or variation exist.

However, for both these metrics, it is often less clear how consistently the findings are used to improve services in ways that directly benefit patients.

The implementation of PROMS across NHS trusts remains patchy due to variation across the country in areas like digital infrastructure, workforce pressures and time constraints and funding.

Too often, the focus of collecting patient experience data appears to be on trust and provider performance, rather than on translating this feedback into meaningful improvements in care.

So, why is the system not making better use of this insight to improve patient experience?

I attended a workshop on scaling PROMs-based remote patient monitoring (RPM) for people on and after systemic cancer treatment.

But what does this mean and what would it look like? In a nutshell, patients would regularly report their symptoms and well-being from home by completing online questionnaires (PROMs) that would allow healthcare teams to track how a patient is doing.

In practice, this could look like a cancer patient completing a short, weekly symptom questionnaire on their phone, and if they report any concerning changes, their clinician will be sent an alert straight away so that they can intervene early.

The workshop brought together healthcare professionals, academics, industry professionals and system leaders to discuss how we can deliver on the ambitions for Neighbourhood Health using PROMs-based RPM.

The discussion made clear that PROMs, when used through RPM, are not simply another data collection exercise. Done well, this can:

• bring the patient’s experience to the forefront of cancer treatment
• support earlier intervention
• improve communication with clinical teams
• help services understand unmet need.

At the beginning of the workshop, we were introduced to international examples, such as the CAPRI trial in France, but also examples in some UK hospitals and cancer centres such as the eRAPID and eSMART trials.

These trials show what PROMs-based RPM can achieve and have demonstrated benefits such as improved symptom management, quality of life, patient-clinician communication, treatment adherence and, in some contexts, survival and cost-effectiveness.

So, what’s stopping the scaling of this in the UK?

We know it can be done; we know it has benefits, so let’s just do it? If only it were that simple.

Participants repeatedly returned to the question of what happens after a patient submits their scores, and who is responsible for acting on them.

There were discussions around what a good response model looks like, stressing the importance of protecting patients by escalating concerning symptoms quickly, whilst also protecting staff from being overwhelmed by high volumes of alerts.

A PROMs-based RPM model also needs a patient feedback loop. If people are asked to complete PROMs, they need to know what happens next and how their responses will help them. This is central to adherence, trust and perceived value.

Addressing these issues requires investment in leadership, governance structures and dedicated roles that can turn PROMs data into meaningful action.

We know that the use of PROMs contributes to better patient experience and outcomes, but how do we demonstrate the cost effectiveness and benefit of dedicating more resources to scaling the implementation of PROMs?

We need to build the economic and operational case for investment, emphasising the impact PROMs can have on reducing instances of unplanned care. This also will have a knock-on effect on increasing clinical capacity.

The value case also needs to land more powerfully with the people making decisions about money, workforce and operational priorities.

For patients

PROMs-based RPM can offer:

• Earlier support when symptoms worsen.
• Greater reassurance between appointments.
• Better access to self-management advice.
• Fewer unnecessary trips to hospital.

As one workshop participantobserved, if patients benefit… the system benefits”.

For clinicians

• Better visibility of patient symptoms between appointments.
• Earlier opportunities to intervene.
• More informed and meaningful conversations during consultations.

For healthcare systems

PROMs-based RPM has the potential to:

• Reduce reliance on unplanned acute care.
• Improve the efficient use of resources.
• Improve understanding of patient need.
• Provider stronger evidence to inform service development.

Importantly, PROMs can also identify challenges that cannot be addressed through hospital-based cancer services alone. Social, practical and wellbeing concerns often require support from primary care, community services and voluntary organisations.

In this way, PROMs could become an important enabler of more integrated, neighbourhood-based care.

PROMs-based RPM cannot be one-size-fits-all solution. This relates to both patient need and the variation of existing resources and capacity in hospitals at a local level.

The needs of someone starting treatment are different from those of someone receiving long-term treatment or living with late effects after treatment. Therefore, the RPM model needs to be tailored across the pathway and reflect diverse treatment pathways.

Workshop discussions also highlighted the importance of ensuring equitable access

Another interesting area of discussion was around patients who can slip through the gaps, those who are unable to complete PROMs. There needs to be an appropriate method for identifying and following up with patients who may be struggling, may be excluded due to reasons such as digital literacy or language barriers, or those who are disengaged with the health system.

When it comes to scaling, there should be a national framework that creates consistency without pretending every local context is the same. What works in one area may not work elsewhere, so implementation needs to be piloted, adapted and refined with local teams and populations.

One thing was clear throughout the workshop: the passion and appetite to implement PROMs-based RPM is clearly there. The challenge now is turning that energy into a practical route to scale.

A reflection that stayed with me was: “we need to stop meeting sub-acute problems with acute solutions”.

PROMs-based RPM offers a way to identify issues earlier, support people more appropriately, and design care around what matters to patients’ day to day. The next step is implementation with purpose: clear enough to scale, flexible enough to work locally, and always anchored in the benefit to patients.

PROMs may have started as a policy priority, but they have the potential to become a practical lever for transforming cancer care. The challenge now is making that vision a reality.