Rapid Fire Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

FIRSTCARE - Nurse-led ePROM monitoring of older adults during anti-cancer treatment at a metropolitan cancer centre in Australia  (146179)

Thilo Schuler 1 2 , Kelly Elsner 1 , Jacqueline Chang 1 , Phichada Kruaval 1 , Sam Baillie 1 , Paula Macleod 1 , Sophie Norton 1 , Meredith Oatley 1 , Madeleine Tilley 1 , Rowena Broadbent 1 , Sarah Hilmer 3 , Christopher Ward 1 4 , Sarah Bergamin 1 4 , Alexander Guminski 1 4
  1. Northern Sydney Cancer Centre, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
  2. Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
  3. Kolling Institute of Research, Northern Sydney Local Health District and The University of Sydney, St Leonards, NSW, Australia
  4. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

Background: Frailty in older adults with cancer is dynamic, often worsening during treatment with variable recovery. Unlike electronic patient-reported outcome measure (ePROM) symptom monitoring, remote ePROM-based frailty monitoring is unstudied.  

Methods: Routine care oncology patients aged ≥65 years who completed the initial FIRSTCARE ePROM-based frailty assessment, were invited via email to complete REDCap based, longitudinal monitoring ePROMs (an adapted subset of the initial assessment) every 2–4 weeks for up to 12 weeks. Responses were auto-scored into colour-coded summaries (green/yellow/red flags) reviewed and acknowledged by the clinical nurse consultant/nurse practitioner (CNC/NP) of the relevant tumour stream, who triaged flags and initiated clinical action.  

Results: In a staged roll-out from March-August 2026, 213 monitoring ePROMs were emailed; 60% were completed, median completion time 5 minutes (IQR 3–6). Of 1,904 flags, 81.5% were green, 17.3% yellow and 1.2% red; red flags reflect severe or uncontrolled pain, bedbound status or poor mental health. The most frequent CNC/NP actions were continued monitoring (55%) and telephone contact (24%); in-person review (8%), escalation (3%) and referral (2%) were infrequent. Case study: A 91-year-old patient with baseline frailty (key vulnerabilities: polypharmacy, iADL impairments) received outpatient immunotherapy for a major problem related to a complex skin cancer. On the 3rd monitoring ePROM she had two red flags (pain and mental health). An in-person review led to admission and change of treatment. Both pain and mental health improved on the two subsequent ePROMs. 

Conclusions: Nurse-led, ePROM-based monitoring is feasible and low-burden, with high and sustained patient adherence over a 12-week period. The green/yellow/red flag system enables CNC/NPs to prioritise attention on the minority needing action, predominantly reassurance or a phone call rather than resource-intensive escalation supporting real-world viability of this approach. FIRSTCARE ePROM-based monitoring demonstrates a scalable model for proactive, precision care of older adults during cancer treatment.