Trajectories of patient-reported outcomes among diverse cancer patients in ambulatory oncology clinics

PURPOSE: Tracking patient-reported outcomes (PROs) offers critical insights into cancer survivors' symptoms and health-related quality of life (HRQOL). This study evaluated longitudinal trajectories of PROs across cancer types and identified factors associated with symptom burden and HRQOL. METHODS: We conducted a retrospective longitudinal observational study of 6939 cancer survivors (breast, prostate, lung, head and neck (H&N), gastrointestinal (GI), gynecological (GYN), and hematological malignancies) in ambulatory oncology clinics. All cancer survivors completed electronic health record-integrated PRO assessments measuring anxiety, depression, pain interference, fatigue, and physical function, and HRQOL. Linear mixed-effect models evaluated difference in PRO level and change over time by cancer types, adjusting for sociodemographic and clinical covariates. RESULTS: Meaningful differences in overall symptom burden were observed across cancer types. Survivors with GYN cancers reported consistently higher anxiety, pain interference, fatigue, and poorer physical function, whereas prostate cancer survivors reported lowest symptom burden and highest HRQOL. Hematologic malignancy survivors improved in physical function over time compared to prostate cancer survivors. Chemotherapy and surgery were associated with greater pain interference, fatigue, reduced physical function, and lower HRQOL. Greater comorbidity burden and being unpartnered were associated with worse PRO. CONCLUSIONS: PRO trajectories varied by cancer types and patient characteristics, underscoring the need for tailored, cancer-specific survivorship care strategies. IMPLICATIONS FOR CANCER SURVIVORS: Routine, EHR-integrated PRO monitoring can identify survivors at risk for persistent symptom burden and support timely, individualized interventions to improve long-term HRQOL.