Implementing the NYU Electronic Patient Visit Assessment (ePVA) for Head and Neck Cancer In Rural and Urban Populations

ABSTRACT Approximately 66,000 individuals will be diagnosed with head and neck cancer (HNC) in the United States (US) in 2022. Most patients with HNC are treated aggressively with multi-modal therapies that have improved survival but at a human cost of substantial symptom burden, decreased health-related quality of life (HRQoL), and

extensive acute care use. Symptom management for patients with HNC is critical. However, up to 50% of patients' symptoms go undetected and electronic health records (EHR) documentation of symptoms is incomplete. Ground-breaking research shows patient-reported symptom (PRO) monitoring during cancer care

is associated with improved symptom control, decreased acute care use, and longer survival. Yet, a closer investigation of the literature finds the effects of PROs on cancer outcomes vary depending on implementation. Reasons for variations in PRO implementation include limited integration with electronic health records (EHR),

inequality in access, and lack of standardized approaches, creating barriers to widespread implementation of PROs. We developed the NYU Electronic Patient Visit Assessment (ePVA) for HNC as a valid, reliable PRO that has evolved into a clinical support tool for early detection of uncontrolled symptoms. The ePVA provides a

global picture of the patient's condition automated to clinicians at point-of-care, enabling real-time interventions. We completed a pilot randomized clinical trial of the ePVA in 32 patients with HNC undergoing radiation therapy (RT) with or without chemotherapy, and found those assigned to the ePVA+Usual Care Arm reported significantly

less severe HNC symptoms (p