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

Purpose 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. Methods 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. Results 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. Conclusions PRO trajectories varied substantially by cancer types, underscoring the need for personalized, cancer-specific survivorship care strategies. Implications for Cancer Survivors 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.